AORTIC GRAFT INFECTION
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1 NURSING CARE Theresa O Keefe NUM Vascular Unit PAH
2 Vascular infections are serious They are associated with high morbidity and mortality The primary cause of surgical wound infections is contamination by skin organisms during surgery
3 Prosthetic graft infections typically result from a progressive wound infection Comorbid conditions are also related to increase risk of vascular infections We should identify vascular patients at increased risk for infection, monitor them closely, and intervene to optimize the healing environment
4 Prosthetic graft infections are an uncommon complication of aortic bypass (1.3% 6% of cases) However they can have serious consequences such as limb loss and death (mortality rates of 25% 75%)
5 Diagnosis (CT) is the most efficacious imaging method for diagnosis of graft infections due to its quick availability
6 The clinical presentation may be straightforward if there is a femoral component There will be: swelling, heat, tenderness, a pulsatile mass, or possibly a draining sinus tract
7 Nonspecific presentations as: malaise, back pain, fever gastrointestinal bleeding hydronephrosis or ischaemic limb should also be considered potential manifestations of a graft infection
8 In the early postoperative period, signs of graft infection can be difficult to differentiate from normal postoperative changes Aorto enteric fistula should be considered a subset of aortic graft infection
9 Because of the high rates of early and late mortality and limb loss, aortic prosthetic graft infections require emergent aggressive intervention and limb salvage procedures Goal of treatment is to save the patient s life
10 Treatment Options Treatment options include Total graft excision Extra-anatomic bypass grafting In situ replacement of the graft
11 A recent study found that percutaneous drainage of perigraft infected fluid can be used as an initial form of treatment Surgery after percutaneous drainage appears to be safer than surgery alone
12 Treatment Options The standard treatment is to remove the infected graft and perform an extra anatomic bypass Risky and has a high rate of death, amputation, and disruption of aortic closure
13 Treatment Options
14 Enteric fistula adhered to the right common iliac anastomosis
15
16 Complications/Nursing care Many patients have underlying coronary artery disease and chronic obstructive pulmonary disease Increase the risk of postoperative actelectasis and decrease the tolerance of hemodynamic changes from blood loss and fluid shifts
17 Complications/Nursing care Prerenal failure can develop for several reasons The kidney can sustain ischaemia from decreased aortic blood flow, decreased cardiac output, emboli, inadequate hydration or the need for clamps on the aorta above the renal arteries during surgery
18 Complications/Nursing care Emboli can also develop and lodge in the arteries of the lower extremities or mesenteric arteries Clinical manifestations include those of acute occlusion in the leg Bowel necrosis is exhibited as fever, leukocytosis, ileus, diarrohea and abdominal pain
19 Complications/Nursing care Paralytc ileus may develop as a result of anaesthesia and the manual manipulation and displacement of the bowel for long periods during surgery The intestine may become swollen and bruised and peristalsis ceases for variable intervals
20 Complications/Nursing care A nasogastric tube is inserted during surgery this decompreses the stomach and duodenum, prevent aspiration of stomach contents, and decrease pressure on suture lines
21 Nursing Care post op ICU post op Return to ward anywhere from day 1 to 30 Varying degrees of wellness
22 Complications/Nursing care Nursing care Strict FBC Monitor IV fluids, TPN Monitor NGT drainage May require dialysis Daily weight
23 Complications/Nursing care Nursing care Minimum Q4H vascular observations Q2H Q4H Vitals - Prolonged hypotention may result in graft thrombosis due to decreased blood flow Severe hypertention may cause undue stress on the arterial anastomosis
24 Complications/Nursing care Nursing care Myocardial ischaemia or infarction may occur in the perioperative period due to decreased oxygen supply Cardiac arrhythmias also may occur due to electrolyte imbalances, hypoxaemia, hypothermia or myocardial ischaemia
25 Complications/Nursing care Nursing care ECG monitoring, frequent electrolyte and blood gas (ABG) O2 and antiarrhythmic medications as needed Replacement of electrolytes as indicated, adequate pain control and resumption of preoperative cardiac medications
26 Complications/Nursing care Nursing care Cause of decreased renal perfusion can be embolization of a fragment of thrombus or plaque from the aorta that subsequently lodges in one or both of the renal arteries
27 Complications/Nursing care Nursing care This can cause ischaemia of one or both kidneys Hypotension, dehydration, prolonged aortic clamping, can also lead to decreased renal perfusion
28 Complications/Nursing care Nursing care Ensure adequate nutrition and observe the surgical incision for any evidence of delaying healing, signs of infection or prolonged drainage
29 Complications/Nursing care Nursing care While NBM mouth care should be regularly given Ice chips may be given to the patient If the blood supply to the bowel is disrupted during surgery there will be no bowel sounds, fever, abdominal distention, diarrohea, and bloody stools
30
31
32 Long term care Rehablitation Long term antibiotics up to 6 months
33 Thankyou Questions
34
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