Internal department of Strahov
The basic focus of the Center for Vascular Approaches (CCP) of the VFN is the comprehensive care of vascular approaches for extracorporeal cleansing methods. It is about establishing vascular access, comprehensive diagnostics and treatment of vascular access complications, which are the most common cause of morbidity in dialysis patients. In addition to this clinical work, the Center provides diagnostic and logistical issues in science and research, and provides training for other specialists.
In our department, we provide patients with chronic renal failure with vascular access for hemodialysis. We impose acute (temporary) and permanent (long-term) catheters, we solve catheter-related complications: infections, mechanical complications, functional disorders. Performances are performed on an outpatient basis even under short-term hospitalization. We provide our services to patients not only from our dialysis center, but also from hemodialysis centers throughout the Czech Republic. Our workplace is part of the Center for Vascular Approaches for Extracorporeal Purification Methods.
We work with II. Surgical Clinic of Cardiovascular Surgery, General Teaching Hospital and Radiodiagnostic Clinic of General Teaching Hospital. Like the subcutaneous vascular approaches, all permanent central venous catheters introduced in our department are being monitored as part of the development of a separate monitoring program. Members of the Catheterization Team are members of the Czech Society for Vascular Access and pass on their experience at professional events. The educational video can be viewed on YouTube under the title Central tunneled venous catheter for hemodialysis.
The Center was established 18.1. 2010 by decision of the director of the General Teaching Hospital on the proposal of the workplace with the following objectives of its activities:
- elaboration of clinical trials and clinical trials in the framework of the CE marking procedure for dialysis medical devices, assessment of clinical trials conducted by notified bodies for other subjects,
- consultations, tests, measurements and cooperation with research and development departments of dialysis manufacturers.
Participation in multicentric international projects fits into these activities. A number of smaller projects are dealt with in the form of final bachelor and master theses. Part of the dissemination of the results of these works is the corresponding publication activity.
The foundation of the Center was preceded by the medical-technical and technical activities developed at the Strahov Dialysis Center practically since its inception, thanks to its founder prof. MUDr. Albert Valek, DrSc. († 1998) on the multidisciplinarity of the work team. For these works, there is a clinical engineer, qualified doctors - nephrologists and a team of experienced dialysis nurses at the Center. Since its establishment, the Center has prepared a number of clinical trials of dialysis medical devices for Czech and foreign manufacturers, and has conducted a number of clinical trials, either alone or as part of multicentre projects. The newest activity of the workplace is the testing (and even the introduction into practice - the first in the Czech Republic!) Of domestic hemodialysis with low dialysate flow (American System One by NxStage).
The Center is able to provide comprehensive care to patients with chronic renal failure from the pre-dialysis clinic through the outpatient operation of the dialysis center to the treatment of complications and eventual hospitalization in the ward.
The workplace also provides consultative examination of patients from other hemodialysis centers, both outpatient and hospitalized. We provide these consulting services mainly to patients with complicated vascular access for HD (in cooperation with the 2nd Surgical Clinic of Cardiovascular Surgery of the First Faculty of Medicine and General Teaching Hospital and the Radiodiagnostic Clinic of the First Faculty of Medicine and General Teaching Hospital) and patients with advanced or complicated forms of renal osteopathy.
Four programs already have a stable formalized structure
- Kidney replacement program
- A program for the diagnosis and treatment of mineral bone disorders in chronic kidney disease
- Provision and monitoring of vascular access for hemodialysis
- Wound healing program for dialysis patients
Peritoneal dialysis (PD) treatment has been performed continuously in the Internal Department of Strahov VFN since 1978. Peritoneal dialysis is performed in its entirety: education and choice of method in predialysis, catheter implantation in cooperation with surgical departments and subsequent postoperative care, education of patients and family members, treatment with automated PD, monitoring of dialysis adequacy, peritoneal transport characteristics, quality of life, nutritional status, acute and chronic complications, assisted PD, etc. A great advantage of the workplace is a multidisciplinary team caring for patients including clinical psychologists, nutritional therapists and rehabilitation staff. Since 2010 we have been a VFN specialist center for peritoneal dialysis. We are conducting extensive cooperation and providing super-consular assistance to other dialysis centers in the Czech Republic. Since 2014, when a network of workplaces offering assistance with peritoneal dialysis was created within CNS, our workplace one of them.
An important part of the PD program is the education of doctors and nurses from other workplaces. In our workplace, in cooperation with the VFN Education Department, since 2010 several courses have been held each year for nurses on assisted peritoneal dialysis. It is a course accredited by the Ministry of Health of the Czech Republic. The expert guarantor of the course is Mrs. Ludmila Nermutová and MUDr. Barbora Szonowská.