Die verbesserte Prognose der Patienten mit akutem Herzinfarkt durch den Einsatz des Herzkatheters (HK) und den damit verbundenen Möglichkeiten der schnellen Revaskularisierung gilt heute als unumstritten. Nicht nur in der Notfallmedizin, sondern ganz besonders in der Diagnostik der koronaren Herzkrankheit (KHK) gilt die Herzkatheteruntersuchung (HKU) als Goldstandard. Bei steigenden Untersuchungszahlen dürfen die Risiken der effektiven Strahlenbelastung dieser apparativen radiologischen Untersuchungsform für den Patienten nicht vernachlässigt werden. Aufgrund der bisher mangelnden Angaben zur Strahlenbelastung bei Herzkatheteruntersuchungen war das Ziel der Studie die prospektive Erfassung der Durchleuchtungszeit, des Flächendosisproduktes und der effektiven Strahlendosis an einer großen Kohorte von Patienten, welche sich zwischen 01/2006 und 01/2009 einer Herzkatheteruntersuchung unterzogen hat. Zusätzliche Aufgabe war es mögliche Einflussfaktoren herauszuarbeiten und ihre Auswirkung auf die Strahlenbelastung mit einzubeziehen und zu diskutieren. Es wurden im Zeitraum von 1/2006 bis 1/2009 n = 32.153 durchgeführte Herzkatheteruntersuchungen erfasst und die Fluoroskopiezeiten und Strahlenbelastungen ermittelt. Die Herzkatheteruntersuchungen wurden in Abhängigkeit des Ziels der Untersuchung in diagnostische, therapeutische und kombinierte Untersuchungen unterteilt. Erfasst wurden die Patienten, die sich in diesem Zeitraum einer Herzkatheteruntersuchung unterzogen haben. Weitere patientenbezogene Daten wie das Geschlecht, Alter, Körpergröße und das Gewicht wurden in die Studie mit eingeschlossen. Des Weiteren wurden die durchgeführte Herzkatheteruntersuchung oder Intervention, das jeweilige Herzkatheterlabor sowie der Untersucher selbst erfasst. Bezüglich der verschiedenen Untersuchungen wurden insgesamt vier Hauptgruppen gebildet. Hierbei zeigte sich, dass diagnostische Herzkatheter signifikant weniger Strahlung benötigen, als therapeutische und kombinierte Interventionen. Zusätzlich von besonderem Interesse waren der Einfluss des Zugangsweges, des Untersuchers sowie der Vergleich unterschiedlichster Untersuchungsarten. Beim Vergleich der Zugangswege konnte aufgezeigt werden, dass der femorale Zugangsweg dem radialen bei rein diagnostischen Herzkatheteruntersuchungen in Bezug auf die primären Endpunkte signifikant überlegen ist. Bei therapeutischen und kombinierten Untersuchungen tritt der Unterschied jedoch in den Hintergrund. Bei der Analyse der Untersucher konnte aufgezeigt werden, dass in den ersten zwei Jahren die erfahrenen Kardiologen signifikant weniger Strahlung verbrauchen, als Unerfahrenere.

The overall aim of this thesis was to evaluate methods for urinary catheter handling in patients undergoing hip surgery. The intention was to gain knowledge in order to provide optimal and cost- effective care regarding urinary catheterisation in this group of patients. In Study I , 45 of the 86 catheterised patients (52%) contracted nosocomial urinary tract infections (UTIs). Diabetes was a risk factor for developing UTI, and cloxacillin as a perioperative antibiotic prophylaxis seemed to offer a certain protection. Study II was a randomised controlled trial on the effect of clamping (n = 55) or not (n = 58) of the indwelling urinary catheter before removal. No significant differences were found between the groups with respect to time to normal bladder function, need for recatheterisation, or length of hospital stay. Study III was a randomised controlled trial among patients with hip fracture and hip arthroplasty, in which the patients were randomised to intermittent (n = 85) or indwelling (n = 85) urinary catheterisation. No significant differences in nosocomial UTIs (9% vs. 12%) or cost-effectiveness were shown. The patients in the intermittent group regained normal bladder function significantly sooner after surgery. Fourteen percent of the patients in the intermittent group did not need any catheterisation. In Study IV , 30 patients were interviewed about their experiences of bladder emptying and urinary catheterisation. The patients’ views were described through the main category ‘An issue but of varying impact’. Both bladder emptying through micturition and bladder emptying through catheterisation were described as convenient, but also as uncomfortable and an intrusion on dignity. The patients were aware of risks and complications of urinary catheterisation. In conclusion, this thesis indicates that UTI is common in hip surgery patients. Clamping of indwelling catheters seems not necessary. There is no preference for either intermittent or indwelling urinary catheterisation according to the results of this thesis, either for the development of nosocomial UTI or, for cost-effectiveness, or from the patient perspective. Nurses should be aware that catheterisation might make the patients feel exposed, and it is essential that their practice reflect the best available evidence.

