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Thesis (MScEng)--Stellenbosch University, 2012. / ENGLISH ABSTRACT: The monitoring of patients in healthcare is of prime importance to ensure their efficient treatment. The monitoring of blood oxygen saturation in tissues affected by diseases or conditions that may negatively affect the function is a field that has grown in importance in recent times. This study involved the development and testing of a highly sensitive noninvasive blood oxygen saturation device. The device can be used to continuously monitor the condition of tissue affected by diseases which affect the blood flow through the tissue, and the oxygen usage in tissue. The device’s system was designed to specifically monitor occluded tissue which has low oxygen saturations and low perfusion. With the use of the device, it is possible to monitor the status of tissue affected by diseases such as meningococcemia and diabetes mellitus or conditions such as the recovery after plastic surgery. The study delved into all aspects involved in the development of a non-invasive artificial pulse oximeter, including but not limited to that of a detailed device design, signals analysis, animal in-vivo and laboratory in-vitro system design for the calibration of the system as well as human clinical validation and testing procedures. All these aspects were compared to determine the relative accuracies of the different models. Through testing it was shown that it is possible to non-invasively measure the mixed oxygen saturation in occluded tissue. However, without accurate validation techniques and methods of obtaining both arterial and venous blood samples in occluded tissue the system could not be fully validated for determining both the arterial and venous oxygen saturations in the human invivo study. Although the system was unable to accurately measure specifically the venous oxygenation it was able to measure the mixed oxygen saturation. With further research it would be possible to validate the system for measuring both the arterial and venous oxygen saturations. / AFRIKAANSE OPSOMMING: Die monitering van pasiënte in gesondheidsorg is van uiterste belang om doeltreffende behandeling te verseker. Die monitering van bloedsuurstofversadiging in weefsels wat geaffekteer word deur siektes of toestande wat ’n negatiewe impak kan hê op die funksie daarvan is ’n gebied wat aansienlike groei getoon het in die onlangse verlede. Die studie het die ontwikkeling en toetsing van ’n hoogs sensitiewe nieindringende bloedsuurstofversadigingsensor ingesluit. Hierdie sensor kan gebruik word om deurentyd die toestand van weefsel te monitor wat geaffekteer word deur siektes wat bloedvloei deur weefsel affekteer sowel as die suurstofgebruik in die weefsel. Die stelsel is ontwerp om spesifiek die ingeslote weefsel wat lae suurstofversadiging en lae perfusie het, te monitor. Deur gebruik te maak van die toestel is dit moontlik om die toestand van die weefsel wat geaffekteer word deur siektes soos meningococcemia en diabetes mellitus of toestande soos die herstel na plastiese sjirurgie te monitor. Die studie het gekyk na alle aspekte wat betrokke is in die ontwikkeling van ’n nie-indringende kunsmatige pols-oksimeter, insluitend maar nie beperk tot gedetailleerde ontwerp nie, sein analise, dier in-vivo en laboratorium in-vitro stelselontwerp vir die kalibrasie van die stelsel sowel as menslike kliniese bekragtiging en toetsprosedures. Al hierdie aspekte is vergelyk om die relatiewe akkuraatheid van die verskillende modelle te bepaal. Die toetse het gewys dat dit moontlik is om nie-indringend die gemengde suurstofversadiging in weefsel te bepaal. Sonder akkurate bekragtigingstegnieke en metodes om beide arteriële en vene bloedmonsters te versamel in ingeslote weefsel kan die stesel nie ten volle bekragtig word om beide arteriële- en veneversadigings in menslike in-vivo studie te bepaal nie. Hoewel die stelsel nie ’n akkurate meting van die aarsuurstof kon kry nie, is daar wel ’n akkurate meting geneem van die gemengde suurstofversadiging. Toekomstige navorsing kan lei tot die bekragtiging van die stelsel om beide arteriële en slagaar suurstofversadigings te meet.

