Causas anatómicas inusuales de malposición de catéteres venosos centrales / Unusual anatomical causes of malposition of central venous catheters

Resumen: La malposición de los catéteres venosos centrales se asocia a importantes riesgos, a menudo infraestimados. Aunque se han descrito algunos factores que pueden favorecer la malposición, generalmente su causa no llega a diagnosticarse y parece ser de origen multifactorial. Presentamos dos casos de malposición de catéteres venosos centrales motivadas por causas anatómicas inusuales, diagnosticadas en el perioperatorio. En el primer caso, se diagnostica una agenesia de vena cava superior en el transcurso de una sustitución mitral por esternotomía, que lógicamente se asocia con una malposición de la vía central insertada. La utilización de catéteres y dispositivos a través de venas yugulares y subclavias en pacientes con esta infrecuente patología implica importantes limitaciones y complicaciones potenciales graves. En el segundo caso, la existencia de un bocio no diagnosticado provoca la malposición bilateral y simultánea de dos catéteres venosos canalizados, en el contexto de una situación de emergencia, en ambas venas yugulares internas.

Abstract: Malposition of central venous catheters is associated with important and underestimated risks. Although some factors have been related with malposition, its cause is generally not diagnosed, and it seems to have multifactorial origin. We present two cases of central venous catheter malposition due to unusual anatomical causes, diagnosed in the perioperative period. In the first case, superior vena cava agenesis was diagnosed during mitral replacement by sternotomy, which was logically associated with malposition of the inserted central line. The use of catheters and devices through jugular and subclavian veins in patients with this infrequent pathology is associated with important limitations and serious potential complications. In the second case, an undiagnosed goiter causes bilateral and simultaneous malpositioning of two inserted central venous catheters, in the context of an emergency situation, in both internal jugular veins.

Cross-sectional study of quality of life in relation with vascular access in hemodialysis patients. Study in a hospital and a satellite center

Introduction: Vascular access for hemodialysis (HD) is essential for the patient. Even though Arteriovenous fistula (AVF) is the preferred access, in certain age groups, the central venous catheter (CVC) may provide advantages. This study aims to investigate the quality of life related to vascular access. Methods: Cross-sectional study including patients from a hospital, a home HD unit and a satellite hemodialysis center. Clinical data was collected from the patients, who went through a quality-of-life questionnaire SF12 and a Vascular Access Questionnaire (VAQ). Results: 91 patients participated, mostly male (70 %), with a mean age of 68.9 ± 16.2 years. AVF was the current vascular access in 60.4 %, the rest used a CVC. Home HD was performed in 12.1 % of patients and 76 % started it via CVC. Regarding patients who have had both AVF and CVC, 58 % prefer AVF and only 26.5 % of current CVC carriers would have a new AVF, mostly due to fear of pain (52 %). Most people (72.5 %) reported having received sufficient information, with no differences between both accesses. The SF12 results showed no differences between patients with AVF or CVC. Regarding the VAQ, patients with AVF were more satisfied with the social aspect (p = 0.036) and complications (p = 0.006). Conclusion: Patients with AVF had better outcomes than those using CVC regarding complications and social aspects. These differences are not attributable to a worse overall quality of life status of CVC patients. Most patients with CVCs refuse to go through a new AVF for fear of puncture pain.

Introducción: el acceso vascular para la hemodiálisis (HD) es esencial para el paciente. Aunque la fístula arteriovenosa (FAV) es el acceso preferido, en ciertos grupos de edad el catéter venoso central (CVC) puede aportar ventajas. Este estudio pretende investigar la calidad de vida relacionada con el acceso vascular. Métodos: el estudio transversal incluye pacientes del hospital, de una unidad de HD domiciliaria y de un centro de hemodiálisis periférico. Se recogieron datos clínicos de los pacientes que contestaron el cuestionario de calidad de vida SF12 y Cuestionario de Acceso Vascular (VAQ). Resultados: 91 pacientes, en su mayoría varones (70 %), con una edad media de 68,9 ± 16,2 años. La FAV era el acceso vascular actual en el 60,4 %. La HD domiciliaria se realizó en el 12,1 % de los pacientes y el 76 % la inició mediante CVC. En cuanto a los pacientes que han tenido tanto FAV como CVC, el 58 % prefiere la FAV y sólo el 26,5 % de los actuales portadores de CVC se sometería a una nueva FAV, sobre todo por miedo al dolor (52 %). La mayoría de las personas (72,5 %) declararon haber recibido suficiente información, sin diferencias entre ambos accesos. Los resultados del SF12 no mostraron diferencias según el acceso. En cuanto al VAQ, los pacientes con AVF estaban más satisfechos con el aspecto social y las complicaciones. Conclusión: los pacientes con FAV tuvieron mejores resultados en comparación con los que utilizaron CVC en cuanto a complicaciones y aspectos sociales, sin deberse a un peor estado general de la calidad de vida. La mayoría de los pacientes con CVC se niegan a someterse a una nueva FAV por miedo al dolor de la punción.

Ultrasound-guided central venous access for patients in the Intensive Care Unit in prone position: report of three cases

Abstract The prone position is extensively used to improve oxygenation in patients with severe acute respiratory distress syndrome caused by SARS-CoV-2 pneumonia. Occasionally, these patients exhibit cardiac and respiratory functions so severely compromised they cannot tolerate lying in the supine position, not even for the time required to insert a central venous catheter. The authors describe three cases of successful ultrasound-guided internal jugular vein cannulation in prone position. The alternative approach here described enables greater safety and well-being for the patient, reduces the number of episodes of decompensation, and risk of tracheal extubation and loss of in-situ vascular lines.