In our study, we analyzed four stress markers (cortisol, cortisone, DHEA and DHEAS) in blood serum in young sows using minimally invasive heart catheterisation as the stress factor. The marker levels were assessed in four defined periods of the experiment, beginning with the baseline level on the day before intervention (1), the second period was after the introduction of anaesthesia (2), the third was after conducting tissue stimulation or ablation (3), and the final period was after the end of the catheterisation (4). Cortisol and cortisone were detected using HPLC method, DHEA(S) by commercial kits. For statistical analyses non-parametric tests were used (due to non standard Gaussian data distribution). In our study we arranged these experiments: 1. Diurnal variability in these markers concentration during heart catheterisation was tested. 2. Are there differences between stress markers concentration the day before experiment (sampling 1) and in the day of the catheterisation (samplings 2, 3, 4)? 3. Are there differences between these markers concentration during operation (the first sampling was excluded)? 4. The cortisol/cortisone ratio was calculated. We found only minimal statistical differences in studied markers between the morning and afternoon group (p > 0.05) in experiment 1. For tested...

Die verbesserte Prognose der Patienten mit akutem Herzinfarkt durch den Einsatz des Herzkatheters (HK) und den damit verbundenen Möglichkeiten der schnellen Revaskularisierung gilt heute als unumstritten. Nicht nur in der Notfallmedizin, sondern ganz besonders in der Diagnostik der koronaren Herzkrankheit (KHK) gilt die Herzkatheteruntersuchung (HKU) als Goldstandard. Bei steigenden Untersuchungszahlen dürfen die Risiken der effektiven Strahlenbelastung dieser apparativen radiologischen Untersuchungsform für den Patienten nicht vernachlässigt werden. Aufgrund der bisher mangelnden Angaben zur Strahlenbelastung bei Herzkatheteruntersuchungen war das Ziel der Studie die prospektive Erfassung der Durchleuchtungszeit, des Flächendosisproduktes und der effektiven Strahlendosis an einer großen Kohorte von Patienten, welche sich zwischen 01/2006 und 01/2009 einer Herzkatheteruntersuchung unterzogen hat. Zusätzliche Aufgabe war es mögliche Einflussfaktoren herauszuarbeiten und ihre Auswirkung auf die Strahlenbelastung mit einzubeziehen und zu diskutieren. Es wurden im Zeitraum von 1/2006 bis 1/2009 n = 32.153 durchgeführte Herzkatheteruntersuchungen erfasst und die Fluoroskopiezeiten und Strahlenbelastungen ermittelt. Die Herzkatheteruntersuchungen wurden in Abhängigkeit des Ziels der Untersuchung in diagnostische, therapeutische und kombinierte Untersuchungen unterteilt. Erfasst wurden die Patienten, die sich in diesem Zeitraum einer Herzkatheteruntersuchung unterzogen haben. Weitere patientenbezogene Daten wie das Geschlecht, Alter, Körpergröße und das Gewicht wurden in die Studie mit eingeschlossen. Des Weiteren wurden die durchgeführte Herzkatheteruntersuchung oder Intervention, das jeweilige Herzkatheterlabor sowie der Untersucher selbst erfasst. Bezüglich der verschiedenen Untersuchungen wurden insgesamt vier Hauptgruppen gebildet. Hierbei zeigte sich, dass diagnostische Herzkatheter signifikant weniger Strahlung benötigen, als therapeutische und kombinierte Interventionen. Zusätzlich von besonderem Interesse waren der Einfluss des Zugangsweges, des Untersuchers sowie der Vergleich unterschiedlichster Untersuchungsarten. Beim Vergleich der Zugangswege konnte aufgezeigt werden, dass der femorale Zugangsweg dem radialen bei rein diagnostischen Herzkatheteruntersuchungen in Bezug auf die primären Endpunkte signifikant überlegen ist. Bei therapeutischen und kombinierten Untersuchungen tritt der Unterschied jedoch in den Hintergrund. Bei der Analyse der Untersucher konnte aufgezeigt werden, dass in den ersten zwei Jahren die erfahrenen Kardiologen signifikant weniger Strahlung verbrauchen, als Unerfahrenere.