A presente pesquisa avaliou a determinação dos valores da pressão da artéria pulmonar, da oximetria, da hemogasometria e dos teores plasmáticos de lactato em bezerros neonatos, com a finalidade de contribuir nos estudos de clonagem e no desenvolvimento de neonatologia veterinária. A monitorização logo após o parto e o nascimento se tornou necessária para a manutenção da vida destes animais, aprimorando-se os protocolos e procedimento tomados, a avaliação clínica do sistema cardiovascular e respiratório neste momento de transição e a partir disto, o objetivo deste trabalho foi padronizar a metodologia utilizada para avaliações hemodinâmica da pressão da artéria pulmonar por meio da utilização do cateter de Swan-Ganz em bezerros, padronizar a técnica de oximetria e correlacionar os resultados obtidos para saturação de oxigênio com aqueles encontrados na hemogasometria de sangue arterial, e estabelecer valores de referência e avaliar a influência dos primeiros 30 dias de vida na mensuração da pressão da artéria pulmonar, da oximetria, da hemogasometria e dos teores plasmáticos de lactato obtidos em bezerros sadios. Foram utilizados 10 bezerros hígidos do estado de São Paulo, acompanhados do nascimento aos 30 dias de vida, onde pudemos observar o fechamento do forame ovale e ducto arterioso na 1º semana de vida, utilizando o sangue misto, o sangue venoso também foi um ótimo avaliador de distúrbios acidobásico, no entanto não avalia a função respiratória; para isso bastou utilizar a oximetria de pulso como um método não invasivo, que nos fornece dados que a gasometria arterial iria fornecer com a saturação de oxigênio. E a mensuração do lactato sérico serve como um marcador biológico para prognóstico de diversas enfermidades, onde seu aumento no sangue demonstra uma má perfusão tecidual (hipóxia) / This study investigated the measurement of the pulmonary artery pressure, pulse oximetry, the blood gas, plasma lactate and glucose levels in newborn calves, in order to contribute in cloning studies and the development of neonatal veterinary medicine. Monitoring soon after birth or help the calving became necessary for the maintenance of life of these animals, improving the protocols and procedures taken, the clinical assessment of cardiovascular and respiratory systems in this time of life transition, the objective of this study was to standardize the methodology used for hemodynamic assessment of pulmonary artery pressure using a Swan-Ganz catheter in calves, standardize the technique of pulse oximetry and correlate the results obtained for oxygen saturation found in blood gas analysis of arterial blood, and set reference values and to evaluate the influence of the first 30 days of life in the measurement of pulmonary artery pressure, pulse oximetry, blood gas and the plasma lactate levels obtained in healthy calves. We used 10 calves healthy from Sao Paulo state, followed from birth to 30 days of life, where we could see the closure of the foramen ovale and ductus arteriosus in the 1st week of life, using the mixed blood, venous blood was also a great evaluator acid-base disturbance, but does not assess respiratory function. The pulse oximetry was good enough to evaluate the oxygen saturation like a noninvasive method. And the measurement of serum lactate serves as a biomarker for prognosis of various diseases, when increase in blood shows poor tissue perfusion (hypoxia)

Although steady progress has been made towards the development of a wearable pulse oximeter to aid in remote physiological status monitoring (RPSM) and triage operations, the ability to extract accurate physiological data from a forehead pulse oximeter during extended periods of activity and in the presence of pressure disturbances acting on the sensor remains a significant challenge. This research was undertaken to assess whether the attachment method used to secure a pulse oximeter sensor affects arterial oxygen saturation (SpO2) and heart rate (HR) accuracy during motion. Additionally, two sensor housings were prototyped to assess whether isolating the sensor from external pressure disturbances could improve SpO2 and HR accuracy. The research revealed that measurement accuracy during walking is significantly affected by the choice of an attachment method. Specifically, the research indicated that an elastic band providing a contact pressure of 60 mmHg can result in decreased measurement error and improved reliability. Furthermore, the research validated that the two isolating housings we have investigated improve SpO2 and HR errors significantly at pressures as high as 1200 mmHg (160 kPa) compared to current commercial housings. This information may be helpful in the design of a more robust pulse oximeter sensor for use in RPSM.

