{"id":2142,"date":"2020-03-18T20:55:28","date_gmt":"2020-03-18T20:55:28","guid":{"rendered":"https:\/\/www.slovhep.sk\/verejnost\/clanok?uid=7bf9980121ba45ce9d75ced75c086389"},"modified":"2026-07-20T22:35:41","modified_gmt":"2026-07-20T20:35:41","slug":"odborne-7bf9980121ba45ce9d75ced75c086389","status":"publish","type":"post","link":"https:\/\/slovhep.sk\/en\/odborne-7bf9980121ba45ce9d75ced75c086389","title":{"rendered":"Usmernenie pre poskytovanie hepatologickej  starostlivosti v s\u00favislosti s epid\u00e9miou COVID-19"},"content":{"rendered":"<p>&nbsp;<\/p>\n<p><strong>Ofici&aacute;lne Stanovisko Slovenskej Hepatologickej spolo\u010dnosti&nbsp; a&nbsp;pracovnej skupiny pre transplant&aacute;cie pe\u010dene<\/strong><\/p>\n<p>&nbsp;<\/p>\n<p>Na z&aacute;klade&nbsp; s&uacute;\u010dasne dostupn&yacute;ch epidemiologick&yacute;ch &uacute;dajov o &scaron;&iacute;ren&iacute;&nbsp; koronav&iacute;rusu COVID-19 aj cestou asymptomatick&yacute;ch jedincov, s potvrdenou cestou prenosu kvap&ocirc;\u010dkovou infekciou, stolicou ako i mo\u010dom, odpor&uacute;\u010dame pozastavi\u0165 d\u0148om 16.3.2020 pl&aacute;novan&eacute; ambulantn&eacute; hepatologick&eacute; vy&scaron;etrenia ako aj vy&scaron;etrenia na transplanta\u010dn&yacute;ch hepatologick&yacute;ch ambulanci&aacute;ch.&nbsp; S&uacute;vis&iacute; to s vysok&yacute;m rizikom prenosu n&aacute;kazy na zdravotn&iacute;cky person&aacute;l ako aj na in&yacute;ch pacientov.<\/p>\n<h2>Ak&uacute;tne vy&scaron;etrenia<\/h2>\n<ul>\n<li>Na hepatologick&yacute;ch ambulanci&aacute;ch odpor&uacute;\u010dame vykon&aacute;va\u0165 len vy&scaron;etrenia ak&uacute;tne zhor&scaron;en&yacute;ch pacientov. Odpor&uacute;\u010dame informova\u0165 v&scaron;etk&yacute;ch ostatn&yacute;ch &bdquo;neak&uacute;tnych&ldquo; pacientov o zru&scaron;en&iacute; pl&aacute;novan&yacute;ch vy&scaron;etren&iacute; dodan&yacute;m telefonick&yacute;m kontaktom alebo priamo na ambulancii, pokia\u013e nie je kontakt k&nbsp;dispoz&iacute;cii. Priamy kontakt pacientov so sestrami na ambulanci&aacute;ch odpor&uacute;\u010dame obmedzova\u0165 na minimum.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li>U&nbsp;pacientov s nejasn&yacute;mi a mal&iacute;gnymi lo\u017eiskov&yacute;mi l&eacute;ziami &ndash; hepatocelul&aacute;rny karcin&oacute;m odpor&uacute;\u010dame pokra\u010dova\u0165 v diagnostick&yacute;ch postupoch, s prihliadnut&iacute;m na nevyhnutne zmenen&yacute; prev&aacute;dzkov&yacute; re\u017eim poskytovate\u013eov a&nbsp;rizikov&yacute; stupe\u0148 samotn&eacute;ho pacienta (pozri ni\u017e&scaron;ie). Rovnako odpor&uacute;\u010dame pokra\u010dova\u0165 aj v&nbsp;pl&aacute;novan&yacute;ch v&yacute;konoch z&nbsp;onkologickej indik&aacute;cie &#8211; TACE, \u010di RFA a chirurgick&eacute; v&yacute;kony. Skuto\u010dn&yacute; rozsah poskytovan&yacute;ch v&yacute;konov stanovia jednotliv&eacute; zdravotn&iacute;cke zariadenia individu&aacute;lne.