In our study, we analyzed four stress markers (cortisol, cortisone, DHEA and DHEAS) in blood serum in young sows using minimally invasive heart catheterisation as the stress factor. The marker levels were assessed in four defined periods of the experiment, beginning with the baseline level on the day before intervention (1), the second period was after the introduction of anaesthesia (2), the third was after conducting tissue stimulation or ablation (3), and the final period was after the end of the catheterisation (4). Cortisol and cortisone were detected using HPLC method, DHEA(S) by commercial kits. For statistical analyses non-parametric tests were used (due to non standard Gaussian data distribution). In our study we arranged these experiments: 1. Diurnal variability in these markers concentration during heart catheterisation was tested. 2. Are there differences between stress markers concentration the day before experiment (sampling 1) and in the day of the catheterisation (samplings 2, 3, 4)? 3. Are there differences between these markers concentration during operation (the first sampling was excluded)? 4. The cortisol/cortisone ratio was calculated. We found only minimal statistical differences in studied markers between the morning and afternoon group (p > 0.05) in experiment 1. For tested...

Introduction: Vascular injury is the crucial initiating event in atherosclerosis and is universal following percutaneous coronary intervention. The cellular response to this injury largely determines vessel outcome. Endothelial progenitor cells (EPCs) and their progeny, late outgrowth endothelial cells (EOCs) are thought to play an important role in this process and characterising this role would be valuable in better understanding vascular injury and repair. Methods: The radial artery in the context of transradial cardiac catheterisation was examined as a model of vascular injury with characterisation of structural injury, longitudinal function and EPC populations. To examine the role of late outgrowth endothelial cells a method for GMP-compliant cell culture and labelling with F18Fluorodeoxyglucose was developed with a view to conducting a cell-tracking study of human administration. Results: Radial artery function was reduced following transradial cardiac catheterisation with recovery over a period of three months. There was no correlation between recovery of arterial function and EPC populations as defined by conventional surface markers. A research grade protocol for EOC culture was successfully translated to a GMP-compliant process producing a viable, phenotypically homogeneous EOC product. Cells were successfully labelled with F18Fluorodeoxyglucose and whilst proliferation was reduced, acute viability and function were not compromised. Conclusion: The radial artery in the context of transradial cardiac catheterisation is a useful model of vascular injury and repair although recovery of vascular function does not appear to be influenced by EPC populations. GMP-compliant culture and labelling of EOCs is feasible and will allow examination of the physiology of these cells in vivo in man.

The purpose of this research study was to improve the nursing care of intravenous catheters by providing evidence on the effects of prolonged duration of intravenous administration set use. Intravenous therapy is a vital part of modern health care. However, its invasive nature can result in infection, with high associated morbidity and mortality. The highest infection rates are displayed in intensive care patients with central venous catheters. The duration of intravenous administration set use may have an impact on infection rates,however the current practice usage and the optimum duration of use is unknown. Previous studies of central venous catheters have reported equal infection rates with 1 to 4 days of administration set use; however few patients have been evaluated with administration sets used beyond this time. Previous research has been limited by the inadequacy of available definitions for Catheter-Related Infection. A prospective, randomised, controlled clinical trial was performed to assess the infection risk of using administration sets for prolonged periods. In the developmental phase prior to the clinical trial; definitions of Catheter-Related Bloodstream Infection (CRBSI) were developed; a nursing practice survey was undertaken to establish the current duration of administration set use; and laboratory experiments were executed to assess the impact of prolonged use on administration set physical integrity and performance. Central venous catheters were randomised to have their administration sets used for 4 days (n = 203) or 7 days (n = 201). Percutaneous central venous catheters were enrolled into the study from two adult intensive care units at a metropolitan, tertiary-referral, teaching hospital. Catheters were multiple-lumen, chlorhexidine-gluconate and silver-sulphadiazine coated lines, both inserted and removed in the intensive care unit. Catheters were cultured for microbial colonisation on removal using the Maki roll-plate technique. Patients were assessed for CRBSI using the developed definitions consisting of categories: definite, probable (type I and II), possible and absent. Prior to the clinical trial, a practice survey questionnaire was administered, and laboratory experimentation was performed. Normality of distribution for continuous variables was assessed using the Kolmogorov- Smirnov statistic. The distribution between groups of variables considered risk factors for Catheter-Related Infection were tested to assess for bias using Chi-square and T-test. Logistic regression modelling was performed to analyse the influence of potentially confounding variables. The incidence of catheter colonisation and CRBSI was tested between groups using Kaplan-Meier survival curve with Log-rank test. Paired T-tests were performed to test for difference in programmed and delivered volumes of administration sets. A general linear model (ANOVA)± a Scheffe post hoc test to isolate difference was fitted to the standardised values of delivered volumes to determine the effects of day of measurement and volume delivery rate on the accuracy of volume delivery. There were 10 colonised tips in the intervention group and 19 in the control group. This difference was not statistically significant (Kaplan Meier survival analysis, Log Rank = 0.87, df = 1, p = 0.35). There were 3 cases of CRBSI per group and the difference in survival from CRBSI was not statistically significant (Kaplan Meier with Log Rank test, p = 0.86). The pre-clinical trial phases of the research programme established that current clinical practice was 3 to 7-day use of administration sets; that administration sets were physically intact and delivered clinically accurate volumes after 7 days of use; and developed useful definitions of CRBSI. Prolonged intravenous administration set use of 7 days was found to have no significant impact on patient infection indicators or physical performance of the sets. This finding is congruent with previous research and trends in current clinical practice. In conclusion, the research findings support the use of intravenous administration sets for 7 days.