<p>Changes in swallowing function are common in elderly and chronically ill individuals. Therefore it is important to be aware of these changes and their prevalence. The aim of this study was to assess the prevalence of dysphagia in nursing homes in the municipality of Linköping, and to correlate dysphagia with variables that can be a cause or a consequence of dysphagia. These variables were gender, age, MMT-result, dentition, weight loss, medical diagnose or number of medications. The intention was also to examine the additional information regarding dysphagia supplied by pulse oximetry.</p><p>Sixty nursing home residents aged 74-101 years were chosen to participate in the study. The individual's ability to participate was based on their result on Mini-mental state and subjective judgements made by staff members and the authors. The material to assess oral motor and sensory function was the Nordic Orofacial Test - Screening. During the clinical swallowing examination the Standardised Swallowing Assessment (SSA) and pulse oximetry were used. In addition, data regarding the participants' medical diagnoses, number of medications and possible weight loss was collected.</p><p>The result showed that the prevalence of dysphagia and suspected dysphagia was 40 %. Oral dysphagia was present in 20 participants and pharyngeal dysphagia in seven participants. With pulse oximetry one participant with dysphagia and two with suspected dysphagia were identified in addition to those identified by SSA. Analysis of the assessed variables showed no correlations or any significant results.</p> / <p>Förändringar av sväljförmågan är vanligt hos äldre och kroniskt sjuka individer. Det är viktigt att vara medveten om dessa förändringar och hur vanligt förekommande det är med nedsatt sväljförmåga. Syftet med föreliggande studie var att undersöka förekomsten av dysfagi på äldreboenden i Linköpings kommun samt att korrelera dysfagi med parametrar som kan vara orsak till eller konsekvens av dysfagi. Dessa parametrar var kön, ålder, MMT-resultat, tandstatus, viktnedgång, sjukdomsdiagnos och antal läkemedel. Ett delsyfte i studien var att undersöka om man med hjälp av pulsoximetri kan upptäcka fler fall av dysfagi.</p><p>Sextio vårdtagare på äldreboenden, i åldern 74-101 år, valdes ut att delta i studien. Urvalet baserades på resultat på Mini-Mental Test samt personalens och testledarnas subjektiva bedömning om vårdtagarens möjlighet att delta. Materialet som användes för att bedöma oral motorik och sensorik var Nordiskt Orofacialt Test – Screening. Vid den kliniska sväljningsbedömningen användes Standardised Swallowing Assessment (SSA) och pulsoximetri. Utöver detta inhämtades uppgifter för samtliga deltagare om sjukdomsdiagnos, antal stående läkemedel samt eventuell viktnedgång.</p><p>Resultatet visade att förekomsten av dysfagi och misstänkt dysfagi var 40 %. Oral dysfagi förekom hos 20 deltagare och faryngeal dysfagi hos sju deltagare. Pulsoximetern identifierade en deltagare med dysfagi och två med misstänkt dysfagi utöver dem som identifierats med hjälp av SSA. Korrelations- och signifikansberäkningar av de undersökta parametrarna visade inga signifikanta resultat.</p>

Changes in swallowing function are common in elderly and chronically ill individuals. Therefore it is important to be aware of these changes and their prevalence. The aim of this study was to assess the prevalence of dysphagia in nursing homes in the municipality of Linköping, and to correlate dysphagia with variables that can be a cause or a consequence of dysphagia. These variables were gender, age, MMT-result, dentition, weight loss, medical diagnose or number of medications. The intention was also to examine the additional information regarding dysphagia supplied by pulse oximetry. Sixty nursing home residents aged 74-101 years were chosen to participate in the study. The individual's ability to participate was based on their result on Mini-mental state and subjective judgements made by staff members and the authors. The material to assess oral motor and sensory function was the Nordic Orofacial Test - Screening. During the clinical swallowing examination the Standardised Swallowing Assessment (SSA) and pulse oximetry were used. In addition, data regarding the participants' medical diagnoses, number of medications and possible weight loss was collected. The result showed that the prevalence of dysphagia and suspected dysphagia was 40 %. Oral dysphagia was present in 20 participants and pharyngeal dysphagia in seven participants. With pulse oximetry one participant with dysphagia and two with suspected dysphagia were identified in addition to those identified by SSA. Analysis of the assessed variables showed no correlations or any significant results. / Förändringar av sväljförmågan är vanligt hos äldre och kroniskt sjuka individer. Det är viktigt att vara medveten om dessa förändringar och hur vanligt förekommande det är med nedsatt sväljförmåga. Syftet med föreliggande studie var att undersöka förekomsten av dysfagi på äldreboenden i Linköpings kommun samt att korrelera dysfagi med parametrar som kan vara orsak till eller konsekvens av dysfagi. Dessa parametrar var kön, ålder, MMT-resultat, tandstatus, viktnedgång, sjukdomsdiagnos och antal läkemedel. Ett delsyfte i studien var att undersöka om man med hjälp av pulsoximetri kan upptäcka fler fall av dysfagi. Sextio vårdtagare på äldreboenden, i åldern 74-101 år, valdes ut att delta i studien. Urvalet baserades på resultat på Mini-Mental Test samt personalens och testledarnas subjektiva bedömning om vårdtagarens möjlighet att delta. Materialet som användes för att bedöma oral motorik och sensorik var Nordiskt Orofacialt Test – Screening. Vid den kliniska sväljningsbedömningen användes Standardised Swallowing Assessment (SSA) och pulsoximetri. Utöver detta inhämtades uppgifter för samtliga deltagare om sjukdomsdiagnos, antal stående läkemedel samt eventuell viktnedgång. Resultatet visade att förekomsten av dysfagi och misstänkt dysfagi var 40 %. Oral dysfagi förekom hos 20 deltagare och faryngeal dysfagi hos sju deltagare. Pulsoximetern identifierade en deltagare med dysfagi och två med misstänkt dysfagi utöver dem som identifierats med hjälp av SSA. Korrelations- och signifikansberäkningar av de undersökta parametrarna visade inga signifikanta resultat.

