Bakgrund: Vid de flesta kirurgiska ingrepp används diatermi. Diatermi används dels för att skära i vävnad, dels för att koagulera blodkärl, och en adekvat blodstillning är avgörande för en säkeroperation. Vid användning av diatermi utvecklas en skadlig rök, diatermirök. Trots att evidens finns för att diatermiröken innehåller skadliga ämnen som kan orsaka kroppsliga symptom, förekommer variation i användandet av rökevakueringssystem.   Syfte: Syftet med denna studie var att undersöka i vilken utsträckning rökevakueringssystem, för diatermirök, används. Vi ämnade även undersöka om det förelåg några skillnader mellan avdelningarna samt mellan de två yrkeskategorierna; operatör och operationssjuksköterska.   Metod: Operationssjuksköterskor och operatörer från nio operationsavdelningar, vid fyra sjukhus i Stockholmsregionen undersöktes i en deskriptiv tvärsnittsundersökning, med kvantitativ ansats, med ett intervjustött frågeformulär. 114 personer intervjuades, 83 operationssköterskor och 31 operatörer.   Resultat: Resultatet visade att rökevakueringssystem användes vid de flesta operationer, dock ej vid samtliga. Användningsgraden skilde sig mellan operationsavdelningar. Operationssköterskor ansåg i större utsträckning än operatörer att diatermirök kunde vara skadlig samt var mindre nöjda med åtgärderna för rökevakuering. Samtliga avdelningar saknade riktlinjer, vilket strider mot SOSFS 2011:9.   Slutsats och klinisk betydelse: För att förekomma att rökevakueringssystem och annan skyddsutrustning ej används konsekvent bör riktlinjer och rutiner framtagas. Även utbildning bör ges, till operationspersonal, eftersom okunskap kan vara en bidragande faktor till att rökevakueringssystemen ej används konsekvent. Detta kan bidra till en ökad användning vilket i sin tur leder till en förbättrad operationsmiljö för såväl personalen som för patienten. / Background: In most surgical procedures electro cautery is used. Electro cautery is used both for surgical dissection and hemostasis, and adequate hemostasis is critical for a safe operation. When using the electro cautery, a noxious smoke is developed, surgical smoke. Although evidence shows that surgical smoke contains harmful substances that can cause physical symptoms, the usage of smoke evacuation system varies.   Aim: The aims with the present study were to investigate the extent to which smoke evacuation system, for surgical plum, was used.  We further aimed to study if there were any possible differences between the surgical departments and between the two occupational categories; theatre nurses and surgeons.   Method: Operation theatre nurses and surgeons from nine surgical departments at four hospitals in the Stockholm region were studied in a descriptive cross-sectional study, with quantitative approach, and an interview supported questionnaire.   Results: The results showed that smoke evacuation system was used at most but not all surgical procedures. The use of the smoke evacuation system differed between surgical departments. A larger proportion of the theatre nurses than of the surgeons believed surgical smoke to be harmful and were less satisfied with measures to eliminate them. No surgical department had guidelines for handling surgical smoke which is in violation of SOSFS 2011:9.   Conclusion and clinical implications: To prevent that smoke evacuation systems and other protective equipment is not used consistently, policies and procedures should be derived. Education should be provided to surgical personnel, this because ignorance could be a contributing factor to the inconsistent use of smoke evacuation systems. This may contribute to an increase in usage of the device which in turn leads to an improved environment in the theater room for both the personnel as well as for the patient.

Made available in DSpace on 2015-07-22T20:50:11Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-02-24 / Introdução: A coloproctopatia actínica crônica (CAC) é uma complicação reconhecida da radioterapia. O sangramento retal (SR) é a queixa mais comum da CAC e a melhor modalidade de tratamento endoscópico para este sintoma permanece controversa. Objetivo: Comparar a eficácia e a segurança da eletrocauterização bipolar (EB) com a eletrocauterização com plasma de argônio (EPA) no tratamento do SR secundário à CAC. Pacientes e Métodos: Foram incluídos 30 pacientes com SR ativo proveniente da CAC, randomizados em 2 grupos (15 para EB e 15 para EPA) e classificados de acordo com escore de Saunders. A potência foi de 50 W para a EB e de 40 W para a EPA. Todos foram submetidos à colonoscopia inicial para o diagnóstico da lesão e sua extensão e exclusão de outras doenças. O sucesso do tratamento foi definido pela erradicação de todas as telangiectasias. Foram consideradas falhas de tratamento, os casos nos quais sete sessões não foram suficientes para o controle do sangramento. Complicações foram divididas em três diferentes grupos: sensitivas (dor anal, dor abdominal e febre), hemorrágicas (piora do sangramento durante o tratamento e sangramento por úlceras) e anatômico-motoras (afilamento das fezes, estenoses e pseudopólipos). Resultados: A média de idade foi de 67,4 anos (variação de 33 a 82 anos) com 14 mulheres e 16 homens. Não houve diferença estatística significante entre os grupos no número de sessões (p = 0,313). Não houve diferença significativa em relação às complicações sensitivas (p = 0,245), hemorrágicas (p = 0,169) ou anatômico-motoras (p = 0,700) entre os grupos. Entretanto, a incidência total de complicações foi significativamente maior no grupo EB. Somente uma falha terapêutica foi observada em cada grupo (p = 1,000). Também não houve diferença significativa na recidiva (p = 1,000). Pacientes em uso de aspirina necessitaram de um número maior de sessões para cessação do SR (p = 0,036) e para erradicação das telangiectasias (p = 0,047). Conclusões: A EPA e a EB apresentaram semelhanças em relação à eficácia no tratamento da coloproctopatia actínica crônica hemorrágica. Contudo, a EPA é mais segura que a EB. / Introduction: Chronic radiation coloproctopathy (CRCP) is a well-recognized complication of radiotherapy. Rectal bleeding is the most common symptom of radiation injury and the optimal endoscopic treatment of bleeding due to CRCP is still controversial. Aim: To compare the efficacy and safety of bipolar eletrocauterization (BEC) and argon plasma eletrocauterization (APE) in the management of bleeding from CRCP. Methods: Thirty patients with active bleeding from telangiectasias were enrolled, randomized into two groups (15 BEC and 15 APE) and classified according to Saunders score. Power settings were 50 W for BEC and 40 W for APE. Initial treatment was performed after a complete colonoscopy to rule out synchronous lesions and follow-up was performed with flexible sigmoidoscopies. Success was defined as eradication of all telangiectasias. Failure was defined whenever more than seven sessions or other therapies were necessary for treatment of bleeding. Complications were divided into three different groups: sensory (anal pain, abdominal pain and/or fever), hemorrhagic (worsening of bleeding during treatment, bleeding from ulcers) and anatomic/motor (tapered feces, stenosis and/or pseudopolyps). Results: Mean age was 67.4 years (range 33-82), with 14 women and 16 men. There was no significant difference regarding the number of sessions in both groups (p = 0.313). There were no significant differences regarding sensory (p = 0.245) hemorrhagic (p = 0.169) or anatomic/motor (p = 0.700) complications between both groups. However, the overall complication rate was significantly higher in EB group (p = 0.020). Only one failure was observed in each group (p = 1.000). There was also no significant difference regarding relapse (p = 1.000) Conclusions: BEC and APE are equally effective in patients with bleeding telangiectasias from CRCP. Nevertheless, APE is safer than EB. / TEDE / BV UNIFESP: Teses e dissertações