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.
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.
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.
The avoidance of repeated PICC insertions, noncentral tip position, and placement of single-lumen silicone PICCs for administration of four or more intravenous solutions is suggested. Interventions should be explored that facilitate PICC insertion success and correct tip placement.
The study aimed to describe the management of Peripherally Inserted Central Catheters insertion in neonates admitted at a neonatal intensive care unit of a private hospital, after implementation of the institutional protocol. An exploratory, quantitative descriptive study with prospective data collection was carried out. Data of 45 catheters insertion were analyzed. The rate of catheter's with elective removal was 63.8%, and catheter's complications rate was 30.8%. The most frequently complications were rupture (15.4%), occlusion (11%) and accidental dislodgement (4.4%). No records about the catheter dressings were observed in 33% of catheter's insertion. One conclude that the complications were related to care practices of the catheter, requiring professional training and new tools to record the care provided in relation to the catheter's management.
fumiko@usp.br ABSTRACT:The study aimed to translate and to adapt a version of the Premature Infant Pain Profile into the Brazilian Portuguese language. This is a cross-sectional and methodological study for the validation of a translated version of a tool. The process was conducted in four stages: initial translation, synthesis, back-translation, and analysis by experts. Four independent versions of the instrument translated into Brazilian Portuguese were produced. Based on these initial translations, a synthesis version was developed. Two back-translated versions were independently produced, and none showed major differences compared to the original instrument. An expert committee reviewed the summary version and the back-translations with respect to semantic and idiomatic equivalence. The committee considered the translation into Brazilian Portuguese as appropriate. Therefore, the Perfil de Dor no Recém-Nascido Pré-termo was considered adapted to Brazilian Portuguese, for research purposes and for clinical practice. It will contribute to the internationalization of research results in Brazil. DESCRIPTORS:Neonate. Pain. Pain assessment. Nursing. TRADUÇÃO E ADAPTAÇÃO DO PREMATURE INFANT PAIN PROFILEPARA A LÍNGUA PORTUGUESA RESUMO: O estudo objetivou traduzir e adaptar a versão do Premature Infant Pain Profile para a língua portuguesa adotada no Brasil. Trata-se de estudo transversal de caráter metodológico para validação de tradução de instrumento. O processo foi conduzido em quatro etapas: tradução inicial, síntese, retrotradução e análise por juízes. Foram elaboradas quatro versões independentes do instrumento traduzido para o português. Posteriormente, uma versão síntese foi produzida com base nas traduções anteriores. A seguir, duas retrotraduções foram elaboradas independentemente e nenhuma destas apresentou discrepâncias importantes em relação ao instrumento original. Um comitê de juízes analisou a versão síntese e as retrotraduções com relação à equivalência semântica e idiomática e julgou adequada a versão do instrumento em língua portuguesa. Assim, o Perfil de Dor no Recém-Nascido Pré-termo foi considerado adaptado à língua portuguesa do Brasil, para aplicação em pesquisa e na prática clínica, o contribuirá, especialmente, para a internacionalização de pesquisas brasileiras. DESCRITORES:Recém-nascido. Dor. Avaliação da dor. Enfermagem. TRADUCIÓN Y ADAPTACIÓN DEL PREMATURE INFANT PAIN PROFILE AL PORTUGUÉSRESUMEN: El objetivo del estudio fue traducir y adaptar la versión del Premature Infant Pain Profile para el portugués de Brasil. Es un estudio transversal y metodológico para validación de la tradición de instrumento. El proceso se llevó a cabo en cuatro etapas: traducción inicial, síntesis, retraducción y análisis por jueces. Se establecieron cuatro versiones distintas del instrumento traducido al portugués y una versión sintética fue producida a partir de traducciones anteriores. Posteriormente, dos versiones fueron retraduccidas independientemente y no mostraron diferencias importantes del original. ...
