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Anestesisjuksköterskans hantering av medicinsk syrgas under generell anestesi – en enkätstudie
Luleå University of Technology, Department of Health Sciences, Nursing Care.
Luleå University of Technology, Department of Health Sciences, Nursing Care.
2019 (Swedish)Independent thesis Advanced level (degree of Master (One Year)), 40 credits / 60 HE creditsStudent thesisAlternative title
The nurse anaesthetist’s management of medical oxygen <br/> during general anaesthesia – a cross sectional study (English)
Abstract [sv]

Abstrakt Bakgrund: Administrering av syrgas syftar till att behandla hotande eller manifest hypoxi, som i värsta fall är direkt dödligt. Det har traditionellt ansetts riskfritt och säkert, men studier har under senare år påvisat att överdriven syrgasadministrering utgör risker för skada. Negativa effekter innefattar bland annat atelektasbildning, minskat cardiac output och nedsatt perfusion till vävnader. Det råder variation kring syrgas- och ventilatorinställningar peroperativt, och patienter utsätts för betydande risker i och med hypoxi och hyperoxemi. Syftet med studien var att undersöka hur anestesisjuksköterskor hanterar administration av syrgas perioperativt till lungfriska patienter >18 år, bedömda enligt ASA klassifikation I-II under generell anestesi. Metod: Tvärsnittsstudie; en webbenkät skickades ut till verksamma anestesisjuksköterskor på totalt åtta sjukhus i Västra Götaland, Stockholm och Norrland. 575 enkäter skickades ut och svarsfrekvensen var 33.2%. Analyser utfördes i SPSS med bland annat Chi2- och Kruskal-Wallis tester. De kommentarer som lämnades i fritext analyserades och kategoriserades. Resultat: 71.20% uppgav att de eftersträvade SpO2 mellan 96-98%, majoriteten uppgav även att de justerade ned FiO2 vid uppmätt SpO2 100%. De flesta baserade sina syrgasinställningar på praxis från sin enhet, följt av att vad de lärt sig under sin vidareutbildning. Inga signifikanta skillnader kunde påvisas utifrån utbildningsnivå eller yrkeserfarenhet. Regionalt fanns skillnader där Västra Götaland i högre utsträckning administrerade syrgas under transport till postop/UVA än Stockholm. Lägsta tänkbara nivå av FiO2 deltagarna kunde tänka sig varierade mellan Västra Götaland och Norrland, och i Stockholm var man mer aktiv i att justera FiO2 peroperativt jämfört med de två andra regionerna. Diskussion: Variationer i deltagarnas svar diskuterades bland annat mot bakgrund av specialistsjuksköterskans kärnkompetenser. De signifikanta skillnaderna som kunde påvisas var regionsbaserade, vilket kan bero på variationer i arbetssätt, rutiner och organisationskultur mellan de olika klinikerna. Bortfallet och dess eventuella betydelse för studiens validitet diskuterades. Slutsatser/Kliniska implikationer: Praxis behöver vara utarbetat utifrån evidens och inte enbart utifrån tradition. Forskningen kring syrgas och dess fördelar och risker är komplex och potentiellt är en vanlig uppfattning att hyperoxemi är riskfritt. Möjligen skulle utbildningstillfällen eller reflektionsmöten specifikt inriktade på syrgasbehandling kunna balansera praxis mer mot att undvika både hyperoxemi och hypoxi.

Abstract [en]

Abstract Background: Oxygen administration is aimed at treating threatening or manifest hypoxia, which in the worst case is directly deadly. Traditionally it has been regarded risk-free and safe, but recent years studies have found that excessive use of oxygen poses risks of adverse effects. Negative effects include, amongst others, atelectasis formation, reduced cardiac output and tissue perfusion. There is variation in perioperative oxygen- and ventilator settings, and patients are subjected to considerable risks in regards to hypoxia and hyperoxemia. The aim of this study was to investigate how nurse anaesthetists manage the administration of perioperative oxygen to patients >18 years of age under general anaesthesia, without pulmonary disorders, with ASA classification I-II. Method: Cross-sectional study; an electronic survey was sent out to practicing nurse anaesthetists in a total of eight hospitals in the regions Västra Götaland, Stockholm and Norrland in Sweden. 575 surveys were sent out and the response rate was 33.2%. Analyzes were conducted in SPSS with tests including Chisquare and Kruskal-Wallis among others. The comments that were provided at the end of the survey were analyzed and categorized. Results: 71.20% stated that they strive for an SpO2 of 96-98%, the majority also stated they’d adjust FiO2 to lower levels when SpO2 was 100%. Most participants based their oxygen-settings on local practice at their place of work, followed by what they learned during their specialization. No significant differences were found in regards to level of education or work experience. There were regional differences where Västra Götaland to a higher extent would administer oxygen during transport to the postoperative unit than Stockholm would. The lowest level of FiO2 the participants would consider differed between Västra Götaland and Norrland, and in Stockholm nurses were more active in adjusting FiO2 perioperatively compared to the two other regions. Discussions: Variations in how the participants responded were discussed in the light of the specialized nurse core competences. The significant differences that were found were based on region, which could be explained by variations in routines and organizational culture between different clinics. The non-completion rate and it’s possible importance for the validity of the study was discussed. Conclusions/clinical implications: Local practice needs to be based on current evidence and not solely on tradition. Research regarding oxygen and its beneficial and detrimental effects is complex, and perhaps the perception that hyperoxemia is risk-free is common. It’s possible that training opportunities or seminars on oxygen treatment could balance practice more towards avoiding both hypoxia and hyperoxemia.

Place, publisher, year, edition, pages
2019. , p. 37
Keywords [en]
Nurse anaesthetist, oxygen, FiO2, hypoxia, hyperoxemia, perioperative
Keywords [sv]
Anestesisjuksköterska, syrgas, FiO2, hypoxi, hyperoxemi, perioperativt
National Category
Nursing
Identifiers
URN: urn:nbn:se:ltu:diva-74385OAI: oai:DiVA.org:ltu-74385DiVA, id: diva2:1323175
Subject / course
Student thesis, at least 15 credits
Educational program
Specialist Nursing, Anaesthesia Care
Supervisors
Examiners
Available from: 2019-06-24 Created: 2019-06-11 Last updated: 2019-06-24Bibliographically approved

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