The Institute for Cardiovascular Diseases and the Department for Intensive Cardiology Care at the University Hospital Dubrava

    Authors

    Abstract

    According to data from the World Health Organization, cardiovascular diseases are the leading cause of mortality and morbidity in the world. The Department for Intensive Cardiology Care at the University Hospital Dubrava was founded 20 years ago with the goal of providing intensive treatment and healthcare to cardiological patients in mortal danger. The Department for Intensive Cardiology Care has been renovated and expanded several times since its foundation with the goal of improving the healthcare provided to such patients. Their treatment and healthcare require a highly-educated professional team, high-quality medical devices, and precise organization of diagnostics and treatment.

    Keywords

    cardiovascular diseases, intensive cardiology care, intensive healthcare

    DOI

    https://doi.org/10.15836/ccar2019.289

    Full Text

    ## History The Department for Intensive Cardiology Care – the Coronary Care Unit (CCU) – was first founded in September 1999 with the goal of providing intensive treatment and performing intensive healthcare procedures in cardiologic patients. The CCU initially comprised five patient beds in 1 room and an additional bed in a separate isolation room. Intensive healthcare and treatment were facilitated by a central monitoring system for continuous electrocardiogram (ECG) monitoring, a portable respirator – Oxylog 100 (without a mechanical ventilation device), an ECG device, a generator for temporary pacemakers, etc. The treatment and healthcare team consisted of 1 cardiologist, a head nurse, 2 nursing graduates and 5 nurses with completed vocational nursing schools. Over the course of its existence, the CCU has been expanded and reorganized due to the growing need for medical care and treatment of cardiologic patients. In September 2003 the CCU was transferred to a new and larger location on the 1 st floor of the hospital next to the Laboratory for Heart Catheterization. At the time the CCU consisted of 1 room with 7 patient beds, and the Postcoronary Unit was opened next to it with 6 additional patient beds. An angiography procedure room for implantation of permanent pacemakers with a radiological device was also opened next to the Laboratory for Heart Catheterization. Healthcare and treatment have been improved by the acquisition of additional and higher-quality medical equipment including central monitoring and continuous ECG with audio-visual and text data, two EVITA 4 devices for mechanical ventilation, 1 transportable respirator – Oxylog 3000, 1 echocardiography device with a transesophageal probe, a portable pulse oximeter, infusion pumps, perfusion devices, fluid warmers, an i-Stat blood analyzer, CTNI blood analyzer, patient heater, aspirators, a defibrillator – Lifepak 15, telemetry devices (postcoronary), an extracorporeal membrane oxygenation (ECMO) device, and an intra-aortic balloon pump (angiography procedure room). Due to the need for more personnel, the treatment was conducted by 4 cardiologists assisted by a cardiology resident, a head nurse, a nurse with a bachelor’s degree in nursing, and 18 nurses with a vocational school degree. The Postcoronary Unit and the pacemaker implantation hall were shut down in 2014. At the time, the CCU comprised 1 room with 7 patient beds. Function and activity of the Department for Intensive Cardiology Care The Institute for Cardiovascular Diseases is organized as follows: Cardiology 1 – Department for Intensive Cardiology Care; Cardiology 2 – Department for Ischemic Heart Diseases and Pacemaker Implantation with a Laboratory for Invasive Diagnostics and Treatment; Cardiology 3 – Department for Vascular and Cardiac Valve Diseases; Cardiology 4 – Department for Cardiomyopathy, Heart Failure, and Transplantation Cardiology; Diagnostic Department for Echocardiography and Non-invasive Cardiological Diagnostics with a Day Hospital; Polyclinic. The Institute hospitalizes about 4100 patients annually, which includes performing over 1600 coronarographies, 870 interventions on coronary arteries, 45 percutaneous coronary interventions (PCIs) for chronic total occlusion (CTO), 18 rotablation procedures, and more than 300 permanent pacemaker implantations (of which 18 implantable cardioverter defibrillators and 8 resynchronization therapy devices). Noninvasive cardiological diagnostics performed annually include over 4300 24-hour ECG monitoring procedures, 