Variables associated with peripherally inserted central catheter related infection in high risk newborn infants

Abstract

OBJECTIVE: to relate the variables from a surveillance form for intravenous devices in high risk newborn infants with peripherally inserted central catheter related infection. METHODOLOGY: approximately 15 variables were studied, being associated with peripherally inserted central catheter related infection, this being defined by blood culture results. The variables analyzed were obtained from the surveillance forms used with intravenous devices, attached to the medical records of newborn infants weighing between 500 and 1,499 g. The statistical association was defined using the Chi-squared and Student t tests. The study was approved by the Research Ethics Committee of the Instituto Fernandes Figueira under process N. 140.703/12. RESULTS: 63 medical records were analyzed. The infection rate observed was 25.4%. Of the variables analyzed, only three had a statistically-significant relationship with the blood culture - the use of drugs capable of inhibiting acid secretion, post-natal steroid use, and undertaking more than one invasive procedure (p-value of 0.0141, 0.0472 and 0.0277, respectively). CONCLUSION: the absence of significance of the variables of the form may be related to the quality of the records and to the absence of standardization. It is recommended that the teams be encouraged to adhere to the protocol and fill out the form.

Adesão ao bundle de inserção de cateter venoso central em unidades neonatais e pediátricas

“…A similar result was found in another study conducted in Rio de Janeiro (22) . In a study conducted in an ICU in Porto Alegre, Brazil, the CVC insertion bundle adherence rate ranged from 36.1 to 78.3% in the study period, values that are much higher than those found in this study (23) .…”

A correlação entre procedimentos assistenciais invasivos e a ocorrência de sepse neonatal

“…The VLBW infants using parenteral nutrition, who are strongly exposed to the NICU environment, to the colonization of the non-inserted distal catheter tip due to handling by the health team professionals and contact with the microbiota of their own skin, represent important risk factors, as mentioned in different studies that observed high rates of blood infections associated with central venous catheters. (4,8,13,(17)(18)(19) In this study, the arterial umbilical catheter was 8.5 times more associated with the occurrence of late sepsis, in line with other association studies between hospital infections and venous catheters. (17,19) The blood infections related to the use of venous catheter are reported to be the most common at the NICU, and mostly result from technical errors in the installation and care for the insertion site and in catheter handling.…”

“…(18) Venous accesses stand out as HAI and associated with cases of sepsis. (4,12,(16)(17)(18) In this study, the birth weight (p= 0.03), peripheral venous access (p= 0.05) and arterial umbilical catheter (p= 0.10) showed higher significance rates with p< 0.20, being included in the logistic regression model adjusted to gesta- Adjusted model for gestational age and gender tional age and gender. In the final model, however, birth weight and arterial umbilical catheter remained as independent factors, the latter being an important determinant in the occurrence of late sepsis.…”

<b>Cateter central de inserção periférica: registros de enfermagem e segurança do paciente/ Central catheter peripheral inserted: records of nursing and patient’s safety<b>

“…Com base nesses dados, a ultrassonografia vascular pode ser uma ferramenta útil para facilitar o processo de inserção de PICC por enfermeiros e promover a segurança de neonatos e crianças que requerem uso do cateter (15) . Contudo, habilidade e destreza do enfermeiro, adquiridas pela prática frequente de uso do cateter, também influenciam no menor número de tentativas e no tempo discorrido para inserção de cateteres guiada por palpação, visto que outros estudos apresentam tempo de duração do procedimento ainda menor (9,16) . Podem-se relacionar as inúmeras tentativas de punção e o demasiado tempo de duração do procedimento à intercorrência durante o procedimento, condição que este estudo não correlacionou.…”

“…Reputa-se que dados referentes à remoção do cateter por suspeita de infecção sejam registrados com maior precisão, pois pesquisas demonstram que infecções relacionadas ao uso de PICC podem ser agravadas por fatores de risco, como a prematuridade, bem como pela inexperiência da equipe de enfermagem no cuidado diário ao cateter, pelas múltiplas manipulações, contaminação e longo tempo de permanência (5) , embora se constate baixa a incidência de culturas positivas em PICC (16) . O cuidado com procedimentos que envolvem acesso vascular deve ser prioridade da equipe assistencialpara prevenção e controle de efeitos adversos, garantindo a segurança do paciente.Isso exige dos enfermeiros conhecimentos técnico-científicos para promover a educação em serviço junto à sua equipe e, consequentemente, para proporcionar uma assistência de qualidade ao paciente.…”