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The Stent

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This paper gives an in-depth analysis of the development of the stent and its contributions in the medical field. The discovery of the stent has been held as one of the major breakthroughs in the medical fraternity.  In an attempt to establish the history behind this invaluable medical discovery, the paper will Endeavour to examine the history of the stent in the order of chronology. In this respect, the paper will focus on the chronology of stents by body systems including vascular stents, and advance to urinary, biliary system among other systems.  It is clear that the discovery and subsequent development of the stent has been hailed in the medical fraternity as panacea to numerous fatal health complications. This paper, therefore, elucidates the impact of the stent on patient care and the accompanying setbacks.

Introduction

A stent is defined as a narrow tube inserted in veins to treat malfunctioning arteries. Arteries are blood vessels that carry blood away from the heart. A stent is usually inserted in an artery via a process called angioplasty. The purpose of a stent in the body is to facilitated localized flow of fluids. In as much as, the discovery of the stent has brought massive achievement in the medical sector, experts still do not know where the term stent originated from. However, most dictionaries concur that the word stent originated from the word stenting, whose meaning was to stretch in Middle English. It is worth noting that because of its vast importance in various medical fields, a stent has earned many names. Stents are widely used in numerous medical fields including dentistry. Experts allege that the stent was initially used in dentistry. Dentists used the stent to make dental impressions. Currently, stents are made of plastic or steel and are mostly inserted in arteries to prevent collapse of the veins (Laird, & Yeo, 2012)

During the early 20th century, stents were used in plastic surgery and dental replacements. The stent gained popularity because of a generalized mode of medical training. The curriculum insisted on the use of the stent to treat or replace most malfunctioning or disfigured parts.  It is synonymous in most surgical operations and almost every branch of medicine appreciates the value of the stent. The use of the stent grew from just dental and plastic surgery to complex functions like nasal and gynecology reconstruction. 

With increased use and demand, experts had to find ways of bolstering the production of the stent. A number of firms ventured in stent production business as a response to increased demand. However, a major breakthrough was realized in 1992 when a company called Spiroflo started manufacturing of bioabsorbable stents. This discovery made the stent more versatile and, thus gained significance in other medical procedures. Soon after, that great discovery, other techniques were adopted and further improved the efficiency of the stent (Dineen, Shore, Lumerman,  Saslawsky, & Corica, 2008).

The stent was first used in the facial reconstruction of First World War victims. Since soldiers on the battle front used trenches to target their enemies, most of them ended up with facial injuries because trenches exposed their faces during attacks. Many soldiers were facially disfigured in the course of the war. The number of wounded soldiers who needed facial reconstruction was overwhelming. Doctors experienced difficulties in treating these victims.  A Dutch physician assigned in Vienna discovered the use of plastic stents while treating soldiers. This marked the introduction of stents in the medical fraternity. At this stage, stents were mostly used to repair skin grafts in surgical repairs of war victims.

Since 1990s, the idea of stenting or insertion of artificial tubes in arteries gained popularity in the treatment of cardiovascular or endovascular diseases that result in the narrowing of blood vessels. Doctors found the stent to a suitable tool to treat heart related complications and many complications that resulted to vessel constriction. Since early 1990s, the use of the stent has gained popularity. As of now, there are numerous types of stents being used to treat numerous kinds of vessel complications ranging from ranging from heart, arteries, legs, brain, kidneys and lungs among other body organs.

Treatment of heart related complications using stents has proved to be a perfect solution to constricting vessels. Coronary artery stents are basically tubes placed coronary arteries that supply the heart with blood. Since stents are flexible, they have the potential to maintain pressure within the artery. Doctors concur that if properly inserted, stents have the ability to reduce heart failure by a significant proportion. Furthermore, doctors recommend the use of stents in other medical operations.