Factores de riesgo para infecciones asociadas al cuidado de la salud en recién nacidos sometidos a cirugía en una unidad de cuidados intensivos neonatales / Risk factors for healthcare-associated infections in newborns after surgery in a neonatal intensive care unit

Resumen Antecedentes: Las infecciones asociadas a la atención de la salud (IAAS) son causa frecuente de morbilidad y mortalidad. Objetivo: Identificar los factores de riesgo para el desarrollo de IAAS en recién nacidos (RN) sometidos a cirugía. Material y métodos: Estudio de casos y controles anidado en una cohorte. Los casos fueron RN sometidos a cirugía, con IAAS y los controles, RN sometidos a cirugía sin IAAS. Se registraron datos perinatales, uso de profilaxis antimicrobiana, de catéter venoso central (CVC), ventilación mecánica, nutrición parenteral y sondas; edad y peso al momento de la cirugía, tipo de cirugía, clasificación de la herida quirúrgica, duración de la cirugía, número de procedimientos quirúrgicos y tipo de infección. Se realizó análisis univariado y multivariado. Resultados: Se incluyeron 71 casos y 142 controles. Las IAAS más frecuentes fueron las infecciones sanguíneas (36.6 %); los principales microorganismos aislados en hemocultivos fueron cocos grampositivos. Los factores de riesgo asociados a IAAS en el análisis multivariado fueron duración del CVC > 8 días (RMa = 17.2), ≥ 2 intervenciones quirúrgicas (RMa = 16.5) y cirugía abdominal (RMa = 2.6). Conclusiones: Los RN sometidos a cirugía, principalmente aquellos con factores de riesgo, requieren vigilancia estrecha durante el posoperatorio. El CVC debe ser retirado tan pronto sea posible.

Abstract Background: Healthcare-associated infections (HAIs) are a common cause of morbidity and mortality. Objective: To identify the risk factors for the development of HAIs in newborns (NBs) undergoing surgery. Material and methods: Nested case-control study. Cases were NBs undergoing surgery with HAIs, while controls were NBs undergoing surgery with no HAIs. Perinatal data, use of antimicrobial prophylaxis, use of central venous catheter (CVC), mechanical ventilation, parenteral nutrition, and other medical devices were recorded, as well as age and weight at the time of surgery, type of surgery, surgical wound classification, duration of surgery, number of surgical procedures, and type of infection. Univariate and multivariate analyses were performed. Results: Seventy-one cases and 142 controls were included. The most frequent HAI was bloodstream infection (36.6%); the main microorganisms isolated in blood cultures were gram-positive cocci. The risk factors associated with HAIs in the multivariate analysis were CVC duration > 8 days (aOR = 17.2), ≥ 2 surgical interventions (aOR = 16.5) and abdominal surgery (aOR = 2.6). Conclusions: NBs undergoing surgery, mainly those with risk factors, require close monitoring during the postoperative period. CVC should be withdrawn as soon as possible.

Expert consensus on perioperative nursing standards for pediatric kidney transplantation / 器官移植

Pediatric kidney transplant recipients differ from adult counterparts in primary disease, physiology, psychology, organ function and immune status and their perioperative treatment and nursing management are different from those of adult kidney transplantation. To standardize holistic perioperative nursing regimens for pediatric kidney transplantation, Surgery Nursing Committee of Shanghai Nursing Association organized national medical and nursing experts in the fields of transplantation to jointly draft "expert consensus on perioperative nursing standards for pediatric kidney transplantation " (abbreviated as "consensus"). After three rounds of online expert inquiry, all revised opinions were jointly discussed combined with literature evidence, and the expert consensus was finally reached. The highlights of perioperative treatment and nursing care for pediatric kidney transplantation were summarized and stated, including preoperative evaluation, preoperative and postoperative nursing care, which were of scientific and practical value.

Application of catheter information platform based on failure mode and effect analysis in preventing central venous catheter-related infection in intensive care unit / 中国实用护理杂志

Objective:To investigate the effect of failure mode and effect analysis (FMEA) based catheter information platform in preventing catheter-related bloodstream infection (CRBSI) in intensive care unit to improve the current status of CRBSI.Methods:In this study, a retrospective cohort study was conducted using the purposive sampling method, and 140 patients with indwelling central venous catheters admitted to the ICU of Peking University Shenzhen Hospital from August to December 2021 were set as the control group; the 140 patients with indwelling central venous catheters admitted to the ICU from January to May 2022 were set as the observation group. The control group used electronic forms to record and manage at the bedside after CRBSI cluster nursing measures were given, and the observation group used the catheter information platform based on FMEA to conduct information management on catheter evaluation and maintenance process after CRBSI cluster nursing measures were given. Compared the implementation rate (6 items), implementation time, qualification rate, and incidence of CRBSI in ICU patients between two groups of ICU nurses.Results:The implementation rate of CRBSI cluster nursing measures among ICU nurses in the observation group: strict hand hygiene by nurses was 87%(122/140), maximum aseptic barrier during puncture was 97%(136/140), aseptic operation during catheter maintenance was 91%(128/140), 75% alcohol disinfection of connectors was 84%(118/140), 24-hour change of infusion lines was 95%(133/140), and timely change of patches/dressings was 89%(125/140), they were greater than those in the control group 70%(98/140), 87%(122/140), 71%(100/140), 61%(86/140), 71%(99/140), 69%(96/140), the differences were statistically significant ( χ2 values were 9.67 to 29.07, all P<0.05); the execution time and qualification rate among ICU nurses in the observation group were (9.11 ± 2.83) minutes and 91.4% (128/140), the control group were (10.00 ± 2.84) minutes and 60.7% (85/140), with statistically significant differences ( t value was -2.64, χ2 values was 36.28, all P<0.05). Conclusions:The FMEA-based catheterization information platform can help enhance the efficiency of the implementation of CRBSI clustering nursing measures by ICU nurses, improve the quality of care, and thus reduce the occurrence of CRBSI, and the feasibility of clinical promotion is high.

Peripherally inserted central venous catheter-related thrombosis in a neonate / 中国当代儿科杂志

The female infant in this case study was admitted to the hospital 4 hours after birth due to preterm birth and respiratory distress. On the third day after birth, peripherally inserted central venous catheter (PICC) catheterization was performed. On day 42, thrombus was found at the entrance of the right atrium from the inferior vena cava during a cardiac ultrasound, and it was considered to be related to PICC placement. Low-molecular-weight heparin and urokinase were given. After two weeks of treatment, ultrasonic monitoring showed thrombus shrinkage. No bleeding or pulmonary embolism occurred during the treatment. The patient discharged after improvement. This article mainly introduces a multidisciplinary team approach to diagnosis and treatment of PICC-related thrombosis in neonates.

