We present two cases of misplaced central venous catheters having in common the absence of free blood return from one lumen immediately after placement. The former is a case of right hydrothorax associated with central venous catheterization with the catheter tip in intra-pleural location. In this case the distal port was never patent. In the latter case there was an increased aspiration pressure through the middle port due to a catheter looping. The absence of free flow on aspiration from one lumen of a central catheter should not be undervalued. In these circumstances the catheter should not be used and needs to be removed.
Porphyria cutanea tarda (PCT) can occur in HIV patients. Current evidence suggests that HIV infection may interfere with the hepatic cytochrome oxidase system, leading to porphyrin metabolism impairment. Moreover, chronic hemodialysis in renal failure may be a risk factor for PCT. In addition to the contributory factors for PCT associated to HIV infection, it is possible that porphyrin accumulation secondary to renal failure may play a role in the expression of this disease. We report a case of PCT in an HIV-1 infected patient under blood dialysis, refractory to antimalarials and controlled with desferrioxamine.
ResumoEnquadramento: A presença de familiares no serviço de urgência é uma realidade. Em algumas situações como as de emergência a presença de familiares é algo controverso para os enfermeiros. Objetivos: Conhecer a opinião dos enfermeiros sobre a presença de familiares em situações de emergência no serviço de urgência de adultos. Metodologia: Estudo exploratório descritivo, recorrendo-se à aplicação de um questionário numa amostragem por conveniência. A amostra foi constituída por 233 enfermeiros dos 4 serviços de urgência polivalentes da região de Lisboa e Vale do Tejo. Resultados: Verifica-se que a maioria dos enfermeiros não concorda com a presença de familiares em contextos de emergência. Destacam-se como vantagens, o fornecimento de informação clínica à equipa e o apoio ao doente, e como desvantagens, a ansiedade dos familiares e o aumento do stresse nos profissionais. Conclusão: Os enfermeiros têm uma opinião desfavorável à presença da família em situações de emergência. Seria importante refletir sobre a prática clínica na sala de reanimação considerando-se o F de família após a prestação dos cuidados de emergência segundo o ABCDE.
Palavras-chave: família; ressuscitação; enfermeiros; serviço hospitalar de emergência
AbstractBackground: Family presence in the emergency department is a reality. However, in some situations, namely emergency situations, family presence is a controversial issue for nurses. Objectives: To identify nurses' opinions about family presence in emergency situations in adult emergency departments. Methodology: A descriptive exploratory study was conducted using a questionnaire in a convenience sample. The sample consisted of 233 nurses from four multipurpose emergency departments in the Lisbon and Tagus Valley region. Results: Most nurses in the study do not agree with family presence in emergency settings. Some of the identified advantages included the provision of clinical information to the team and patient support, whereas the disadvantages related to family anxiety and increased stress for professionals. Conclusion: Nurses have an unfavorable opinion about family presence in emergency situations. It would be important to reflect on the clinical practices in the resuscitation room so that the F for family can be included after the ABCDE approach to emergency care delivery.
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