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li>Poskytovanie urgentnej a&nbsp;elekt&iacute;vnej endoskopickej starostlivosti sa riadi pokynmi SGS &#8211; <a href=\"https:\/\/www.sgssls.sk\/clanok\/2020-03-16-oficialne-stanovisko-slovenskej-gastroenterologickej-spolocnosti\"><strong>https:\/\/www.sgssls.sk\/clanok\/2020-03-16-oficialne-stanovisko-slovenskej-gastroenterologickej-spolocnosti<\/strong><\/a><\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li>U&nbsp;pacientov s&nbsp;potrebou paracent&eacute;zy odpor&uacute;\u010dame overi\u0165 mo\u017enos\u0165 realiz&aacute;cie punkcie ascitu ambulantne &ndash; pod\u013ea mo\u017enost&iacute; konkr&eacute;tneho zdravotn&iacute;ckeho zariadenia. Odpor&uacute;\u010dame paracent&eacute;zy vykon&aacute;va\u0165 3x t&yacute;\u017edenne, v pr&iacute;pade, \u017ee sa jedn&aacute; o tenzn&yacute; ascites v priestoroch na to ur\u010den&yacute;ch. Pred v&yacute;konom rovnako odpor&uacute;\u010dame zhodnoti\u0165 riziko COVID-19 infekcie a&nbsp;na z&aacute;klade toho pou\u017ei\u0165 adekv&aacute;tne OOP. Pacient pr&iacute;de na ambulantn&uacute; paracent&eacute;zu s ochrannou r&uacute;&scaron;kou, s ochrann&yacute;mi rukavicami, ktor&eacute; si nebude sklada\u0165 po\u010das cel&eacute;ho v&yacute;konu.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li>U&nbsp;pacientov vo <strong>virostatickej lie\u010dbe (Viread, Zeffix, Baraclude) odpor&uacute;\u010dame pokra\u010dova\u0165 v&nbsp;preskripcii <\/strong>v pr&iacute;pade platnej schv&aacute;lenej \u017eiadosti elektronicky (eRecept). V pr&iacute;pade skon\u010denia platnosti v&yacute;nimky je potrebn&eacute; realizova\u0165 odber krvi bu\u010f cestou obvodn&eacute;ho lek&aacute;ra &#8211; Krvn&yacute; obraz, bioch&eacute;mia &#8211; bilirub&iacute;n celkov&yacute;, konjugovan&yacute;, album&iacute;n, AST, ALT, ALP, GGT, celkov&eacute; bielkoviny, Na,K, urea, kreatin&iacute;n, INR, PT, aPTT alebo pr&iacute;padne indikuj&uacute;cej ambulancie. Ak to umo\u017e\u0148uje klinick&yacute; stav m&ocirc;\u017ee by\u0165 \u017eiados\u0165 po doru\u010den&iacute; v&yacute;sledkov odoslan&aacute; do pois\u0165ovne bez nutnosti fyzick&eacute;ho vy&scaron;etrenia pacienta<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>Pacienti s kompenzovanou cirh&oacute;zou pe\u010dene maj&uacute; stredn&eacute; riziko \u0165a\u017ek&eacute;ho priebehu ochorenia, pacienti s dekompenzovanou cirh&oacute;zou pe\u010dene maj&uacute; vysok&eacute; riziko \u0165a\u017ek&eacute;ho priebehu ochorenia.<\/p>\n<p>&nbsp;<\/p>\n<h2>Zhodnotenie rizika<\/h2>\n<p>Pred vy&scaron;etren&iacute;m pacienta je nutn&eacute; zhodnoti\u0165 riziko pr&iacute;tomnosti COVID-19 ochorenia nasledovnou anamn&eacute;zou:<\/p>\n<p>a.) M&aacute;te\/mali ste v&nbsp;posledn&yacute;ch 14 d\u0148och pr&iacute;znaky infekcie d&yacute;chac&iacute;ch ciest? (telesn&aacute; teplota vy&scaron;&scaron;ia ako 37,5 st. C, ka&scaron;e\u013e, boles\u0165 hrdla, \u0165a\u017ekosti s d&yacute;chan&iacute;m<\/p>\n<p>b.) mali ste vy, alebo V&aacute;&scaron; rodinn&yacute; pr&iacute;slu&scaron;n&iacute;k v posledn&yacute;ch 14 d\u0148och kontakt s pacientom pozit&iacute;vne testovan&yacute;m&nbsp; na COVID-19<\/p>\n<p>c.) boli ste vy, ale niekto z&nbsp;Va&scaron;ich bl&iacute;zkych za posledn&yacute;ch 14 dn&iacute; v krajine s vysok&yacute;m v&yacute;skytom n&aacute;kazy, \u010di v&nbsp;akejko\u013evek cudzej krajine? V&nbsp;s&uacute;\u010dasnej dobe sa d&aacute; ka\u017ed&aacute; krajina pova\u017eova\u0165 za vysokorizikov&uacute;.