Influencia de variables del manejo de catéteres venosos tunelizados en hemodiálisis sobre la tasa de bacteriemia: estudio analítico observacional / Influence of management variables of tunneled venous catheters in hemodialysis on the bacteremia rate: observational analytical study

RESUMEN Introducción: La infección relacionada con catéter venoso central (CVC) es la complicación más frecuente y grave en los pacientes en hemodiálisis, asociada a una elevada mortalidad y morbilidad. En España, se ha publicado una incidencia de bacteriemia de 0.9 a 2 episodios por catéter y año. Diversas variables se han relacionado con la tasa de bacteriemia asociada a CVC, tales como disfunciones del catéter, la formación y experiencia del personal de enfermería, el número de sesiones de hemodiálisis y la duración de las mismas. El objetivo del presente estudio es analizar la influencia de las variables citadas en la aparición de bacteriemias, en pacientes portadores de catéteres en una unidad de hemodiálisis de un hospital de tercer nivel en España. Material y métodos: Estudio analítico, observacional y retrospectivo en el que se obtuvieron los datos relativos a la formación recibida y experiencia del personal de enfermería, el número y duración de sesiones de hemodiálisis por paciente y disfunciones de CVC. Se contabilizaron las bacteriemias acontecidas en un año, a través de la base de datos de la unidad, y se analizó la posible relación de tales variables en la tasa de bacteriemia. Resultados: Sobre un total de 41 catéteres tunelizados en 35 pacientes, observados durante 365 días, se obtuvo una tasa de incidencia de 1.45/1000 días de catéter, no habiendo encontrada relación estadísticamente significativa con la formación del personal de enfermería (p=0.330), experiencia (p=0.668), número de disfunciones y manipulaciones de catéter (p=0.718; p=0.118). Se objetivó relación inversa con el número y duración de sesiones (p=0.02). Conclusiones: Es preciso seguir analizando la relación entre las variables mencionadas y la tasa de bacteriemias. Abordarlo desde un punto de vista multicéntrico o aumentar el tiempo de observación de forma prospectiva pueden ser aspectos a tener en cuenta para determinar las variables que parecen tener una relación directa con la infección de CVC, que en otros contextos se ha llegado a evidenciar.

ABSTRACT Introduction: Central venous catheter (CVC)-related infection is the most frequent and serious complication in hemodialysis patients, associated with high mortality and morbidity. In Spain, an incidence of bacteremia of 0.9 to 2 episodes per catheter and year has been published. Variables have been related to the rate of bacteremia associated with CVC, such as catheter malfunctions, the training and experience of the nursing, the number of hemodialysis sessions and their duration. The objective of the present study is to analyze the influence of the aforementioned variables on the appearance of bacteremia in patients with catheters in a hemodialysis unit of a tertiary care hospital in Spain. Methods: Analytical, observational, and retrospective study in which data on the training received and experience of the nursing staff, the number and duration of hemodialysis sessions per patient and CVC dysfunctions were obtained. The bacteremia's that occurred in a year were counted, through the unit's database, and the possible relationship of such variables in the rate of bacteremia was analyzed. Results: On a total of 41 tunneled catheters in 35 patients, observed for 365 days, an incidence rate of 1.45/1000 catheter days was obtained, not having found a statistically significant relationship with the training of nursing staff (p = 0.330), experience (p=0.668), number of dysfunctions and manipulations of catheter (p=0.718; p=0.118). An inverse relationship was observed with the number and duration of sessions (p=0.02). Conclusions: It is necessary to continue analyzing the relationship between the mentioned variables and the rate of bacteremia. Approaching it from a multicenter point of view or increasing the observation time prospectively may be aspects to consider to determine the variables that seem to have a direct relationship with CVC infection, which has been shown in other contexts.

Sepsis por catéter central en la unidad de cuidados intensivos del hospital de Esmeraldas, Ecuador / Central catheter sepsis in the intensive care unit of the Esmeraldas hospital, Ecuador

RESUMEN Objetivo: analizar la prevalencia de sepsis por catéter central en pacientes hospitalizados en la unidad de cuidados intensivos del Hospital General Delfina Torres de Concha, de Esmeraldas. Materiales y métodos: estudio con enfoque cuantitativo, corte transversal y descriptivo; la población fue de 435 pacientes ingresados en el Servicio de Terapia Intensiva; la muestra se obtuvo por muestreo no probabilístico por conveniencia, obteniendo 22 pacientes que tuvieron catéter venoso central y cumplieron con los criterios de inclusión. Resultados: la prevalencia de sepsis por catéter venoso central, en los años 2018 y 2019, en el hospital Delfina Torres de Concha, fue de 5,06 %; el sexo femenino fue el de mayor incidencia, con un 57,14 %; en el rango de edad de entre 30 y 44 años se presentaron más casos de sepsis, representando el 6,74 %; los pacientes mayores de 60 años presentaron mayor mortalidad; el 60 % de los pacientes que pertenecían a este grupo y padecieron de sepsis por catéter venoso central fallecieron. La insuficiencia aguda de miocardio fue la patología en la que se presentó el mayor número de casos con sepsis por catéter venoso central; la mortalidad fue de 60 % en los pacientes con diagnóstico de trauma craneoencefálico; el agente etiológico con mayor incidencia fue la Klebsiella pneumoniae, con 54,54 %, seguido del Escherichia coli, con 36 %. Conclusiones: la prevalencia de sepsis por catéter es baja, y cuando se presenta en pacientes menores de 60 años hay mayores posibilidades de recuperación; el personal de salud que labora en la unidad de cuidados intensivos posee un nivel de conocimiento medio en cuanto a los cuidados del catéter venoso central.