Background: It is well known that performance of the right ventricle (RV) determines exercise capacity and may confer prognostic information in different cardiopulmonary diseases. To allow optimal patient management, ideal methods to assess right heart function are therefore important. Echocardiography is an attractive investigation for that purpose, although limited by the anatomical and functional complexities of the RV. The aim of the present thesis was to present applicable methods useful in clinical practice by traditional 2D/Doppler echocardiography and Doppler tissue imaging (DTI) in the assessment of global and regional RV function in both health and disease. Methods: The studies were performed on 4 different groups; (1) 255 healthy subjects (125 females), (2) 92 consecutive patients with different cardiac diseases (36 females), (3) 26 patients with systemic sclerosis, (SSc) (21 females) and (4) 26 consecutive patients with heart failure (8 females) undergoing cardiac catheterisation. Results: RV outflow tract fractional shortening (RVOT fs), which is a new method in the assessment of RV function, correlated significantly with RV systolic long axis motion (r= 0.66, p< 0.001), pulmonary artery acceleration time (r= 0.80, p< 0.001) and RV-right atrial peak systolic pressure drop gradient (r= -0.53, p< 0.001). Furthermore, RVOT fs was reduced in patients with pulmonary hypertension whereas RV systolic long axis motion was not in difference. This finding was confirmed after comparing RV function with invasive pressures. In healthy subjects, while the systolic myocardial velocities were preserved over age, the peak isovolumic contraction velocity (IVCv) was weakly increased with advanced age (r= 0.34, p< 0.01). Furthermore, both global and regional E/A ratios were reduced (r= -0.57, r= -0.67, p< 0.001 for both) with age whereas no alteration was found in the myocardial isovolumic relaxation time (IVRt). In patients with systemic sclerosis (SSc) both global (64± 23 vs. 39± 12 ms, p< 0.001) as well as regional (83± 40 vs. 46± 24 ms, p< 0.001) IVRt were prolonged. After evaluating echocardiographic parameters with invasive pressures we found a significant correlation between DTI derived IVRt and pulmonary artery systolic pressures (r= 0.83, p< 0.01) while the IVCv was related to the state of contractility (r= 0.77, p< 0.001). Furthermore, an IVCv below 6 cm/s was shown to be an accurate marker of increased right atrial pressure (>6 mm Hg). In conclusion, RVOT fs can be used as a complementary measurement of RV systolic function, being more sensitive to elevated pulmonary artery systolic pressures than the systolic longitudinal RV motion. Right heart function, mainly the diastolic function, is relatively weakly influenced by age compared to the left heart function. In patients with SSc, we found diastolic disturbances, including a prolonged IVRt and proposed the findings to be early markers related to intermittent pulmonary hypertension. This observation was strengthened after evaluating IVRt against invasive pulmonary artery systolic pressures. IVCv can be used to determine the state of RV contractility and also be used to identify patients with elevated filling pressures. The presented methods can be used to detect early signs of RV dysfunction which might prohibit right heart failure. All presented methods are non-invasive, reproducible, easy obtainable, and thus useful in clinical practice.