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

Abstract

Objective:To describe the observed behavior of professionals in two neonatal and pediatric intensive care units regarding the use of central venous catheter insertion bundle, and the clinical and birth profile of neonates and children who received the devices. Method: A quantitative descriptive exploratory study was conducted in two intensive care units of a public hospital in Belo Horizonte with neonates and children, between February and September 2016. Results: The sample consisted of 59 observed implants of central venous catheter. Most patients were male preterm infants, of cesarean delivery and proper weight according to the gestational age. Among all procedures observed, only three followed all recommendations for the central venous catheter insertion bundle. Incorrect techniques were observed while performing surgical antisepsis and inadequate use of chlorhexidine, an antiseptic. Conclusion: The findings highlight the importance of more investment in continuous training of the team on the prevention of bloodstream infection caused by central venous catheter to reduce the number of adverse events related to intravenous therapy. DESCRIPTORS INTRODUCTIONThe technical and scientific advances related to invasive procedures have led to reduced infant mortality and increased survival rate of preterm newborns, which has changed the profile of care, raising the demand for increasingly complex care required for the survival of this population (1)(2)(3) . The adoption of central venous catheters (CVC) in clinical practice was an important advance in the care to preterm newborns, ensuring safe venous access with less invasive, simple and low-cost techniques.The types of CVC commonly used in pediatrics and neonatology are peripherally inserted central catheters (PICC), central insertion catheters, and umbilical venous catheters (UVC). These devices allow continuous administration of intravenous fluids and medications, parenteral nutrition, hemodynamic monitoring, and in some cases transfusion of blood products, depending on the catheter caliber and the patient's age (2,4) . Despite the advantages of CVC, there are risks of complications associated with their use, such as venous thromboembolism, hemorrhage, infiltration, rupture, phlebitis and infection, with primary bloodstream infections (PBSI) being the most frequently related to health care (5)(6)(7) . PBSI can lead to clinical complications for patients, longer hospital stay, increased morbidity and mortality, and a significant increase in health care costs (8) . Planning and adopting PBSI prevention measures is essential for reducing morbidity and mortality rates, improving the quality and safety of health care, and reducing hospitalization costs (7,(9)(10) . Strategies have been developed to reduce the incidence of PBSI associated with central venous catheters, for instance, the guidelines proposed by the Centers for Disease Control and Prevention (CDC), called Guidelines for the Prevention of Intravascular Catheter-Related Infections (10) . This is a...

Knowledge and behavior of professionals about bundled strategies of central venous catheter

“…Different findings of other study, developed in a university hospital in Alexandria, Egypt, showed low knowledge of health care professionals regarding the prevention of central venous catheters and low compliance with standard guidelines for the device (12) . Another study conducted in a neonatal ICU in Belo Horizonte, 59 catheter insertions were observed and only three procedures followed all the recommendations of the bundled strategy of catheter prevention (13) . Thus, the authors showed the importance of the implementation and application of a set of measures and investment in staff training to reduce CVC infection rates.…”

“…Thus, the authors showed the importance of the implementation and application of a set of measures and investment in staff training to reduce CVC infection rates. Consequently, a regular scientific-based program of continuing education with a focus on nurses, residents and doctors responsible for catheter insertion and maintenance is essential and can significantly reduce CVC infection rates (2,(12)(13)(14)(15)(16) .…”

“…Professionals who reported greater knowledge about the studied object stated that the training they underwent at the institution contributed to the acquisition of information. Thus, simulations for the health team responsible for CVC insertion, manipulation and the continuous monitoring of practices with the device, through the inclusion of a checklist, are important strategies for reducing primary BSIs (12)(13)(14) .…”

Saberes e práticas da enfermagem na utilização do cateter central de inserção periférica em neonatologia

“…A adoção de tecnologias que qualifiquem o cuidado em terapia intravenosa é essencial para o sucesso na reabilitação neonatal (5) . Dentre essas tecnologias, destaca-se o Cateter Central de Inserção Periférica (PICC) como avanço tecnológico no cuidado intensivo neonatal (6) .…”

Insertion of central vascular catheter: adherence to infection prevention bundle

“…The elements of emphasis that make up the bundles are: hand hygiene, use of chlorhexidine alcohol as an antiseptic for skin preparation, use of maximum barrier precaution, nonuse of femoral vein accesses, and daily verification of the need for catheter permanence (11)(12)(13) .…”