This diploma thesis is related to peripherally inserted central venous catheters (PICC), the role of nursing staff in inserting and care of these systems. The aim of the work, which is partly based on PICC project organized by the Department of Anaesthesiology and Intensive Care Medicine, 1st Faculty of Medicine of the Charles University and General University Hospital in Prague, was to investigate the quality of life in patients with PICC after their insertion, to evaluate the incidence of complications (venous thrombosis, bacteraemia, sepsis, local infections, decubitus, disconnection of the system, mechanical complications, etc.) and compare the economic efficiency of PICC systems with other available methods. The aim of the second part of the thesis, which is unrelated to the previously mentioned project, was to reveal the awareness of nurses/paramedics on PICC catheter. This thesis has two traditional parts - theoretical and empirical. The theoretical part deals initially with the central venous catheter in general and then it describes main features of the PICC systems. The following part reviews indications, insertion techniques and potential complications associated with the PICC systems. The role of nursing staff in the insertion and maintenance of these systems is also highlighted. The...

Hospital-acquired infections (HAIs) pose a significant and increasing threat to global health. One primary cause of this threat is increasing antibiotic resistance. As traditional antibiotics continue to grow less effective, there is an urgent need for novel antimicrobial strategies. This work explores the potential of ceragenins, also known as cationic steroid antimicrobials (CSAs), as a promising alternative to combat HAIs. Specifically, we investigated potential roles that CSAs can play in the context of multiple medical device coatings in healthcare settings. Ceragenins are synthetic mimic of antimicrobial peptides (AMPs) which exhibit broad-spectrum antimicrobial activity against many common pathogens that have been cited as high priority by global health organizations. Unlike traditional antibiotics, which rely on specificity to bacterial enzymes or processes, ceragenins disrupt microbial membranes generally. This mechanism of action allows ceragenins to bypass many of the related antibiotic resistance mutations of bacteria and fungi. As microbial membranes are a highly conserved and fundamental structure of these pathogens, it is much more difficult for microbes to develop mutations that prevent CSA binding. Additionally, ceragenins are resistant to both host and pathogenic proteolytic degradation and are cost-effective to produce, which place CSAs as an attractive alternative to traditional antibiotics. This research investigates the integration of ceragenins into various medical devices to prevent HAIs. Specifically, we investigated silicone tissue expanders, peripherally inserted central catheter (PICC) lines, and adhesive devices which include both polyacrylate and silicone scar tape. These studies include the development of coating techniques to maximize appropriate antimicrobial activity while maintaining stability and biocompatibility across these different base materials. Our experimental results demonstrate that ceragenin-coated devices significantly reduce microbial colonization and biofilm formation. We considered the length of antimicrobial activity needed and developed coatings that would be appropriate for those use cases. This reduction in harmful pathogenic colonization demonstrates their potential to improve patient outcomes and reduce healthcare costs associated with HAIs. Further research and development could facilitate the continued adoption of ceragenin-based coatings in medical devices, which can reduce the incidence of HAIs while contributing to the broader fight against antibiotic-resistant infections worldwide.