Another step that enhanced the use of stents in medical fields was the discovery of radioactive stent. Doctors hailed this discovery because of a number of reasons. The first one was that radioactive stent have the ability to prevent recurrent blockage if applied appropriately via the process of angioplasty process. The discovery of radioactive stents made it possible for doctors to use advanced technologies in artery treatment. This is particularly possible because radioactive stents can be detected through radioactive processes. With radioactive stents, doctors could now carry out stent insertion accurately. Future examination was also enhanced because doctors could easily scan the patient to see how the stent was performing. It must be understood that stents in arteries are used to replace constricting veins. When veins constrict pressure is exerted on heart muscles, which later results chest pain. Continued narrowing of the veins can result to blood clot which causes heart attack. Stent are suitable alternatives for narrowing muscles because they do not constrict and are flexible at the same time.  It must be noted that there are legal challenges in organ transplant treatment. The use of stents has helped easy the disadvantages perpetuated by the organ transplant policies (Dineen, Shore, Lumerman,  Saslawsky, & Corica, 2008).

Cadaveric organ procurement policies are contained in the national organ transplant act of 1984. This act makes it a felony for any individual to trade in body organs for whatever reasons. There are other state provisions that back the provision to strengthen it and seal any loopholes related organ trade. The act, therefore, favors an organ procurement regime based on altruism. The authors argue that this system is bound to fail due to increased countrywide demand for transplantable organs. It is against this backdrop that the author proposes two alternative policies to challenge the economic and theoretic underpinnings of altruism. Firstly, the author advocates for a market system where market forces regulate demand and supply. Secondly, the article roots for a system that shifts property rights in cadaveric organs from donors to recipients. This article critically analyses the author’s main arguments and gives a comprehensive review of the proposed policies in ethical and economic terms

The use of stents has been applied to aid treatment of various parts of the body in order to facilitate the effectiveness of body functioning. Despite its varied use, stent has mostly been associated with treatment of coronary related dysfunctions. Thus, the most commonly known use of stent is in the coronary arteries, which is a type of the mostly applied cardiac treatment stents. In the process of implanting a coronary or any cardiac stent into the heart or in the artery, a bare metal stent, a drug eluting stent or just a covered stent is occasionally inserted into the artery. The procedure of placing coronary stents usually takes place during the process of angioplasty, a procedure that is also known as the percutaneous coronary intervention. Another common use of stent is in the correction of ureter problems mostly involving urethral related issues such as the kidney stones to ensure their patency commonly known as the ureteral stents (McLean, 2009)

The procedure of ureteral stenting is occasionally used as a short term process of preventing damages that are caused by blocked kidneys until the actual procedure of removing the stones or any other thing causing the blockage is carried out. The urethral stent commonly known as the prostatic stent can sometimes be used to aid urination in men if the person has troubles urinating, a situation which is as a result of the prostate enlarging thus pushing itself against the urethra, a condition that leads to blockage of the urethra hindering the passage of urine. In correction of this situation, stents can be placed either temporarily by the urologist in a similar manner as the one for placing a Foley catheter using lodocaine jelly as the anesthesia, or they can be permanently placed where the procedure requires outpatient process by use of spinal anesthesia.

Prostatic or the sphincter stents are also another type of stents which can be used to aid in the draining of the bladder in the patients who are having urethral obstruction or damaged nerves that control the bladder mostly caused by an accident or general illness. Esophageal stents are also a common use of stents where the stents are inserted in the esophagus to aid in the passage of soft food and other swallowing process. The stents have been helpful to the cancer patients who have problems swallowing food in the normal way. Biliary stents are other types of stents used mainly for the correction of the bile drainage and it is usually placed in the bile duct (Feldman, 2002). According to his book, Feldman states that a stent in this case is placed in the duct by use of either endoscopic retrograde cholangiopancreatography (ERCP)1 or percutaneous transhepanic cholangiography (PTC)2 methods (procedures used in correction of pancreas or the flow of bile from the pancreas to the gall bladder respectively

Besides their use in coronary arteries, stents can also be used in the aorta to repair aorta related problems mostly a problem known as the abdominal aortic aneurysm through a procedure known as an EVAR . In this type of procedure, a stent is placed in the aorta and it acts as a false lumen which aids the flow of blood instead of the blood flowing through into the aneurysm sack. Stent graft is the known type of stent primarily used in this process which involves the endovascular surgery, used for vascular interventions. The stent graft is placed in the fistulas and grafts that are used for dialysis where it is used to create an open lumen thus preventing the reverse flow of blood or the blood flowing around it.

