SAŽETAK
Poslijeoperacijska bol predstavlja veliki medicinski, gospodarski i socijalni problem. Neliječenu bol smatramo značajnim čimbenikom povećanog morbiditeta a što ima za posljedicu produljeni boravak u bolnici i povećane troškove liječenja. Bol možemo liječiti farmakološkim, nefarmakološkim, fizikalnim, kirurškim i psihološkim metodama. Jedna od tih metoda je i epiduralna analgezija, a izvodi se tako da se u epiduralni prostor postavi kateter kroz koji se apliciraju analgetici ( 48-72 sata ). Radi se najčešće o kirurškim, urološkim i ortopedskim operiranim bolesnicima, kao i kod rodilja. Uz indikacije za postavljanje epiduralnog katetera imamo također i kontraindikacije na koje moramo obratiti pažnju.
Zadatak anesteziološke sestre/tehničara je edukacija i priprema, bolesnika, prostorije, ležaja, lijekova, setova i dezinficijensa. Kateter postavlja anesteziolog uz asistenciju anesteziološke sestre/tehničara, te se kroz njega aplicira kontinuirana analgezija putem PCA pumpe ili putem perfuzora u JIL-u, a na odjelu u bolusu svaka 4-6 sati, ovisno o VAS skali. U protokolu zdravstvene njege potrebna je česta kontrola analgezije, nuspojava znakova i simptoma, kao i tehničkih komplikacija kao što je pomak katetera ili kvar pumpe.Kontrolu boli vrši pomoću VAS skale svaki sat u prva 24 sata, a kasnije svaka 2-4 sata, te o tome izvješćuje anesteziologa. Zadatak medicinske sestre/tehničara je vođenje sestrinske dokumentacije.
ZAKLJUČAK: Med.sestre/tehničari su uvijek prvi do bolesnika i a taj način uočavaju moguće nuspojave.Brinu se i o pravilnom položaju katetera, o bolusima, pumpama i o kontinuitetu analgetika.Treba naglasiti da je za kvalitetnu epiduralnu analgeziju potrebna kvalitetna i trajna edukacija med.sestara/tehničara da prepoznaju problem i stručno rukuju medicinskom opremom.
Ključne riječi: bol, metode liječenje boli, epiduralna analgezija, epiduralni prostor, priprema i edukacija bolesnika, tehnika lociranja bola, VAS skala
TREATMENT OF PAIN – SCOPE OF DUTIES OF NURSES IN CONTINUED THROUGH ANALGESIA THROUGH EPIDURAL CATHETER
Author:
Miroslav Đureš
Clinical Hospital „Sveti duh“ Zagreb
SUMMARY
Postoperative pain is a major medical, economic and social problem. Untreated pain is important factor to increased morbidity and resulting in prolonged hospital stays and increased costs of treatment. The pain can be treated by pharmacological, non-pharmacological, physical, surgical and psychological methods. One of these methods is the epidural, and it is performed so that the epidural space through a catheter that is administered analgesics (between 48-72 hours).
It is most common to surgical, urological and orthopedic operated patients, as well as on pregnant women. With indications for epidural catheter set have also contraindications to which we must pay attention. The task of anesthesiologic nurses/technicians is constant training and preparation of patients, rooms, beds, medicines, disinfectants and sets. Catheter applies a anesthesiologist assisted by anesthesiologic nurses/technicians, and through it applies continuous analgesia via PCA-pump or by perfusion in the intensive care unit and on the ward bolus every 4-6 hours, depending on the VAS-scale.
The health care protocol requires frequent control of analgesia, a side effects of signs and symptoms as well as technical complications such as catheter displacement or failure of the pump. Pain control is performed by VAS-scale each hour in the first 24 hours, and subsequently every 2-4 hours, with the obligation to inform the anesthesiologist. The task of nurses/technicians is to duly conduct a nursing documentation.
CONCLUSION: The nurse/technicians are always the first to patients and therefore are the first to reveal the side effects. They take care of the proper position of the catheter, the boluses, pumps and the continuity of analgesics. Therefore requires a quality and continuous education of medical nurses/technicians to recognize the problem and expertly handle medical equipment.
Keywords: pain, methods of treating pain, epidural analgesia, epidural space, preparation and education of patients, the technique of locating pain, VAS-scale