3200 exercise stress test procedures, approximately 3145 echocardiography examinations, 13 074 clinical examinations, and approximately 2500 examinations and patients processing procedures at the Day Hospital. The Department for Intensive Cardiology Care treats about 950 patients annually. In 2018 it admitted 450 patients with a diagnosis of acute myocardial infarction, for which emergency interventions on the coronary arteries were performed. Over 60 of the patients underwent mechanical ventilation, approximately 150 central venous catheters were implanted, and extracorporeal membrane oxygenation was applied in 4 patients. Diagnoses that require emergency admission to the CCU are acute myocardial infarction, pulmonary edema, pulmonary embolism, acute heart failure, aortic dissection, paroxysmal rhythm and frequency disturbances, and infectious heart diseases. The Institute for Cardiovascular Diseases is the only institute in the University Hospital Dubrava at which the on-call physicians and nurses perform reanimation procedures without anesthesiological assistance. Nurses conducting treatment and care at the CCU are trained in reanimation procedures as well as in ECG analysis and recognizing signs of disorders and deviation from the norm in ECG results. The specifications for conducting treatment at the CCU include preparing patients for invasive processing (coronarography/emergency PCI, PCI CTO, transcatheter aortic valve implantation, implantation of cardiovascular devices, etc.). Duties also include care for patients after invasive processing or after resultant complications, care for transplant patients, patients with ECMO devices, and patients with left ventricular assist devices, care for patients with pacemakers, application of vasoactive drugs and high doses of anticoagulation or thrombolytic therapy, and assisting and caring for patients undergoing pericardiocentesis, thoracentesis, chest drains, central venous catheter implantation, and dialysis catheter implantation. The team of nurses and intensive cardiology specialists also cooperates with other specializations such are cardiothoracic surgery, vascular surgery specialists for patients with thromboembolism in order to apply alteplase, or the perfusion team for treatment with an ECMO device. Regarding cooperation with other hospital institutions, the Koprivnica General Hospital and Čakovec County Hospital deserve special mention since they form a ring together with University Hospital Dubrava which covers emergencies, i.e. patients with acute myocardial infarction or patients that require complex invasive processing made possible by the Laboratory for Heart Catheterization. ## Current status In November 2018, Dubrava hospital received a non-refundable grant from an EU project, which resulted in the opening of a new space for the Department for Intensive Cardiology Care in June 2019 which consisted of 1 room with 6 patient beds ( Figure 1 , Figure 2 ) and 2 more rooms with a single bed for negative pressure isolation ( Figure 3 ). The new spaces were equipped with high-quality equipment and medical devices in order to provide improved and more precise medical treatment. The acquisition of additional gear allows and facilitates treatment and care as well as the diagnosis of cardiological patients. The Department for Intensive Cardiology Care at the University Hospital Dubrava. Patient area. Single-bed isolation room. Nurses must also undergo a training program for the new medical equipment such as the Dräger wall-mounted supply units, the Infinity AcuteCare system – monitoring, the Infinity PICCO SmartPod, CNAP sensor, etCO2Microstream SmartPod, a ceiling patient lift – Guldmann, Evita 5 respirator, Oxylog 3000 plus, the Lifepak 20 defibrillator and new ultrasound device, Fresenius Kabi Aqila perfusion and infusion pumps, and the Dräger telemetry system for the Day Hospital. Treatment is performed by 2 cardiologists assisted by cardiology residents. Patient care is provided by the head nurse as well as 1 nurse with a bachelor’s degree in nursing and 16 nurses with nursing vocational school degrees. A new Laboratory for Electrophysiology equipped with a Philips angiography device is also being opened, as well as a new space for the Day Hospital of the Department for Cardiovascular Diseases. The existing hall for invasive processing and treatment is also being renovated and equipped. The CCU and Laboratory for Laboratory for Heart Catheterization will celebrate their 20 th founding anniversary soon after these new spaces are opened.