Other commonly known types of stents are the pancreatic stents used for correcting pancreas related problems, the duodenal stents and colonic stents whose activities and their names are derived from the location where the stent is placed. Recently, there has been an operation of fixing stents into the brain also known as brain stents whose main idea is to reduce the increased chances of stroke. The brain stent is operated in the same way as the coronary stents A chronology refers to the description of something through its origin and the process of its development. Various types of stents have a process which led them to come into existence as well as a different scope of development that have made their use to be practical and effective in the correction of body problems of the patients. Coronary stents which are the most common types of stents in the treatment of heart related problems including the blood flow into the heart as well as to ease chest pains was initially developed by John Robert Dugan where the first type of the stent was made of a bare metal.

This has initially been replaced by the recent drug eluting stents and also there is an ongoing development of stents that have biocompatible surface coating and also the absorbable stents that are either metallic or made of polymer and as such, the latter do not elute drugs. Abdomen aortic Aneurysm was first performed by Nicholas Volodos in Kharkov, Soviet Union in 1987 and its first introduction in the medicine articles was done in 1988. Its subsequent performance was introduced in Argentina for the first time in 1991 by Juan Parodi and also in the United States of America where the operation was first performed in the same year by Michael Dake. Before the patients are approved to undergo a through checking and analysis of the parts that the stent need to be inserted, mostly the vascular arteries. This is conducted to indicate the sensitivity of the patient to the metal used in making the stent as well as come up with previous medical history that might hinder the effectiveness of the stent in the body such as allergies, previous occurrence of a stroke, diabetes and other heart related problems (Dineen, Shore, Lumerman,  Saslawsky, & Corica, 2008)

One of the major challenges concerning the vascular stents is that they are likely to have a potentiality of restenosis through the development of an abnormal thick smooth tissue also known as the neointima which develops inside the lumen. The neointima development can in turn re-occlude the lumen vessel, a condition known as the restenosis, although sometimes this development is variable and less fatal.

According to a recent research conducted on the sidelines of the vascular stents, it shows that a considerable effort has been made to counter and reduce the development of neointima after the stent has been placed in the lumen. This is as a result of use of materials that are more biocompatible with the system as well as the anti-inflammatory drug eluting stents and the reabsorbable stents that have reduced the corrosive effects of open metal stents.

Despite, the successful invention and application of the stents in the field of medicine, this success has not been without set backs. Various drawbacks on the health of those who have been operated and their systems are operating with the help of a stent. Most stents, both made with coated or a bare metal or the drug eluting which are drug coated stents are all internally made with a metal or a metal alloy which are either the stainless steel or an alloy of cobalt  and chromium metals.

In the overall make despite these alloys, all stents are made with nickel metal which most people have reported to have an allergy of. Thus the presence of nickel in the stent whether small or large amount pose a problem of creating a reaction in the body though the extent of the reaction has not been clearly studied and analyzed.

Among the drawbacks reported in application of the coronary stents includes the fact that the opening that is created by during the stenting procedure is usually not very smooth. This is because the balloon might not expand evenly all the areas since they have varied degree of hardness or in other terms as a result of atheroma and plaques refusing to work together since the latter is hard while the initial is soft thus creating uneven degree of hardness.

Therefore, as a result of this situation, there is a development of irregular surface in the inner lining of arteries which might even result to cracks which in turn is likely to result in an increased chance of blockage of the arteries in a limited number of patients. Secondly, as a result of coronary angioplasty, some of the material that is compressed into the system may result in a process known as ‘recoil’ or in other words they may spring back (Egan, McCullough, Murray S, et al. 2003).

This condition causes the arteries to reduce in size and become smaller than their normal size immediately after they are expanded by the balloon expansion. The cardiac placement stent has been reported to cause chest pains and discomforts in some patients. The implant can also limit the patients from physical activities as well as cause problems in physical movement of the individual. The placement is also likely to increase the rates of heart attacks. This is because the placement of the stent in the heart can cause irritation of the heart muscles causing them to irregularly function or even stop functioning at all.