<\/p>\n<p>&nbsp;<\/p>\n<p>Pod\u013ea dostupn&yacute;ch odpoved&iacute; rozde\u013eujeme pacientov na<\/p>\n<ul>\n<li><strong>N&Iacute;ZKORIZIKOV&Yacute;CH<\/strong> &#8211;&nbsp; v&scaron;etky tri odpovede negat&iacute;vne<\/li>\n<li><strong>STREDNE RIZIKOV&Yacute;CH<\/strong> &#8211; pacienti so sympt&oacute;mami, ale bez kontaktu s pozit. osobami a bez pobytu v cudzine<\/li>\n<li>pacienti bez sympt&oacute;mov, ale s anamn&eacute;zou kontaktu alebo pobytu v cudzine<\/li>\n<li><strong>VYSOKORIZIKOV&Yacute;CH <\/strong>&#8211;&nbsp; najmenej jeden zo sympt&oacute;mov a bu\u010f kontakt s pozit. osobou alebo pobyt v&nbsp; cudzine<\/li>\n<li><strong>: ak nedok&aacute;\u017eem odobra\u0165 anamn&eacute;zu, pova\u017eujem tak&eacute;ho pacienta za vysokorizikov&eacute;ho!<\/strong><\/li>\n<li>Po zaraden&iacute; pacienta do jednotliv&yacute;ch skup&iacute;n mu bude poskytnut&aacute; starostlivos\u0165, \u010di u\u017e ambulantn&aacute;, alebo hospitaliza\u010dn&aacute; (na &scaron;tandardnom oddelen&iacute;, alebo oddelen&iacute; pre rizikov&yacute;ch pacientov)<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h2>Priebeh vy&scaron;etrenia<\/h2>\n<h5>Ka\u017ed&yacute; pacient bude ma\u0165 zmeran&uacute; teplotu pred vy&scaron;etren&iacute;m.<\/h5>\n<ol>\n<li>Po\u010das odoberan&iacute; anamn&eacute;zy, pou\u010den&iacute; pacienta,&nbsp; sa bude o&scaron;etruj&uacute;ci person&aacute;l sna\u017ei\u0165 dodr\u017eiava\u0165 bezpe\u010dn&uacute; vzdialenos\u0165 od pacienta t.j. 1 meter&nbsp; a v ide&aacute;lnom pr&iacute;pade 2 metre&nbsp;<\/li>\n<li>Vo vy&scaron;etrovac&iacute;ch miestnostiach je pr&iacute;sne zak&aacute;zan&aacute; konzum&aacute;cia n&aacute;pojov a&nbsp;jed&aacute;l<\/li>\n<li>Ochrann&eacute; pom&ocirc;cky s&uacute;: respir&aacute;tor N95\/FFP2\/FFP3, rukavice<\/li>\n<\/ol>\n<ul>\n<li>v&nbsp;pr&iacute;pade potreby pokr&yacute;vka hlavy, ochrann&eacute; okuliare alebo &scaron;t&iacute;t, ochrann&yacute; chirurgick&yacute; pl&aacute;&scaron;\u0165<\/li>\n<li>u n&iacute;zkorizikov&yacute;ch pacientov mo\u017en&eacute; pou\u017ei\u0165 aj chirurgick&eacute; r&uacute;&scaron;ka<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h2>Pou\u017eitie ochrann&yacute;ch pom&ocirc;cok<\/h2>\n<p><strong>1) v&scaron;etk&yacute;m pracovn&iacute;kom hepatologick&yacute;ch ambulanci&iacute; odpor&uacute;\u010dame ma\u0165 na tv&aacute;ri r&uacute;&scaron;ka po\u010das celej pracovnej doby a respir&aacute;tory po\u010das kontaktu s pacientami.<\/strong><\/p>\n<p><strong>2) pou\u017eitie ochrann&yacute;ch pom&ocirc;cok z&aacute;vis&iacute; od stratifik&aacute;cie pacienta<\/strong><\/p>\n<p style=\"padding-left: 30px;\"><strong>N&Iacute;ZKORIZIKOV&Yacute; <\/strong><\/p>\n<p style=\"padding-left: 60px;\">respir&aacute;tor FFP3\/FFP3, ak tento nie je dostupn&yacute; mo\u017eno zv&aacute;\u017ei\u0165 r&uacute;&scaron;ka,&nbsp; ochrann&eacute; okuliare,&nbsp; chirurgick&yacute; pl&aacute;&scaron;\u0165, rukavice<\/p>\n<p style=\"padding-left: 30px;\"><strong>STREDNE RIZIKOV&Yacute;, VYSOKORIZIKOV&Yacute;<\/strong><\/p>\n<p style=\"padding-left: 60px;\">pokr&yacute;vka hlavy, respir&aacute;tor N95 alebo FFP2-3, ochrann&eacute; okuliare alebo &scaron;t&iacute;t, vodeodoln&yacute; chirurgick&yacute; pl&aacute;&scaron;\u0165,&nbsp; 2 p&aacute;ry rukav&iacute;c (spodn&eacute; a druh&eacute; vrchn&eacute; &ndash; na prekrytie cez z&aacute;p&auml;stia a\u017e na pl&aacute;&scaron;\u0165), po\u0165a\u017ene cel&yacute; ochrann&yacute; odev<\/p>\n<p><strong>&nbsp;3)&nbsp;pred