    Cardiologia Croatica
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    The Institute for Cardiovascular Diseases and the Department for Intensive Cardiology Care at the University Hospital Dubrava

    Other
    Issue11-12
    Published
    Pages289-292
    PDF via DOIhttps://doi.org/10.15836/ccar2019.289
    cardiovascular diseases
    intensive cardiology care
    intensive healthcare

    Authors

    Biljana Hržić*ORCIDUniversity Hospital Dubrava, Zagreb, Croatia
    Saška BojanićORCIDUniversity Hospital Dubrava, Zagreb, Croatia

    Abstract

    According to data from the World Health Organization, cardiovascular diseases are the leading cause of mortality and morbidity in the world. The Department for Intensive Cardiology Care at the University Hospital Dubrava was founded 20 years ago with the goal of providing intensive treatment and healthcare to cardiological patients in mortal danger. The Department for Intensive Cardiology Care has been renovated and expanded several times since its foundation with the goal of improving the healthcare provided to such patients. Their treatment and healthcare require a highly-educated professional team, high-quality medical devices, and precise organization of diagnostics and treatment.

    Full Text

    ## History The Department for Intensive Cardiology Care – the Coronary Care Unit (CCU) – was first founded in September 1999 with the goal of providing intensive treatment and performing intensive healthcare procedures in cardiologic patients. The CCU initially comprised five patient beds in 1 room and an additional bed in a separate isolation room. Intensive healthcare and treatment were facilitated by a central monitoring system for continuous electrocardiogram (ECG) monitoring, a portable respirator – Oxylog 100 (without a mechanical ventilation device), an ECG device, a generator for temporary pacemakers, etc. The treatment and healthcare team consisted of 1 cardiologist, a head nurse, 2 nursing graduates and 5 nurses with completed vocational nursing schools. Over the course of its existence, the CCU has been expanded and reorganized due to the growing need for medical care and treatment of cardiologic patients. In September 2003 the CCU was transferred to a new and larger location on the 1 st floor of the hospital next to the Laboratory for Heart Catheterization. At the time the CCU consisted of 1 room with 7 patient beds, and the Postcoronary Unit was opened next to it with 6 additional patient beds. An angiography procedure room for implantation of permanent pacemakers with a radiological device was also opened next to the Laboratory for Heart Catheterization. Healthcare and treatment have been improved by the acquisition of additional and higher-quality medical equipment including central monitoring and continuous ECG with audio-visual and text data, two EVITA 4 devices for mechanical ventilation, 1 transportable respirator – Oxylog 3000, 1 echocardiography device with a transesophageal probe, a portable pulse oximeter, infusion pumps, perfusion devices, fluid warmers, an i-Stat blood analyzer, CTNI blood analyzer, patient heater, aspirators, a defibrillator – Lifepak 15, telemetry devices (postcoronary), an extracorporeal membrane oxygenation (ECMO) device, and an intra-aortic balloon pump (angiography procedure room). Due to the need for more personnel, the treatment was conducted by 4 cardiologists assisted by a cardiology resident, a head nurse, a nurse with a bachelor’s degree in nursing, and 18 nurses with a vocational school degree. The Postcoronary Unit and the pacemaker implantation hall were shut down in 2014. At the time, the CCU comprised 1 room with 7 patient beds. Function and activity of the Department for Intensive Cardiology Care The Institute for Cardiovascular Diseases is organized as follows: Cardiology 1 – Department for Intensive Cardiology Care; Cardiology 2 – Department for Ischemic Heart Diseases and Pacemaker Implantation with a Laboratory for Invasive Diagnostics and Treatment; Cardiology 3 – Department for Vascular and Cardiac Valve Diseases; Cardiology 4 – Department for Cardiomyopathy, Heart Failure, and Transplantation Cardiology; Diagnostic Department for Echocardiography and Non-invasive Cardiological Diagnostics with a Day Hospital; Polyclinic. The Institute hospitalizes about 4100 patients annually, which includes performing over 1600 coronarographies, 870 interventions on coronary arteries, 45 percutaneous coronary interventions (PCIs) for chronic total occlusion (CTO), 18 rotablation procedures, and more than 300 permanent pacemaker implantations (of which 18 implantable cardioverter defibrillators and 8 resynchronization