ABSTRACT Objective: to analyze central catheter sepsis in inpatients admitted of the emergency care unit of General Hospital Delfina Torres de Concha, in Esmeraldas. Materials and methods: study with a quantitative, cross-sectional and descriptive approach; the population was 435 patients admitted to the Intensive Care Service; the sample was chosen by non-probabilistic sampling for convenience, obtaining 22 patients who had a central venous catheter and complied with the inclusion criteria. Results: the prevalence of sepsis due to central venous catheter was 5.06 % in 2018 and 2019 in the hospital Delfina Torres de Concha; female sex was the one with higher incidence, with 57.14 %: age range between 30 and 44 years presented more sepsis cases, representing 6.74 %. Patients over 60 years showed the higher mortality; 60 % of the patients who belonged to this age group and suffered central venous catheter sepsis, died. Acute myocardial failure was the condition which presented the higher number of cases in association with sepsis due to central venous catheter; mortality was 60 % in patients diagnosed of crania-encephalic trauma. The etiologic agent showing higher incidence was Klebsiella pneumoniae, 54,54 %, followed by Escherichia coli, 36 %. Conclusions: the prevalence of catheter sepsis is low, and when it occurs in patient under 60 years there are greater chances of recovery; the health care staff working at intensive care unit has an average level of knowledge regarding care to patient with central venous catheter.

Bacteriemias relacionadas con el uso del catéter venoso en una unidad de hemodiálisis en Cuba / Bacteremia related to the use of venous catheter in a hemodialysis unit in Cuba

Introducción: Las bacteriemias relacionadas con el uso de catéter (BRC) en pacientes con enfermedad renal crónica avanzada (ERCA) representan un importante problema sanitario. Objetivos: Estimar la incidencia de BRC en pacientes con ERCA en el Hospital Ciro Redondo García, Artemisa, Cuba; y describir su relación con el tipo de acceso vascular (AV), así como la conducta médica que se adopta después del diagnóstico. Métodos: Se realizó un estudio descriptivo entre mayo-octubre del 2019, en el que se incluyó el total de los pacientes (n = 78) de la unidad de hemodiálisis del hospital. Se recogió información acerca del tipo y tiempo de uso del AV. Ante un episodio sugerente de bacteriemia, se obtuvo una muestra de sangre para hemocultivo. Se informó la incidencia de BRC según los criterios de Bouza (2004). Resultados: La tasa de incidencia de BRC se estimó buena (1,18/1 000 días-catéter). Para las producidas por Staphylococcus aureus y por bacterias gramnegativas (Escherichia coli, Enterobacter spp., Pseudomonas spp. y Alcaligenes spp.) las tasas fueron excelentes: 0,44 y 0,88/1 000 días-catéter, respectivamente. Los catéteres venosos centrales se constataron como los AV predominantes. Se verificó que se impuso tratamiento empírico ante signos de probable BRC y este se modificó tras el diagnóstico etiológico específico, acompañado de la retirada del AV siempre que las condiciones clínicas lo permitieron. Conclusiones: Se mantienen en el servicio de hemodiálisis buenas prácticas clínicas para la prevención de BRC. Los agentes etiológicos demostrados obligan a mantener la indicación de tratamiento empírico con antibióticos de amplio espectro(AU)

Introduction: Catheter-related bacteremias (CRB) in patients with advanced chronic kidney diseases represent a major health problem. Objective: To estimate the incidence of CRB in patients with advanced chronic kidney diseases at Ciro Redondo García Hospital, Artemisa, Cuba; and to describe its relationship with the type of vascular access (VA), as well as the medical protocol adopted after diagnosis. Methods: A descriptive study was conducted between May and October 2019. All patients (n=78) in the hospital hemodialysis unit were included. Information about the type and duration of VA was collected. In the presence of an episode suggestive of bacteremia, a blood sample was obtained for blood culture. The incidence of CRB was informed according to Bouza´s criteria (2004). Results: The incidence rate of CRB was estimated good (1.18/1 000 1000 catheter-days). For those caused by Staphylococcus aureus and by gram-negative bacteria (Escherichia coli, Enterobacter spp., Pseudomonas spp. y Alcaligenes spp.), the rates were excellent: 0.44 and 0.88/1000 catheter -days, respectively. Central venous catheters were the predominant VAs. It was confirmed that empirical treatment was initiated in the presence of signs of a probable CRB, which was modified after specific etiological diagnosis, together with the withdrawal of the VA whenever the clinical conditions allowed it. Conclusions: Good clinical practices for the prevention of CBR are maintained at the hemodialysis service. The confirmed etiological agents make it necessary to continue with the indication of empirical treatment with broad-spectrum antibiotics(AU)

Thoracic drainage with traditional chest tube versus central venous catheter after video-assisted thoracoscopic lobectomy: A randomized controlled study / 中国胸心血管外科临床杂志

@#Objective    To evaluate the effectiveness and safety of a central venous catheter for thoracic drainage after video-assisted thoracoscopic lobectomy compared with a conventional chest tube. Methods    This study collected 200 patients with lung cancer who underwent thoracoscopic lobectomy and systematic hilar and mediastinal lymph node dissection between January 2018 and September 2019 in our hospital. The patients were randomly divided into two groups, including a group A (left with 28F chest tubes postoperatively) and a group B (left with 12G central venous catheters postoperatively). Patients in both groups were left with 2 chest tubes after upper lobectomy and 1 chest tube after middle or lower lobectomy. Duration and total volume of drainage, length of hospital stay, maximum visual analogue scale score and so forth were compared between the two groups. Results    Finally, 151 patients were included for analysis. There were 73 patients in the group A, including 26 males and 47 females, with an average age of 55.38±9.95 years, and 78 patients in the group B, including 37 males and 41 females, with an average age of 59.86±10.18 years. No statistical  difference was found between the two groups in drainage volume on postoperative day 2, and proportion of prolonged air leaks, hemothorax, chylothorax or drain reinsertion (all P>0.05). There was a statistical difference in drainage volume on postoperative day 1 [200.0 (120.0, 280.0) mL vs. 57.5 (10.0, 157.5) mL, P=0.000], postoperative day 3 [155.0 (100.0, 210.0) mL vs. 150.0 (80.0, 215.0) mL, P=0.023], total volume of drainage [890.0 (597.5, 1 530.0) mL vs. 512.5 (302.5, 786.3) mL, P=0.000], maximum pain score (2.29±0.72 points vs. 2.09±0.51 points, P=0.013) and length of hospital stay [7 (7, 9) d vs. 5 (4, 7) d, P=0.000]. Conclusion    Compared with conventional chest tubes, central venous catheters for chest drainage in patients with lung cancer after thoracoscopic lobectomy shortens the length of hospital stay and reduces postoperative pain.

