Tímea Kiss Rengeiné1, Z Máthé1; E Dinya2; Mészáros Judit3, J Fazakas1
Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary1
Faculty of Health and Public Services, Semmelweis University, Budapest, Hungary2
Doctoral School of Patological Sciences, Semmelweis University, Budapest, Hungary3
Introduction: The Therapeutic Intervention Scoring System (TISS-28) adapted to liver transplantation by King's College Hospital (King’s-TISS) allows the grading of 138 activities to determine the nursing workload, diagnostic, monitoring and therapeutic needs of patients: supportive therapy (4 points), drug therapy (3 points), diagnostics (2 points), monitoring, invasive procedures (1 point). (1.)
Aims: The aim of the study was to evaluate the impact of multimodal hemostasis approach on King’s College TISS score in the first perioperative 48 hours of bloodless liver transplantation.
Methods: The study participants were bloodless liver transplanted patients (n=51). The King’s-TISS activities were grouped by organ systems (neurological, ventilation, cardiology, homeostasis, hemostasis management) with nursing procedures (monitoring, invasive access care, basic patient care) and these activities were also recorded in the first 48 hours.
The special hemostasis management of liver transplanted patients, coagulation assays, hemostasis reserve capacity (HRC) calculation and coagulation factor replacement were similarly documented. The nursing workload with and without multimodal hemostasis management assessed by TISS score (King’s vs. HRC) was analyzed. The data are given mean±SD and were analyzed with rAnova by SPSS 20.0.
Results: The total of King’s-TISS score points were decreased roughly by ≥ 30% daily, from 116±2.9 to 78.6±7.9 to 48 and 64.7±9.8 (p=0.001). More specifically the neurological-, ventilation-, vasopressor support and invasive access care points decreased by 80%, but the homeostasis-, monitoring-, basic patient care points were unchanged. According to the hemostasis monitoring activity points were doubled, however the multimodal hemostasis management (TISS-HRC) increased by another 13-16 points the original King’s-TISS score daily.
Conclusion: The King’s-TISS score is reliable indicator of diseases severity and nursing workload in perioperative care of liver transplantation. The TISS-HRC score could replace the King's-TISS score providing more complete picture of perioperative hemostasis nursing activity during the first few days, following LTx.
Doctoral School of Patological Sciences, Semmelweis University
Program: Health science research
Supervisors: Judit Mészáros, János Fazakas
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