ka\u017ed&yacute;m nasadzovan&iacute;m osobn&yacute;ch ochrann&yacute;ch pom&ocirc;cok dezinfikova\u0165 ruky &ndash; ide&aacute;lne alkoholov&yacute;m roztokom<\/strong><\/p>\n<p>&nbsp;<\/p>\n<p><strong>OBLIEKANIE OOP: <\/strong>najprv pokr&yacute;vka hlavy,&nbsp; n&aacute;sledne pl&aacute;&scaron;\u0165, potom maska,&nbsp; \u010falej okuliare a nakoniec rukavice<\/p>\n<p><strong>VYZLIEKANIE OOP: <\/strong>najprv zlo\u017e&iacute;me rukavice,&nbsp; potom pl&aacute;&scaron;\u0165, \u010falej okuliare, n&aacute;sledne r&uacute;&scaron;ku a nakoniec pokr&yacute;vku vlasov po vyzle\u010den&iacute; ochrann&yacute;ch pom&ocirc;cok op&auml;\u0165 dezinfikujeme ruky<\/p>\n<p>V&scaron;etky pou\u017eite ochrann&eacute; pom&ocirc;cky (okrem okuliarov) by mali by\u0165 zlikvidovan&eacute;<\/p>\n<p><strong>Obrazov&uacute; pr&iacute;lohu ako odieva\u0165 a vyzlieka\u0165 ochrann&eacute; pom&ocirc;cky m&ocirc;\u017eete n&aacute;js\u0165 na:&nbsp; <\/strong><\/p>\n<p><strong>&nbsp;https:\/\/www.cdc.gov\/hai\/pdfs\/ppe\/ppe-sequence.pdf&nbsp; <\/strong><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>V&aacute;\u017een&iacute; \u010dlenovia SHS,<\/p>\n<p>v s&uacute;vislosti s bezprecedentnou situ&aacute;ciou, kedy je Slovensk&eacute; zdravotn&iacute;ctvo vystaven&eacute; epid&eacute;mii COVID-19 prin&aacute;&scaron;ame s&uacute;hrn organiza\u010dn&yacute;ch odpor&uacute;\u010dan&iacute; pre poskytovanie zdravotnej starostlivosti pacientom s ochoreniami pe\u010dene s \u010dase obmedzen&iacute; s&uacute;visiacimi s epid&eacute;miou. Tieto odpor&uacute;\u010dania sa t&yacute;kaj&uacute; prim&aacute;rne pacientov bez ochorenia COVID-19, av&scaron;ak s&uacute; zasiahnut&iacute; obmedzen&iacute;m \u010di zru&scaron;en&iacute;m elekt&iacute;vnej zdravotnej starostlivosti.<\/p>\n<p>Tieto usmernenia s&uacute; ofici&aacute;lnym stanoviskom Slovenskej hepatologickej spolo\u010dnosti.<\/p>\n","protected":false},"author":2,"featured_media":2325,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","inline_featured_image":false,"footnotes":""},"categories":[78,5],"tags":[23],"class_list":["post-2142","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-guidelines","category-pre-clenov","tag-covid-19"],"_links":{"self":[{"href":"https:\/\/slovhep.sk\/en\/wp-json\/wp\/v2\/posts\/2142","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/slovhep.sk\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/slovhep.sk\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/slovhep.sk\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/slovhep.sk\/en\/wp-json\/wp\/v2\/comments?post=2142"}],"version-history":[{"count":1,"href":"https:\/\/slovhep.sk\/en\/wp-json\/wp\/v2\/posts\/2142\/revisions"}],"predecessor-version":[{"id":3395,"href":"https:\/\/slovhep.sk\/en\/wp-json\/wp\/v2\/posts\/2142\/revisions\/3395"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/slovhep.sk\/en\/wp-json\/wp\/v2\/media\/2325"}],"wp:attachment":[{"href":"https:\/\/slovhep.sk\/en\/wp-json\/wp\/v2\/media?parent=2142"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/slovhep.sk\/en\/wp-json\/wp\/v2\/categories?post=2142"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/slovhep.sk\/en\/wp-json\/wp\/v2\/tags?post=2142"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}