Infecciones producto de catéter venoso central y factores asociados en neonatos del Hospital José Carrasco Arteaga

Resumen La utilización de dispositivos intravasculares centrales para la administración de diversas sustancias los ha convertido en una herramienta esencial dentro del área de neonatología, sin embargo, su uso ha llevado al desarrollo de complicaciones infecciosas las cuales son cada vez más frecuentes. Objetivo . Determinar la prevalencia de infecciones producto de catéter venoso central y sus factores asociados en neonatos del Hospital José Carrasco Arteaga durante los años 2013 a 2018. Materiales y métodos . Es un estudio cuantitativo analítico de cohorte longitudinal retrospectivo. La población estuvo conformada por las historias clínicas de neonatos a los cuales se les coloco catéter venoso central, según datos obtenidos del departamento de estadística del Hospital "José Carrasco Arteaga". El tamaño de la muestra fue calculado por un muestreo simple aleatorizado mediante el programa Epidat v4.2, con un nivel de confianza del 95%, se obtuvo un tamaño de muestra de 172 neonatos. Para el análisis se utilizó estadística descriptiva. Resultados. Se determina una prevalencia de 56 neonatos con infección producto del uso de catéter venoso central equivalente al 32.6%, predominando como agente etiológico causal el Estafilococo epidermidis; durante la realización del estudio, la prematuridad, el bajo peso al nacer y el tiempo de uso de catéter por más de 15 días son los factores que más se asocian con la infección. Conclusión. Se demostró que el bajo peso al nacer, neonatos pretérmino y el uso de catéter por más de 15 días son uno de los factores predisponentes.

Abstract The use of central intravascular devices for the administration of various substances has made them an essential tool within the area of neonatology, however, their use has led to the development of infectious complications which are increasingly frequent. Objective. To determine the prevalence of infections caused by the central venous catheter and its associated factors in neonates of the José Carrasco Arteaga Hospital during the years 2013 to 2018. Materials and methods. It is a quantitative analytical retrospective longitudinal cohort study. The population was made up of all neonates to whom a central venous catheter was placed, according to data obtained from the statistics department of the "José Carrasco Arteaga" Hospital. The sample size was calculated by a simple randomized sampling using the Epidat v4.2 program, with a confidence level of 95%, a sample size of 172 neonates was obtained. Descriptive statistics were used for the analysis. Results. A prevalence of 56 neonates with infection resulting from the use of a central venous catheter was determined, equivalent to 32.6%, with Staphylococcus epidermidis as the causal etiological agent; During the study, prematurity, low birth weight and time of catheter use for more than 15 days are the factors most associated with infection. Conclusion . Low birth weight, preterm infants and the use of a catheter for more than 15 days were shown to be one of the predisposing factors.

Resumo O uso de dispositivos intravasculares centrais para a administração de diversas substâncias tem tornado-os uma ferramenta essencial dentro da área de neonatologia, porém, seu uso tem levado ao desenvolvimento de complicações infecciosas cada vez mais frequentes. Objetivo. Determinar a prevalência de infecções causadas pelo cateter venoso central e seus fatores associados em neonatos do Hospital José Carrasco Arteaga durante os anos de 2013 a 2018. Materiais e métodos . Trata-se de um estudo quantitativo analítico de coorte longitudinal retrospectivo. A população foi constituída por todos os neonatos aos quais foi colocado cateter venoso central, conforme dados obtidos no setor de estatística do Hospital "José Carrasco Arteaga". O tamanho da amostra foi calculado por uma amostragem aleatória simples no programa Epidat v4.2, com nível de confiança de 95%, obteve-se um tamanho de amostra de 172 neonatos. Estatísticas descritivas foram utilizadas para a análise. Resultados. Foi determinada uma prevalência de 56 neonatos com infecção decorrente do uso de cateter venoso central, equivalente a 32,6%, sendo o Staphylococcus epidermidis o agente etiológico causal; durante o estudo, prematuridade, baixo peso ao nascer e tempo de uso do cateter por mais de 15 dias são os fatores mais associados à infecção. Conclusão. Baixo peso ao nascer, prematuridade e uso de cateter por mais de 15 dias mostraram-se um dos fatores predisponentes.

Factores relacionados con la supervivencia de pacientes que inician tratamiento de hemodiálisis. Instituto de Nefrología / Factors related to the survival of patients who start receiving hemodialysis. Institute of Nephrology

Introducción: La enfermedad renal crónica constituye un problema de salud por su impacto sobre los individuos, la sociedad y la economía. Existe un insuficiente conocimiento de los factores relacionados con la supervivencia en los pacientes que inician hemodiálisis en nuestro medio. Objetivo: Identificar los factores relacionados con la supervivencia de los pacientes que iniciaron hemodiálisis. Material y Métodos: Se realizó un estudio descriptivo de corte retrospectivo, de pacientes que iniciaron hemodiálisis en el Instituto de Nefrología Dr. Abelardo Buch en el período del 1 de enero de 2011 al 31 de diciembre de 2016. Se analizaron variables sociodemográficas y clínicas, y se realizó una correlación de estas con la supervivencia en hemodiálisis. Para todas las pruebas realizadas se fijó un nivel de significación ɑ= 0.05. Resultados: Se estudiaron 81 pacientes, con edad media de 55 años y predominio del sexo masculino (61,7 por ciento) y la raza blanca (59,3 por ciento). Los resultados estadísticamente significativos fueron la desnutrición (Índice de Masa Corporal < 18.5 kg/m2), con una mediana de supervivencia de (7,6+-4,9; log Rank: 0,015), las cifras de albúmina sérica menores a 35 g/L, con (33.1 +-5.4; log Rank: 0.050) la falta de seguimiento nefrológico previo, con (21,5 +-2,6; log Rank: 0,041), y el empleo de catéter venoso central como acceso vascular, con (32,4+-3,5; log Rank: 0,038). Conclusiones: La desnutrición, la hipoalbuminemia, el empleo de catéter venoso central como acceso vascular y la falta de seguimiento nefrológico previo afectaron negativamente la supervivencia de los pacientes en hemodiálisis(AU)

