Evaluation of the conformity of assistential practice in the maintenance of the temporary double-lumen dialysis catheter

Abstract

Objective to evaluate the conformity of the assistential practice in the maintenance of the temporary double-lumen catheter for hemodialysis, by means of the use of the process indicator, in the University Hospital of the University of São Paulo. Method a quantitative, exploratory-descriptive and observational study. The sample was made up of 155 observations of persons with temporary double-lumen catheters, in the period March - November 2011, using the Indicator of the Maintenance of the Temporary Double Lumen Catheter for Hemodialysis. Results the rate of general conformity of the assistential practice corresponded to 65.8%. Of the practice's 13 components, 9 (69.2%) attained 100% conformity. The hygienization of hands by the professionals and the use of a mask by the patients during the disconnection from the hemodialysis had the worst rates (83.9%). Conclusion although the actions evaluated are implemented in the unit, it is necessary to propose and apply educational strategies with the health team, as well as to institute periodical assessments, so as to raise the conformity rates, ensuring the quality of the hemodialysis services.

Segurança do paciente em hemodiálise

“…In relation to the Hemodialysis Service, it is emphasized that the treatment is complex, with specific activities, requiring adequate structure and trained professionals for a safe care practice, which, if not respected, could cause irreversible damages to the user. 11 It is noteworthy that medical care for patients receiving renal replacement therapy (RRT) is complex and technology-dependent.…”

“…9,12 In the dialysis services, innumerable patients are simultaneously treated in the same environment, which favors the dissemination of microorganisms through direct or indirect contact through devices, equipment, surfaces or hands of health professionals, which evidences the need to perform hand hygiene before and after contact with the patient. 11 Hand hygiene is recognized as essential to prevent the transmission of disease. Central venous catheter infections for hemodialysis are associated with a 15-to 33-fold increase in bloodstream infections when compared to arteriovenous fistulas.…”

“…14 It was found, through authors, that in the hand hygiene component, there were a considerable number of opportunities that demonstrated the fragility in adherence to practice. 11 CKD is also characterized by impaired renal clearance of numerous medications increasing the risk for incorrect dosage and toxicity of therapeutic agents. 10 It is evident in the hemodialysis community that medication errors are reported as the most common event in patient safety.…”

“…9 Quality is understood through the incessant search for identifying the failures in procedures and practices that organize the actions leading to the improvement of processes and results and aiming at the conformities established by the regulatory agencies and the satisfaction of users. 11 It has become a national priority to reduce medical errors and improve patient safety. Patients with chronic kidney disease (CKD) may be at increased risk of adverse health care outcomes, but few studies have evaluated this issue.…”

Insertion of central vascular catheter: adherence to infection prevention bundle

“…In this sense, the quality advocated by the institution must be associated with the compliance of the rules established by regulatory agencies, as well as the constant search for possible failures in the implementation of the practices and their respective corrections, always prioritizing the satisfactory security and quality of the care provided (7) .…”