Objective:to determine the frequency of pain, to verify the measures adopted for pain relief
during the first seven days of hospitalization in the Neonatal Intensive Care Unit
and to identify the type and frequency of invasive procedures to which newborns
are submitted. Method:cross-sectional retrospective study. Out of the 188 hospitalizations occurred
during the 12-month period, 171 were included in the study. The data were
collected from the charts and the presence of pain was analyzed based on the
Neonatal Infant Pain Scale and on nursing notes suggestions of pain. For
statistical analysis, the Statistical Package for the Social Sciences was used,
and the significance level was set at 5%. Results:there was at least one record of pain in 50.3% of the hospitalizations, according
to the pain scale adopted or nursing note. The newborns underwent a mean of 6.6
invasive procedures per day. Only 32.5% of the pain records resulted in the
adoption of pharmacological or non-pharmacological intervention for pain relief.
Conclusion:newborns are frequently exposed to pain and the low frequency of pharmacological
or non-pharmacological interventions reinforces the undertreatment of this
condition.
Estudo transversal com coleta prospectiva de dados, que objetivouidentificar o posicionamento inicial da ponta do cateter central de inserção periférica (PICC) e verificar a prevalência de sucesso de sua inserção em neonatos. Os dados foram coletados no berçário anexo à maternidade do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, entre março e setembro de 2006. Dos 37 neonatos submetidos à inserção do cateter PICC, a taxa de sucesso no procedimento foi de 72,3% (27 neonatos); destes, quatro (14,8%) estavam com as pontas dos cateteres alojadas nas veias axilar ou inominada; outros três (11,1%), alojadas em veia jugular. Estes cateteres foram removidos por desvio de trajeto. 13 (48,2%) estavam com as pontas alojadas em átrio direito, cujos cateteres foram tracionados para reposicionamento da ponta para a veia cava superior.
This is a cross sectional study conducted with 67 newborns admitted at the neonatal intensive care unit of a private hospital in São Paulo, between July and December 2010, who underwent 84 Peripherally Inserted Central Catheter (PICC line) placement procedures. The aim was to describe the prevalence and reasons of non-elective removal of the catheter. Data was collected from medical records and institutional forms related to PICC placement. The mean of corrected gestational age of the neonates was 32.8 weeks, weight 1671.6 g and postnatal age 9.4 days. The non-elective removal was observed in 33 (39.3%) catheters, 18.1% due to occlusion, 9.5% rupture, 7.1% extremity edema, 6.0% suspected infection, 1.2% accidental dislodgement 1.2% poor extremity perfusion and 1.2% due to extravasation. The prevalence and the reasons of non-elective removal indicated that strategies to prevent avoidable complications related to PICC are necessary.
OBJECTIVE: to develop a risk score for unplanned removal of peripherally inserted central
catheter in newborns. METHOD: prospective cohort study conducted in a neonatal intensive care unit with newborn
babies who underwent 524 catheter insertions. The clinical characteristics of the
newborn, catheter insertion and intravenous therapy were tested as risk factors
for the unplanned removal of catheters using bivariate analysis. The risk score
was developed using logistic regression. Accuracy was internally validated based
on the area under the Receiver Operating Characteristic curve. RESULTS: the risk score was made up of the following risk factors: transient metabolic
disorders; previous insertion of catheter; use of a polyurethane double-lumen
catheter; infusion of multiple intravenous solutions through a single-lumen
catheter; and tip in a noncentral position. Newborns were classified into three
categories of risk of unplanned removal: low (0 to 3 points), moderate (4 to 8
points), and high (≥ 9 points). Accuracy was 0.76. CONCLUSION: the adoption of evidence-based preventative strategies based on the
classification and risk factors faced by the newborn is recommended to minimize
the occurrence of unplanned removals.
Objective: To identify the risk factors for bloodstream infection associated with peripherally inserted central catheters in neonates. Methods: A prospective cohort study conducted in the neonatal intensive care unit with newborns undergoing insertion of 401 peripherally inserted central catheters. Clinical characteristics of the newborn, catheter insertion technique, intravenous therapy and catheter dwell time were tested as risk factors for removal due to catheter associated bloodstream infection, using bivariate analysis and multivariate analysis with Poisson regression. Results: The data suggest that the lowest mean in weight and corrected gestational age, as well as the largest catheter dwell time time were associated with the occurrence of bloodstream infection associated with the catheters. The corrected gestational age, clinical diagnosis of transitional metabolic disorder or apnea, and the use of two-lumen catheters have been identified as risk factors. Conclusion: The lowest correct gestational age of the newborn, the clinical diagnosis of metabolic disorder or apnea, and the use of two-lumen catheters were identified as risk factors for bloodstream infection associated with peripherally inserted central catheters in neonates.
ResumoObjetivo: Identificar os fatores de risco para infecção de corrente sanguínea associada ao cateter central de inserção periférica em neonatos. Métodos: Estudo de coorte prospectivo conduzido em unidade de terapia intensiva com recém-nascidos submetidos à instalação de 401 cateteres centrais de inserção periférica. Características clínicas do neonato, técnica de inserção do cateter, terapia intravenosa e tempo de permanência do cateter foram testados como fatores de risco para remoção por infecção de corrente sanguínea associada ao cateter, por meio de análise bivariada e análise multivariada com regressão de Poisson. Resultados: Os dados sugerem que as menores médias de peso e idade gestacional corrigida, bem como o maior tempo de permanência do cateter estiveram associados à ocorrência de infecção de corrente sanguínea associada ao cateter. A menor idade gestacional corrigida, os diagnósticos clínicos de transtorno transitório do metabolismo e apneia, e o uso do cateter de duas vias foram identificados como fatores de risco. Conclusão: A menor idade gestacional corrigida do neonato, os diagnósticos clínicos de transtorno transitório do metabolismo e apneia, e o uso do cateter de duas vias foram identificados como fatores de risco para infecção de corrente sanguínea associada ao cateter central de inserção periférica em neonatos.
Results based on PIPP scores and crying time indicate poorer effects of EBM compared with 25% glucose during heel lancing. Additional studies exploring the vol and administration of EBM and its combination with other strategies such as skin-to-skin contact and sucking are necessary.
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