Introduction: Chronic kidney disease is a health problem because of its impact on individuals, society and the economy. There is not enough knowledge of the factors related to survival in patients who start hemodialysis in our environment. Objective: To identify the factors related to the survival of patients who started receiving hemodialysis. Material and Methods: A descriptive retrospective study was conducted in 81 patients who started receiving hemodialysis in the Dr. Abelardo Buch Institute of Nephrology in the period between January 1, 2011 and December 31, 2016. Sociodemographic and clinical variables were analyzed. A correlation between these variables and survival was made. The level of significance in all the tests performed was determined to be ɑ= 0.05. Results: A total of 81 patients were studied. The mean age was 55 years. The male sex (61,7 percent) and the white race (59,3 percent) predominated in the study. The statistically significant variables were malnutrition (body mass index < 18.5 kg/m2) with a median survival of (7,6+-4,9; log rank: 0,015), serum albumin levels lower than 35 g/L, with (33.1 +-5.4; log rank: 0.050), lack of previous nephrological follow-up, with (21,5 +-2,6; log rank: 0,041) and the use of central venous catheter as vascular access with (32,4+-3,5; log rank: 0,038). Conclusions: Malnutrition, hypoalbuminemia, the use of central venous catheter as vascular access and previous nephrological follow-up negatively affected the survival of patients on hemodialysis (AU)

Risk factors analysis of central venous catheter-related thrombosis in critically ill patients and development of nomogram prediction model / 中华危重病急救医学

Objective:To analyze the risk factors of central venous catheter-related thrombosis (CRT) in critically ill patients and develop the model of a nomogram.Methods:A prospective investigation study was conducted on 385 critically ill patients who received central venous catheters during hospitalization in Hengshui People's Hospital from May 2018 to March 2021. Color Doppler ultrasonography was performed daily after catheterization. Patients were divided into thrombosis group and non-thrombosis group according to whether CRT was formed. The patient's gender, age, body mass index (BMI), acute physiology and chronic health evaluationⅡ(APACHEⅡ) score, complications, existing tumor, D-dimer level on the 3rd day after catheterization, maximum velocity of right internal jugular vein on the 3rd day after catheterization, mechanical ventilation time, and catheter indwelling time were recorded, and the differences of above indexes between the two groups were compared. Multivariate Logistic regression was performed on the influencing factors with statistical differences between the two groups to establish the nomogram prediction. The receiver operator characteristic curve (ROC curve) and calibration curve were used to evaluate the predictive power of the model.Results:The incidence of central venous CRT in critically ill patients was 16.1% (62/385). Compared with non-thrombosis patients, the thrombosis group patients had higher APACHEⅡscore, the proportion of existing tumor, and D-dimer level on the 3rd day after catheterization [APACHEⅡscore: 17 (15, 19) vs. 15 (12, 18), the proportion of existing tumor: 51.6% (32/62) vs. 35.3% (114/323), D-dimer (mg/L): 0.84 (0.64, 0.94) vs. 0.57 (0.44, 0.76), all P < 0.05], the maximum flow rate of right internal jugular vein was slower on the 3rd day after catheterization [cm/s: 14 (13, 15) vs. 16 (14, 18), P < 0.05]. Univariate analysis showed that high APACHEⅡscore, critical patients with existing tumor, high D-dimer level on the 3rd day after catheterization, and slow maximum flow rate of right internal jugular vein on the 3rd day after catheterization were more likely to develop central venous CRT. Further multivariate Logistic regression analysis showed that high APACHEⅡscore, existing tumor, high D-dimer level on the 3rd day after catheterization and slow maximum flow rate of right internal jugular vein on the 3rd day after catheterization were independent risk factors for central venous CRT in critical patients [odds ratio ( OR) and 95% confidence interval (95% CI) were 0.876 (0.801-0.957), 0.482 (0.259-0.895), 0.039 (0.011-0.139), 1.401 (1.218-1.611), and P values were 0.003, 0.021, < 0.001, < 0.001, respectively]. According to the results of multivariate analysis, the prediction model of the nomogram was constructed. The area under ROC curve (AUC) was 0.820, 95% CI was 0.767-0.872, P < 0.001. The calibration curve showed that the prediction probability of central venous CRT nomogram model in critically ill patients had good consistency with the actual occurrence probability. Conclusions:Existing tumor, high APACHEⅡscore, elevated D-dimer on the 3rd day after catheterization, and decreased maximum velocity of right internal jugular vein on the 3rd day after catheterization are independent risk factors for central venous CRT in critical patients. The prediction model based on the proposed model has good clinical efficacy.