Other cardiac stent effects are the clotting of blood2 and other capillary blockages and damage. The clotting and blockage can in turn reduce blood flow into the vital body organs resulting to heart attacks or stroke. The immediate expansion has been reported to cause the material inside to expand and multiply in size thus resulting to a higher chance of causing blockage in the channels. The occurrences have been resulted to occur between a duration ranging from six weeks and six months and the disorder is known as restenosis (Laird, & Yeo, 2012). The brain stents which are used in individuals with high risks of suffering from stroke and open up blocked arteries in the brain has been reported to have an opposite result after the operation. This is because the fixing of stent in the brain has been reported to increase the rate of stroke and consequent death as compared to when it is not fixed. According to a report submitted by the NEJM (New England Journal of medicine), it indicates that after the completion of the operation, patients with stents had a higher chance (twice the rate) of developing stroke than the same patients without the stent fixed in their brains.

Kidney stents or the ureter stents are supposed to connect the bladder with the ureter so as to aid the passage of urine from the kidneys. However the stent is not placed there in a permanent basis as the urologist removes it after sometimes mostly after the obstruction has been repaired either by the removal of the blockage in the ureter. Some of the side effects that have been reported to occur to patients with the ureter stent is the obvious allergy associated with the material used for making the stent. Other side effects include an increased urge of the patient to urinate, and sometimes there have been reported traces of blood in the urine of such patients (Laird, & Yeo, 2012).

Placing of the stent in the ureter might also facilitate bleeding in the kidneys as well as a small amount of bleeding in the bladder. Sometimes the bleeding can even be extremely high thus requiring an operation to correct the fault. This is as a result of the irritation of these organs caused by the placement of a new material although the reaction has been reported to subside after a short period of time.

Kidney stents have also been reported to sometimes migrate from the original position where it was implanted sometimes coiling in the kidney or in the bladder, or it might even cause puncturing on the walls of either of these organs. The biliary stenting is also another type of stent that have been described to have similar complications and side effects just as similar as those associated with kidney stents including migration of the stent, bleeding and irritations. Thus. as a result of all the complication associated with stenting, a research has shown that o normal operation to remove those materials that causes blockages in different organs of the body system could reduce these complications can be used as a major alternatives to stents.

The discovery of the stent has numerous advantages. To start with, stent have reduced the huge problem of access to organ transplant medication. Organ transplant is a huge challenge in most countries.  It is incumbent upon physicians to try and safe the patents life. Furthermore, it is the prerogative of any responsible physician to hold their patient’s interests paramount and promote access to the required medical intervention including organ transplant. However, the current system based on altruism makes it difficult for patients to receive the best medical attention as required by the law. The altruistic organ donation system presupposes that a person should willfully give out his or her organ without demanding anything. The codified de facto system of organ donation requires that organ acquisition takes place at zero value. There is no any form of compensation or restitution advanced to families of organ suppliers (Laird, & Yeo, 2012).

The number of people in need of organs has continued to rise every year. Available data estimates that this statistics are bound to raise and reach catastrophic levels in the foreseeable future. As if that is not enough, experts assert that the number of patients waiting for organ transplant is much higher than the number of people willing to donate organs. Based on this scenario, the other suggested other means that would increase the number of organs donated. Among the ways suggested include proposal of a market system that would be regulated by wiling buyer willing seller forces.

The medical fraternity needs to prioritize research and come up with other medical options to avert the increasing need for organ transplant. Boosting the number of organs donated alone can not solve the problem. Alternative measures like the use of stents have the potential to significantly reduce the number of patients in need of organ transplant. In my view, instead, of prioritizing measures to harness organ donation, efforts should be directed to alternative cures. Diverse measures should directed at finding the solution to organ failure, and how about preventive measures? Does it mean that there are no means to avert organ failure among human beings? Researchers must invest in the means to reduce organ failure humans. This will reduce the number of patients in need of organ transplant and thus reduce the number of cadaveric organs significantly (Flaherty, Fulmer, & Mezey, 2003).