Objective: To measure pain in neonates during placement of central line catheter via peripheral insertion by comparing pain at the moment of the introduction of the catheter and pain at the progression of the catheter. Methods: This was a descriptive exploratory study with 28 neonates from a large teaching hospital in Sao Paulo city. Data were collected with the Premature Infant Pain Profile (PIPP) 15 seconds prior the initial introduction of the catheter, during the initial introduction of the catheter (30 seconds), and during the progression of the catheter (30 seconds). Results: The majority of neonates (59.1%) had a score e" 7 on the PIPP, moderate to high pain intensity, during the initial introduction of the catheter. A greater number of neonates (45.5%) who did not receive analgesic or sedative medication had score e" 7 on the PIPP, moderate to high pain intensity, during the progression of the catheter. Conclusion: There is a need for adoption of use of analgesic medication in the neonatal unit, since neonates often undergo invasive and painful procedures. Key words: Neonatal Nursing; Measurement of Pain; Neonatal Critical Care Unit. RESUMOObjetivo: Dimensionar a dor durante a instalação do cateter central de inserção periférica, comparando o momento da punção venosa com a progressão do cateter. Métodos: Estudo descritivo exploratório com coleta prospectiva dos dados realizado na unidade neonatal de um hospital-escola de grande porte da cidade de São Paulo. Avaliou-se a resposta dolorosa ao procedimento de inserção do cateter em 28 neonatos utilizando-se a escala Premature Infant Pain Profile (PIPP) nas etapas de pré-punção (15 segundos), punção venosa (30 segundos) e progressão do cateter (30 segundos). Resultados: O escore PIPP maior ou igual a sete, indicativo de dor moderada a intensa, ocorreu em 13 RN (59,1%) na primeira punção venosa e 10 RN (45,5%) na progressão do cateter do grupo que não recebeu analgésico ou sedativo. Conclusão: Os resultados apontam para a necessidade de se adotar medidas analgésicas, uma vez que neonatos internados em unidade de terapia intensiva neonatal são freqüentemente submetidos a procedimentos invasivos e dolorosos. Descritores: Enfermagem neonatal; Medição de dor; Terapia intensiva neonatal. RESUMENObjetivo: Medir la intensidad del dolor durante la instalación del catéter central de inserción periférica, comparando el momento de la punción venosa con la progresión del catéter. Métodos: Estudio descriptivo exploratorio con recolección prospectiva de los datos realizado en la unidad neonatal de un hospital-escuela de gran porte de la ciudad de Sao Paulo. Se evaluó la respuesta dolorosa al procedimiento de inserción del catéter en 28 neonatos, utilizándose la escala Premature Infant Pain Profile (PIPP) en las etapas de pre-punción (15 segundos), punción venosa (30 segundos) y progresión del catéter (30 segundos). Resultados: El puntaje PIPP mayor o igual a siete, indicativo de dolor moderado a intenso ocurrió en 13 RN (59,1%) en la primera punción venosa y 10 RN ...
Objetivou-se caracterizar as estratégias de analgesia e sedação em neonatos submetidos à instalação do cateter central de inserção periférica (CCIP) e relacioná-las ao número de punções venosas, duração do procedimento e posicionamento da ponta do cateter. Estudo transversal com coleta prospectiva de dados, realizado em uma unidade de cuidados intensivos neonatais de um hospital privado na cidade de São Paulo, no período de 31 de agosto de 2010 a 01 de julho de 2011, em que foram avaliadas 254 inserções do CCIP. A adoção de estratégias analgésicas ou sedativas ocorreu em 88 (34,6%) instalações do cateter e não esteve relacionada ao número de punções venosas, duração do procedimento ou posicionamento da ponta do cateter. As estratégias mais frequentes foram a administração endovenosa de midazolam em 47 (18,5%) e fentanil em 19 (7,3%) inserções do cateter. Recomenda-se maior adoção de estratégias analgésicas antes, durante e após o procedimento.
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