Application research of segmented teaching combined with Kirkpatrick model evaluation in the teaching of PICC specialized nurses / 中华医学教育探索杂志

Objective:To explore the application effect of segmented teaching combined with Kirkpatrick model evaluation in the teaching of specialized nurses of peripherally implanted central venous catheter (PICC).Methods:A total of 60 trainees in the PICC specialized nurse training class in PICC Clinic of Cancer Hospital Affiliated to Nantong University from June 2020 to September 2020 were selected in the study, and they were randomly divided into a control group and a study group, with 30 nurses in each group. The control group conducted traditional training for PICC specialized nurses, and the research group used segmented teaching. After training, the Kirkpatrick model was used to evaluate the response level, learning level, behavior level and result level of the training effect of the two groups of PICC specialized nurses. SPSS 22.0 was used for t test and chi-square test. Results:Through the segmented teaching training, the evaluation results of the Kirkpatrick model showed that the effect of the PICC specialized nurse training was significantly better in the study group than that in the control group in terms of response level, learning level, behavior level and result level. The study group's satisfaction with the training program and teaching content scored higher than that of the control group, with statistically significance ( P<0.001). The research group nurses' mastery of theoretical knowledge and practical skills and humanistic care scores were higher than those of the control group, with significant differences ( P<0.001). After the training, the self-behavior assessment scores of the two groups increased, and the improvement of the research group was more obvious. When the nurses of the research group returned to the hospital clinical work after training, their professional identity, PICC teaching and guidance ability, treatment, nursing service quality, the recognition of patient and family members and the effectiveness of the department were improved to varying degrees, the corresponding measures could be carried out in the hospital, and the development of PICC technology was promoted. Conclusion:The combination of segmented teaching and Kirkpatrick model evaluation can effectively meet the training needs of PICC specialized nurses and make a full range of effect evaluations to improve the quality of PICC specialized nursing services.

Application of family-centered nursing model and home care platform in PICC nursing of elderly tumor patients / 中国实用护理杂志

Objective:To explore the application value of the family-centered nursing model and home care platform in PICC nursing of elderly tumor patients, in order to provide reference for PICC nursing of elderly tumor patients.Methods:A total of 122 elderly tumor patients admitted to Boao Hengda International Hospital, Hainan Province from October 2017 to October 2019 were selected and divided into control group (61 cases) and observation group (61 cases) according to the random number table method. The control group received routine care. The observation group combined family-centered care with home care platform for nursing intervention. Before and 3 months after intervention, the self-management ability, quality of life and mental resilience of the two groups were evaluated by Cancer Patients PICC Self-Management scale(CPPMS), 36-item Short Form Health Survey(SF-36) and Connor-Davidson Resilience Scale(CD-RISC). The incidence of complications during the observation period and service volume was recorded.Results:There was no significant difference in the score of CPPMS,SF-36, CD-RISC before intervention between the two groups( P>0.05). The CPPSM scores of the observation group and the control group after intervention were (144.21±8.93) points and (125.85±10.52) points, the difference was statistically significant ( t value was 10.392, P<0.05). The scores of social function, life vitality, physical pain, physical function, physical role limitation, emotional role limitation, mental health and overall health were (70.34±5.96),(68.27±5.01),(63.46±4.57),(58.53±5.78),(59.74±6.49),(60.32±5.69),(59.83±6.72),(66.58±6.76) points in the observation group, and (65.32±6.04), (65.33±6.57), (58.35±4.92), (54.51±4.82), (55.64±6.12), (54.59±6.42), (55.67±5.06), (62.14±4.77) points in the control group, the differences were statistically significant ( t values were 2.779-5.943, P<0.05). The CD-RISC scores of the observation group and the control group after intervention were (82.41±8.79) points and (73.39±7.64) points, the difference was statistically significant ( t value was 6.049, P<0.05). There was no significant difference in the complication rate between the two groups ( P>0.05). The number of calls, consultations, and door-to-door services were (6.77±1.27), (6.34±1.92), (2.58±0.52) times/person in the observation group, and (4.52± 1.48), (4.06±1.41), (2.03±0.19) times/person in the control group, the difference was statistically significant( t values were 9.011, 7.475, 7.759, P<0.05). Conclusions:Compared with conventional care, the family-centered care model and home care platform have higher application value in elderly patients with PICC oncology, which can effectively improve the PICC management ability and quality of life of patients, and further improve the psychological flexibility. It is worthy of promotion and application.

O uso da lock terapia na prevenção e tratamento de infecção relacionada ao cateter venoso central de longa permanência: revisão integrativa / Using lock therapy to prevent and treat long-term central venous catheter-related infections: an integrative review

Introdução: A lock terapia, ou terapia de bloqueio, consiste na administração e manutenção de uma solução, em concentração supra terapêutica, nos cateteres venosos centrais. Estas soluções combinam antimicrobianos altamente concentrados com um anticoagulante, sendo aplicáveis tanto para a prevenção, quanto para o tratamento da infecção relacionada ao cateter. Objetivo: Sintetizar o conhecimento sobre o uso da lock terapia na prevenção e tratamento de infecção relacionada ao cateter intravascular de inserção central. Método: Revisão integrativa da literatura, sendo a busca realizada nas seguintes bases de dados CINAHL, Cochrane Central, Embase, LILACS, PubMed, Scopus e Web of Science, abrangendo o período de 1 janeiro de 2010 a 3 de março de 2020, sem restrições de idioma. As referências foram exportadas para o gerenciador EndNote e para o Rayyan, para a seleção dos estudos. As etapas de amostragem, categorização dos estudos, avaliação dos estudos incluídos, interpretação dos resultados e síntese do conhecimento foram realizadas por dois revisores de forma independente. Em seguida, foi realizada uma busca manual nas referências dos estudos incluídos. Os dados foram analisados de forma descritiva. Resultados: A amostra compilou 15 estudos. Seis estudos (40%) abordaram o uso da lock terapia como prevenção de infecção relacionada ao cateter venoso central, e nove artigos (60%) abordaram tal terapia como tratamento. Os artigos incluídos nessa revisão que abordaram a prevenção relatam o uso de soluções antimicrobianas não antibióticas (taurolidina (n=2), etanol (n=2), citrato trissódico (n=1) e nitroglicerina (n=1)). Dentre os nove estudos que abordaram a lock terapia como tratamento para a infecção, a maioria (n=7) utilizou soluções antibióticas, (dois estudos avaliaram a eficácia da daptomicina e os outros cinco utilizaram soluções antibióticas variadas). Os outros dois estudos utilizaram soluções antimicrobianas (ácido clorídrico e taurolidina) associadas com antibioticoterapia sistêmica. Dentre os 15 estudos, em apenas um não foi possível especificar a duração da intervenção. Dois avaliaram a eficácia da lock terapia em curta duração (de três a quatro dias) e seis avaliaram em maior duração (entre 10 e 14 dias). Cada estudo especificou uma técnica de intervenção e o tempo de permanência da solução intraluminal. Em relação ao risco de viés, foram avaliados cinco ensaios clínicos randomizados pela ferramenta da Cochrane Risk of Bias (RoB 2), sendo todos de baixo risco. Dois ensaios clínicos sem randomização avaliados pela ferramenta proposta pelo Joanna Briggs Institute (JBI) resultaram em risco de viés baixo. Dentre os oito estudos observacionais, a ferramenta AXIS avaliou sete como sendo de baixo risco e um como risco moderado. Conclusões: Na prevenção identificou-se o uso de antimicrobianos não antibióticos como o etanol. A taurolidina também foi utilizada em um estudo relacionado ao tratamento, em associação com antibioticoterapia sistêmica. Em três estudos sintetizados para as situações de tratamento da infecção relacionada ao cateter, o antibiótico utilizado foi a daptomicina endovenosa. Tais antibióticos sistêmicos, utilizados concomitantemente na maioria dos estudos de tratamento, foram selecionados em conformidade com o resultado da hemocultura e antibiograma