The most common cardiovascular disease is cardiac failure, which is responsible, for the largest number of severe admissions in hospitals. Of those hospitalized with heart failure, 78% are over 65 years, and 50% of them are over 75 years of age. According to Carryer (2002), the number of these cases is on the rise not only because of cardiovascular disability, but also because of the adverse lifestyles and the aging process. Cardiovascular diseases are the most common cause of mortality and morbidity for those over 65 years. The other causes of cardiac failure are heart diseases and hypertension. Most research studies on cardiovascular ailments do not focus on the elderly. As a result, there is limited data concerning elderly people in this field. According to (Barasha,  2010) lack of comprehensive information about cardiovascular geriatrics among the elderly has forced medical persons to extrapolate data to fit patients who are over 65 years or treat them on the basis of their symptoms. The risk of these diseases increases with age; therefore, secondary prevention is the most cost-effective method. The aim of treatment is to improve the quality of life, promoting a more active lifestyle hence avoiding the feeling of dependence. As the percentage of aging people increases, so does the demand for expert nurses competent enough to care for this group. Available records reveal that most registered nurses are clinical nurse specialists or nurse practitioners if not both, but few actually are certified and specialize in geriatrics.

There exists Clinical Practice Guidelines, which are the blueprints for the provision of health promotion and disease prevention services, important to both nurse practitioners and clinical nurse specialists. Core competencies in clinical nursing have been documented and integrated into the nursing curriculum. (Laird, & Yeo, 2012) states that competency is the performance level expected that encompasses skills, sound judgment, learnt skills and acquired knowledge together with one’s abilities. They are universal regardless of the area of specialization. They ensure that all care providers are competent to care for individuals that need stenting, even if they are not specialists in stent technology and or gerontology, which is the social study of the aging process. To come up with a competency plan, it is vital to establish it relevance- if it is a necessary skill and if it has been stated clearly with no ambiguity, as well. This is necessary in identifying practitioner’s practice scope. Competent practices ensure that a patient receives quality and safe professional care directly and indirectly (Flaherty, Fulmer, & Mezey, 2003).

Initially, there were 43 competencies and after validation, and evaluation by nursing bodies over the years, 25 of them remained that are in operation up to date. Few will be discussed here. First is the direct clinical practice. This involves direct contact and interaction with the patient or patients and their families. Direct practice should be differentiated from indirect care in that, in indirect care, care is provided through activities that influence the attention and medical care of patients with no direct immediate engagement with the patient. The CNS provides guidance on the appropriate treatment and care for patients. The strategy to address this is to provide comprehensive and family-centered services. Through these services, the patient can receive multiple services during a single clinic visit. The specialist should develop a healthy long-term relationship with the patient in order to strengthen his or her resourcefulness. This should further aim at advancing the communication process and enhancing clients access to direct services like, for example, counseling and teaching. Direct care is invaluable because it embodies the actual physical aspects of nursing care. It requires physical contact with the patient and the one on one interaction.  The specialist observes and evaluates the patient’s health status, provides direct care in administration of drugs, treatment and medication and helps develop positive behavior. It encompasses the aspect of professionalism and ethics in that dignity should be upheld and privacy maintained. This direct contact allows for the specialist to assess the spiritual and cultural outlook for an all-round assessment.

Conclusion

The discovery of the stent has always been hailed as a significant breakthrough in the medical fraternity. The concept of inserting tubular devices in veins continues to provide a solution to critical health complications. Its uses range from skin crafting to very complicated organ and vein replacement. Since its inception, the stent technology has continued to improve and spread to other medical fields. Currently, the stent is used to treat numerous health complications. Its versatility has been improved to make it suitable for artery replacement. Although, experts caution that use of the stent is limited and propose other solutions like stem cell research, the gains made in this respect can not be wished away. Advanced research and technology can improve the suitability of the stent. Experts argue that the use of the stent has saved millions of lives and caution that the use of the must be enhanced to make it more efficient. 

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