Στόχος της παρούσας εργασίας αποτελεί η έγκαιρη πρόβλεψη οξυαιμίας βασιζόμενη στην ανάλυση των πολύ χαμηλής συχνότητας συστατικών του εμβρυϊκού καρδιακού ρυθμού και των καταγραφών της εμβρυϊκής παλμικής οξυμετρίας (FSpO2) κατά τη διάρκεια του τοκετού. Για τη φασματική ανάλυση έγινε εφαρμογή του συνεχούς μετασχηματισμού κυματιδίων (CWT). Για την ανάλυση των καταγραφών του FSpO2 υπολογίστηκε το ποσοστό του συνολικού χρόνου όπου ο FSpO2 είναι κάτω του ορίου 30% (TFSpO2<30%). Όπως αποδείχθηκε τόσο από την εφαρμογή του CWT, όσο και από την παράμετρο TFSpO2<30%, οι κυματισμοί του εμβρυϊκού καρδιακού ρυθμού στην περιοχή συχνοτήτων του 0.01 Hz, παρουσιάζουν ικανοποιητική ευαισθησία (80% and 90%, αντίστοιχα) για την έγκαιρη πρόβλεψη οξυαιμίας, ενώ ο συνδυασμός τους παρουσιάζει υψηλή προσδιοριστικότητα (89%). Τα αποτελέσματα της ανάλυσης των δεδομένων όπως προκύπτουν από την ανάλυση του εμβρυϊκού καρδιακού ρυθμού – μέσω εφαρμογής του CWT – και των καταγραφών της εμβρυϊκής παλμικής οξυμετρίας δύναται να αποτελέσουν μια επιπρόσθετη πηγή πληροφορίας όσον αφορά την κατάσταση του εμβρύου βοηθώντας ταυτοχρόνως τον γυναικολόγο στην απόφαση για το χρόνο και τον τρόπο διεξαγωγής του τοκετού. / The objective of the present study is the prediction of fetal acidemia based on the Very Low Frequency (VLF) components of the Fetal Heart Rate (FHR) and Fetal Pulse Oximetry (FSpO2) recordings during labor. In order to perform the spectral analysis, we applied the Continuous Wavelet Transform (CWT). The evaluation of FSpO2 was based on calculating the time duration in which the FSpO2 was less than 30% (TFSpO2<30%). We demonstrate that the oscillating activity of the FHR of about 0.01 Hz identified by the CWT and the TFSpO2<30% parameter, show an adequate sensitivity (80% and 90%, respectively) in predicting fetal acidemia, whereas the combination of these two variables shows a very good specificity (89%). The results of the analysis of our data demonstrate that the analysis of the fetal heart rate by the CWT and the fetal pulse oximetry recordings may provide additional source of information about fetal status and to alert the clinician to decide under objective conditions when and how to perform the delivery.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2018-03-06T16:41:53Z No. of bitstreams: 1 Viviane de Moraes Sptiz.pdf: 2589490 bytes, checksum: d0198dcb329c6b60384507e96166a773 (MD5) / Made available in DSpace on 2018-03-06T16:41:53Z (GMT). No. of bitstreams: 1 Viviane de Moraes Sptiz.pdf: 2589490 bytes, checksum: d0198dcb329c6b60384507e96166a773 (MD5) Previous issue date: 2017 / Mestrado Profissional em Enfermagem Assistencial / Não há na literatura científica descrição de algoritmo que direcione o enfermeiro para a prática de banho em pacientes com síndrome coronariana aguda (SCA). Dessa forma, a busca por melhores práticas norteou esta pesquisa, que assumiu como objeto de estudo o efeito do banho no leito sobre as repercussões oxi-hemodinâmica nos pacientes com SCA. Objetivos: Geral: Construir um algoritmo para sistematização das etapas do banho no leito tradicional no paciente adulto internado com SCA. Específico: descrever, com base na busca por evidências científicas, o padrão oxi-hemodinâmico de pacientes críticos durante o banho no leito e as principais práticas assistenciais em saúde guiadas por algoritmo; descrever, com base nos resultados do projeto integrado, os efeitos oxi-hemodinâmicos do controle hidrotérmico em pacientes com SCA durante o banho no leito e; adaptar a descrição do banho no leito geral proposto por Potter e Perry ao contexto do paciente com SCA. Método: Pesquisa descritiva operacionalizada em quatro etapas: análise das evidências encontradas na literatura científica sobre os efeitos do banho no leito e algoritmos norteadores da assistência em saúde, resultados de um projeto integrado, adaptação de um protocolo de banho no leito e construção do algoritmo. Resultados: Foram selecionadas três publicações sobre banho no leito e dezenove publicações sobre a utilização de algoritmos para a tomada de decisão. As principais alterações hemodinâmicas descritas na literatura foram aumento da frequência cardíaca (FC) e da pressão arterial diastólica (PAs) diminuição da saturação periférica de oxigênio (SpO2). Relacionado ao projeto integrado, houve incremento estatisticamente significante no consumo de oxigênio miocárdico (MVO2), quando o banho foi realizado com temperatura a 40ºC no paciente taquicárdico e no banho sem constância da temperatura da água em pacientes com PAs alta e pressão alterial média da normalidade. Quanto ao uso de algoritmos, a maioria dos estudos demonstrou ferramentas úteis para nortear as decisões clínicas. O algoritmo foi construído a partir da adaptação das etapas de banho e indicando o banho a 40ºC para o paciente com PAs ≥ 140mmHg e banho sem manipulação da temperatura da água para paciente com FC > 100bpm. Sua utilização poderá ser realizada por meio de bundle ou em formato digital. Conclusão: O algoritmo de banho necessita ser validado antes de ser aplicado na prática assistencial. Espera-se que esta ferramenta contribuia para a tomada de decisão profissional, podendo também ser utilizada como ferramenta para o ensino de fundamentos de enfermagem. Faz-se necessário novas pesquisas para aprofundamento do tema e em outras populações / There is no description in the scientific literature of an algorithm that directs nurses to bathing in patients with acute coronary syndrome (ACS). Thus, the search for best practices guided this research, which took as object of study the effect of bathing in the bed on the oxy hemodynamic repercussions in patients with ACS. Objectives: General: To construct an algorithm to systematize the stages of bathing in the traditional bed in the adult patient hospitalized with ACS. Specific: to describe, based on the search for scientific evidences, the oxy-hemodynamic pattern of critically ill patients during bed bath and the main health care practices guided by algorithm; to describe, based on the results of the integrated design, the oxy hemodynamic effects of hydrothermal control in patients with ACS during bathing in bed and; adapt the description of the bath in the general bed proposed by Potter and Perry to the context of the patient with ACS. Method: Descriptive research operationalized in four stages: analysis of the evidence found in the scientific literature on the effects of bathing in the bed and algorithms guiding health care, the results of an integrated project, the adaptation of a bath protocol in bed and the construction of the algorithm. Results: Three publications on bathing in bed and nineteen publications on the use of algorithms for decision making were selected. The main hemodynamic changes described in the literature were increased heart rate (HR) and diastolic blood pressure (BP) decrease in peripheral oxygen saturation (SpO2). In relation to the integrated design, there was a statistically significant increase in the myocardial oxygen consumption (MVO2), when the bath was performed with temperature at 40ºC in the tachycardic patient and in the bath without constancy of the water temperature in patients with high PA and normal mean alteration pressure. Regarding the use of algorithms, most of the studies demonstrated useful tools to guide clinical decisions. The algorithm was constructed from the adaptation of the bath stages and indicated the bath at 40ºC for the patient with PAs ≥ 140mmHg and bath without manipulation of the water temperature for patients with HR> 100bpm. Its use can be done by means of bundle or in digital format. Conclusion: The bath algorithm needs to be validated before being applied in care practice. It is hoped that this tool contributes to professional decision-making and can also be used as a tool for teaching nursing fundamentals. Further research is needed to deepen the subject and in other populations