Le roman Les Métamorphoses d'Apulée se distingue par les nombreux récits insérés qu’il contient et qui interrompent fréquemment la trame principale. Ces histoires étaient probablement déjà présentes en partie dans le roman grec qui a servi de source à Apulée, les Μεταμορφώσεις. Cependant, ce texte ne nous étant parvenu que sous une forme abrégée (l'ὄνος), il demeure difficile de déterminer à quel point la structure de la version latine des Métamorphoses retient de celle de l’original grec. Certes, certains éléments sont facilement attribuables à Apulée, comme le conte de Cupidon et Psyché, ou encore le 11ème et dernier livre du roman. En plus d’être divertissants, ces récits insérés reprennent les thèmes principaux exploités dans le roman, renforçant la cohérence de celui-ci. Par ailleurs, toutes ces histoires secondaires nécessitent l’intervention de plusieurs narrateurs et, en plus de Lucius (personnage et narrateur principal), divers personnages prennent la parole. Enfin, Apulée accorde aussi une grande attention à la perception que ses personnages ont des événements dont ils sont témoins ou des histoires qui leur sont rapportées. À plusieurs reprises, la subjectivité des personnages influence le récit. Ainsi, les histoires insérées des Métamorphoses, qui peuvent donner l’impression que la trame du récit est brouillonne, sont au contraire l’élément le plus original et le mieux développé du roman. / The Metamorphoses of Apuleius is notable for its numerous inserted tales often interrupting the novel’s main plot. These stories were probably already present, at least partly, in the Greek novel that was used as a source by Apuleius, the Μεταμορφώσεις. However this work is lost and only reached us through an epitomized version (Ὄνος), making it difficult to establish just how much the structure of the Latin Metamorphoses retains from its Greek source. Still some elements can be easily attributed to Apuleius, like Cupid and Psyche’s tale or the novel's 11th (and last) book. Besides having an entertaining purpose, these inserted tales share common themes with the main plot, creating a unity within the novel. Furthermore, multiple narrators are required in order to tell all these stories implying that, in addition to Lucius (the novel’s main character and narrator), many characters play an active part in storytelling. Finally, Apuleius pays great attention to his characters’ perception of events they witness or of stories they hear. And at several occasions the characters’ subjectivity influences the storyline. Thus the Metamorphoses’ inserted tales, even though they may at first give a false impression of confusion, should be considered as the most original and most well developed feature of Apuleius’ novel.

Nous avons mené une étude prospective randomisée dans le but de comparer l'effet de l'irrigation du cathéter de type PICC avec deux types d'anticoagulants: Héparine standard et Tinzaparine, une héparine de faible poids moléculaire. Notre étude s'adresse aux patients de la clinique externe d'oncologie de l'hôpital Maisonneuve-Rosemont. Entre début Mai 2005 et Mars 2008, nous avons recruté 131 patients dont 70 ont été randomisés. Parmi les 61 patients exclus, 23 n'ont pas rencontré les critères d'inclusion, 30 ont refusé de participer et 8 ne sont pas inclus pour d'autres raisons. Sur les 70, 36 sujets sont randomisés dans le groupe Héparine standard et 34 dans le groupe Tinzaparine. La population en intention de traiter comprend 65 sujets dont 32 dans le groupe Héparine standard et 33 dans le groupe Tinzaparine. Le médicament a été administré pendant un mombre maximal de 30 jours et les sujets ont été suivis pendant 90 jours. La thrombose veineuse associée au cathéter (TVAC) a été objectivée par une phlébographie ou une échographie-Doppler à la fin de la période de 30 jours suivant l'installation du cathéter. L'incidence de la TVAC sur 30 jours est de 14,39 par 1000 cathéter-jours (IC à 95%:[9,0;19,79]/1000 cathéter-jours ou 41,5% (27/65). L'incidence de la thrombose veineuse profonde (TVP) symptômatique du membre supérieur sur la période de suivi de 90 jours est de 0,41 par 1000 cathéter-jours (IC à 95%:[0,08;0,81]/1000 cathéter-jours ou 3% (2/65). Nous n'avons observé aucune différence entre les deux groupes par rapport à la fréquence de la TVAC ni de la TVP. Nous ne pouvons conclure à une différence dans l'efficacité de la Tinzaparine par rapport à l'Héparine standard dans la prévention de la TVAC. / Our prospective, randomized study aims at comparing the effectiveness of two types of heparin used for the instillation of peripherally inserted central catheter (PICC): Standard heparin and Tinzaparin, a low molecular weight heparin. We recruited patients from the ambulatory center of Maisonneuve-Rosemont hospital. Between the beginning of May 2005 and March 2008, 131 patients were enrolled. Of 61 patients excluded, 23 did not satisfy the inclusion criteria, 30 refused to participate and 8 were not enrolled for other reasons. Seventy patients were randomized into two groups, 36 in the Standard heparin group and 34 in the Tinzaparin group. Our population intent-to-treat included 65/70 patients, 32 of these received Standard heparin and 33 received Tinzaparin. The experimental intervention was administered for a maximum of 30 days and all the subjects were followed up for 90 days. The events were documented objectively with a venogram or Doppler ultrasonography by the end of the 30 days following the catheter installation. The incidence of catheter-related venous thrombosis (CRVT) during 30 days of instillation is 14,39/1000 catheter-days (CI 95%:[9,0;19,79]/1000 catheter-days or 41.5% (27/65). The incidence of symptomatic upper extremity deep venous thrombosis (DVT) during the observation period of 90 days is 0,41/1000 catheter-days (CI 95%:[0,08;0,81]/1000 catheter-days or 3% (2/65). We did not observe any difference in the frequency of CRVT or DVT between the two groups. We can not conclude that either Standard heparin or Tinzaparin is more effective in the prevention of CRVT in our population.