therapy devices). Noninvasive cardiological diagnostics performed annually include over 4300 24-hour ECG monitoring procedures, 3200 exercise stress test procedures, approximately 3145 echocardiography examinations, 13 074 clinical examinations, and approximately 2500 examinations and patients processing procedures at the Day Hospital. The Department for Intensive Cardiology Care treats about 950 patients annually. In 2018 it admitted 450 patients with a diagnosis of acute myocardial infarction, for which emergency interventions on the coronary arteries were performed. Over 60 of the patients underwent mechanical ventilation, approximately 150 central venous catheters were implanted, and extracorporeal membrane oxygenation was applied in 4 patients. Diagnoses that require emergency admission to the CCU are acute myocardial infarction, pulmonary edema, pulmonary embolism, acute heart failure, aortic dissection, paroxysmal rhythm and frequency disturbances, and infectious heart diseases. The Institute for Cardiovascular Diseases is the only institute in the University Hospital Dubrava at which the on-call physicians and nurses perform reanimation procedures without anesthesiological assistance. Nurses conducting treatment and care at the CCU are trained in reanimation procedures as well as in ECG analysis and recognizing signs of disorders and deviation from the norm in ECG results. The specifications for conducting treatment at the CCU include preparing patients for invasive processing (coronarography/emergency PCI, PCI CTO, transcatheter aortic valve implantation, implantation of cardiovascular devices, etc.). Duties also include care for patients after invasive processing or after resultant complications, care for transplant patients, patients with ECMO devices, and patients with left ventricular assist devices, care for patients with pacemakers, application of vasoactive drugs and high doses of anticoagulation or thrombolytic therapy, and assisting and caring for patients undergoing pericardiocentesis, thoracentesis, chest drains, central venous catheter implantation, and dialysis catheter implantation. The team of nurses and intensive cardiology specialists also cooperates with other specializations such are cardiothoracic surgery, vascular surgery specialists for patients with thromboembolism in order to apply alteplase, or the perfusion team for treatment with an ECMO device. Regarding cooperation with other hospital institutions, the Koprivnica General Hospital and Čakovec County Hospital deserve special mention since they form a ring together with University Hospital Dubrava which covers emergencies, i.e. patients with acute myocardial infarction or patients that require complex invasive processing made possible by the Laboratory for Heart Catheterization. ## Current status In November 2018, Dubrava hospital received a non-refundable grant from an EU project, which resulted in the opening of a new space for the Department for Intensive Cardiology Care in June 2019 which consisted of 1 room with 6 patient beds ( Figure 1 , Figure 2 ) and 2 more rooms with a single bed for negative pressure isolation ( Figure 3 ). The new spaces were equipped with high-quality equipment and medical devices in order to provide improved and more precise medical treatment. The acquisition of additional gear allows and facilitates treatment and care as well as the diagnosis of cardiological patients. The Department for Intensive Cardiology Care at the University Hospital Dubrava. Patient area. Single-bed isolation room. Nurses must also undergo a training program for the new medical equipment such as the Dräger wall-mounted supply units, the Infinity AcuteCare system – monitoring, the Infinity PICCO SmartPod, CNAP sensor, etCO2Microstream SmartPod, a ceiling patient lift – Guldmann, Evita 5 respirator, Oxylog 3000 plus, the Lifepak 20 defibrillator and new ultrasound device, Fresenius Kabi Aqila perfusion and infusion pumps, and the Dräger telemetry system for the Day Hospital. Treatment is performed by 2 cardiologists assisted by cardiology residents. Patient care is provided by the head nurse as well as 1 nurse with a bachelor’s degree in nursing and 16 nurses with nursing vocational school degrees. A new Laboratory for Electrophysiology equipped with a Philips angiography device is also being opened, as well as a new space for the Day Hospital of the Department for Cardiovascular Diseases. The existing hall for invasive processing and treatment is also being renovated and equipped. The CCU and Laboratory for Laboratory for Heart Catheterization will celebrate their 20 th founding anniversary soon after these new spaces are opened.