A presente pesquisa avaliou a determinação dos valores da pressão da artéria pulmonar, da oximetria, da hemogasometria e dos teores plasmáticos de lactato em bezerros neonatos, com a finalidade de contribuir nos estudos de clonagem e no desenvolvimento de neonatologia veterinária. A monitorização logo após o parto e o nascimento se tornou necessária para a manutenção da vida destes animais, aprimorando-se os protocolos e procedimento tomados, a avaliação clínica do sistema cardiovascular e respiratório neste momento de transição e a partir disto, o objetivo deste trabalho foi padronizar a metodologia utilizada para avaliações hemodinâmica da pressão da artéria pulmonar por meio da utilização do cateter de Swan-Ganz em bezerros, padronizar a técnica de oximetria e correlacionar os resultados obtidos para saturação de oxigênio com aqueles encontrados na hemogasometria de sangue arterial, e estabelecer valores de referência e avaliar a influência dos primeiros 30 dias de vida na mensuração da pressão da artéria pulmonar, da oximetria, da hemogasometria e dos teores plasmáticos de lactato obtidos em bezerros sadios. Foram utilizados 10 bezerros hígidos do estado de São Paulo, acompanhados do nascimento aos 30 dias de vida, onde pudemos observar o fechamento do forame ovale e ducto arterioso na 1º semana de vida, utilizando o sangue misto, o sangue venoso também foi um ótimo avaliador de distúrbios acidobásico, no entanto não avalia a função respiratória; para isso bastou utilizar a oximetria de pulso como um método não invasivo, que nos fornece dados que a gasometria arterial iria fornecer com a saturação de oxigênio. E a mensuração do lactato sérico serve como um marcador biológico para prognóstico de diversas enfermidades, onde seu aumento no sangue demonstra uma má perfusão tecidual (hipóxia) / This study investigated the measurement of the pulmonary artery pressure, pulse oximetry, the blood gas, plasma lactate and glucose levels in newborn calves, in order to contribute in cloning studies and the development of neonatal veterinary medicine. Monitoring soon after birth or help the calving became necessary for the maintenance of life of these animals, improving the protocols and procedures taken, the clinical assessment of cardiovascular and respiratory systems in this time of life transition, the objective of this study was to standardize the methodology used for hemodynamic assessment of pulmonary artery pressure using a Swan-Ganz catheter in calves, standardize the technique of pulse oximetry and correlate the results obtained for oxygen saturation found in blood gas analysis of arterial blood, and set reference values and to evaluate the influence of the first 30 days of life in the measurement of pulmonary artery pressure, pulse oximetry, blood gas and the plasma lactate levels obtained in healthy calves. We used 10 calves healthy from Sao Paulo state, followed from birth to 30 days of life, where we could see the closure of the foramen ovale and ductus arteriosus in the 1st week of life, using the mixed blood, venous blood was also a great evaluator acid-base disturbance, but does not assess respiratory function. The pulse oximetry was good enough to evaluate the oxygen saturation like a noninvasive method. And the measurement of serum lactate serves as a biomarker for prognosis of various diseases, when increase in blood shows poor tissue perfusion (hypoxia)

Patients with end-stage renal disease frequently suffer from cardiovascular complications. Many factors contribute to their development: hyperkinetic circulation caused by anaemia, fluid retention and by presence of dialysis arteriovenous access; metabolic changes leading to acceleration of atherosclerosis and increase of vascular stiffness and also fluctuation of blood pressure and organ perfusion during haemodialysis, that cause repeated tissue hypoxia. We performed our research on patients in chronic haemodialysis programme. The project studying long-term patency of dialysis access showed that dialysis graft patency is negatively influenced by presence of coronary artery disease and low serum concentrations of cholesterol. In our studies about tissue hypoxia we proved that haemodialysis patients suffer from hypoxia of cerebral tissue and muscle tissue of the dialysis access arm, and that the hypoxia worsens during dialysis. Factors associated with brain hypoxia are presence of heart failure, higher BNP levels and higher erythrocyte distribution width. One of the serious consequences of brain hypoxia is development of cognitive deficit. Among the negative impact of haemodialysis on the heart, we observed left atrial dysfunction, which is a consequence of long-term remodelling and cannot be...