Nous avons mené une étude prospective randomisée dans le but de comparer l'effet de l'irrigation du cathéter de type PICC avec deux types d'anticoagulants: Héparine standard et Tinzaparine, une héparine de faible poids moléculaire. Notre étude s'adresse aux patients de la clinique externe d'oncologie de l'hôpital Maisonneuve-Rosemont. Entre début Mai 2005 et Mars 2008, nous avons recruté 131 patients dont 70 ont été randomisés. Parmi les 61 patients exclus, 23 n'ont pas rencontré les critères d'inclusion, 30 ont refusé de participer et 8 ne sont pas inclus pour d'autres raisons. Sur les 70, 36 sujets sont randomisés dans le groupe Héparine standard et 34 dans le groupe Tinzaparine. La population en intention de traiter comprend 65 sujets dont 32 dans le groupe Héparine standard et 33 dans le groupe Tinzaparine. Le médicament a été administré pendant un mombre maximal de 30 jours et les sujets ont été suivis pendant 90 jours. La thrombose veineuse associée au cathéter (TVAC) a été objectivée par une phlébographie ou une échographie-Doppler à la fin de la période de 30 jours suivant l'installation du cathéter. L'incidence de la TVAC sur 30 jours est de 14,39 par 1000 cathéter-jours (IC à 95%:[9,0;19,79]/1000 cathéter-jours ou 41,5% (27/65). L'incidence de la thrombose veineuse profonde (TVP) symptômatique du membre supérieur sur la période de suivi de 90 jours est de 0,41 par 1000 cathéter-jours (IC à 95%:[0,08;0,81]/1000 cathéter-jours ou 3% (2/65). Nous n'avons observé aucune différence entre les deux groupes par rapport à la fréquence de la TVAC ni de la TVP. Nous ne pouvons conclure à une différence dans l'efficacité de la Tinzaparine par rapport à l'Héparine standard dans la prévention de la TVAC. / Our prospective, randomized study aims at comparing the effectiveness of two types of heparin used for the instillation of peripherally inserted central catheter (PICC): Standard heparin and Tinzaparin, a low molecular weight heparin. We recruited patients from the ambulatory center of Maisonneuve-Rosemont hospital. Between the beginning of May 2005 and March 2008, 131 patients were enrolled. Of 61 patients excluded, 23 did not satisfy the inclusion criteria, 30 refused to participate and 8 were not enrolled for other reasons. Seventy patients were randomized into two groups, 36 in the Standard heparin group and 34 in the Tinzaparin group. Our population intent-to-treat included 65/70 patients, 32 of these received Standard heparin and 33 received Tinzaparin. The experimental intervention was administered for a maximum of 30 days and all the subjects were followed up for 90 days. The events were documented objectively with a venogram or Doppler ultrasonography by the end of the 30 days following the catheter installation. The incidence of catheter-related venous thrombosis (CRVT) during 30 days of instillation is 14,39/1000 catheter-days (CI 95%:[9,0;19,79]/1000 catheter-days or 41.5% (27/65). The incidence of symptomatic upper extremity deep venous thrombosis (DVT) during the observation period of 90 days is 0,41/1000 catheter-days (CI 95%:[0,08;0,81]/1000 catheter-days or 3% (2/65). We did not observe any difference in the frequency of CRVT or DVT between the two groups. We can not conclude that either Standard heparin or Tinzaparin is more effective in the prevention of CRVT in our population.

The theme of this diploma thesis is fittings of heating systems and it is divided into three parts. The first part deals with this topic on theoretical level. In the second part, there is a calculations and drawings that deals with heating and water heating of the apartment building in Uherské Hradiště. This part is solved in two variants concerning hydraulic balancing and regulation of the heating system. The last part of the thesis is an experimental solution and processing of pressure loss results of selected valves. These results are compared with the values reported by the manufactures of the valve.