Introduction: Lock therapy, or blockade therapy, is the administration and maintenance of a solution, at a dosage higher than the therapeutic one, in central venous catheters. Blockade solutions combine highly concentrated antimicrobials with an anticoagulant. They can be applied to both prevent and treat catheter-related infections. Objective: To summarize the knowledge about use of lock therapy to prevent and treat intravascular catheter-related infections. Methods: Integrative literature review, whose search was carried out in the databases CINAHL, Cochrane Central, Embase, LILACS, PubMed, Scopus and Web of Science, considering the period from January 1, 2010 to March 3, 2020, without any languages restriction. The references were exported to EndNote and subsequently to Rayyan, so studies could be selected. Sampling, study categorization, study evaluation, interpretation of results, and synthesis of knowledge were executed by two researchers independently and blindly. A manual search was then carried out in the references of the included articles. The data were analyzed descriptively. Results: The final sample was composed of 15 studies. Six studies (40%) addressed the use of lock therapy to prevent central venous catheter-related infections and nine publications (60%) addressed this therapy as a form of treatment. The articles included in this review that addressed prevention reported use of nonantibiotic antimicrobial solutions (taurolidine (n=2), ethanol (n=2), trisodium citrate (n=1), and nitroglycerin (n=1)). Among the nine studies that evaluated lock therapy as a treatment alternative, most (n=7) described the use of antibiotic solutions (two evaluated the effects of daptomycin and five reported the application of varied antibiotic solutions). The other two articles described use of antimicrobial solutions (hydrochloric acid and taurolidine) associated with systemic antibiotic therapy. Among all 15 studies, one did not specify the intervention duration, two assessed the efficacy of lock therapy in the short term (from three to four days), and six assessed it within a longer duration (between 10 and 14 days). Each study specified an intervention technique and length of permanence of the intraluminal solution. Regarding risk of bias, five randomized clinical trials were evaluated with the tool Cochrane Risk of Bias (RoB 2), which indicated all as low risk of bias. Two nonrandomized clinical trials were assessed through the tool proposed by the Joanna Briggs Institute, and resulted in low risk of bias. Among all eight observational studies, the AXIS tool evaluated seven as showing low risk of bias and one as moderate risk of bias. Conclusions: Regarding prevention, the studies reported the use of non-antibiotic antimicrobials such as ethanol. The taurolidine was also mentioned in a study describing therapeutic applications, in combination with systemic antibiotic therapy. In three studies addressing treatment of catheterrelated infections, the antibiotic used were Daptomycin. These systemic antibiotics, which were concomitantly used in most treatment studies, were chosen according to the results of blood culture with antibiogram

Implantação de um protocolo de cateter central de inserção periférica: contribuição dos enfermeiros gestores do processo para a segurança do paciente / Implementation of a peripherally inserted central catheter protocol: contribution of process managers nurses for patient safety

A segurança do paciente é uma das bases de uma organização hospitalar. É um tema de ampla discussão nas últimas décadas em todo o mundo. As crianças estão na linha de frente quando consideramos os fatores de risco para a ocorrência de incidentes. A infecção primária da corrente sanguínea associada a um cateter venoso central é a principal infecção em Unidade de Terapia Intensiva Neonatal. Em uma Unidade de Terapia Intensiva Neonatal, é muito frequente a utilização do cateter central de inserção periférica. Visando a redução da probabilidade de eventos adversos faz-se necessário identificar os erros e melhorar os processos, apontando aspectos do cuidado que podem ser melhorados tornando a assistência aos pacientes mais segura. Os protocolos são ferramentas que contribuem para a sistematização da assistência de enfermagem, favorecendo a melhoria dos processos na busca pela excelência do cuidado. Neste contexto, questiona-se: a implantação de um protocolo de inserção e manutenção do cateter central de inserção periférica pode contribuir para melhorar os processos de segurança do paciente na Unidade de Terapia Intensiva Neonatal de um hospital público em Belo Horizonte? O estudo teve como objetivo implantar o protocolo de inserção e manutenção de cateter central de inserção periférica na Unidade de Terapia Intensiva Neonatal de um hospital municipal de grande porte em Belo Horizonte - Minas Gerais. Metodologia: Para atingir os objetivos propostos, o estudo foi desenvolvido com métodos mistos em três etapas. Na 1ª etapa, por se tratar de busca de significados, optou-se pela pesquisa qualitativa, de natureza descritiva, o método escolhido foi a pesquisa-ação, os participantes foram os enfermeiros da UTIN, como instrumento para a coleta de dados foi escolhida a entrevista semiestruturada e a análise dos dados foi realizada através da análise de conteúdo. Foram realizadas entrevistas com os participantes sobre o conhecimento e contribuições acerca do protocolo de inserção e manutenção de PICC e levantado os pontos críticos do protocolo para serem validados pelos especialistas. Na 2ª etapa, ocorreu a validação do protocolo por enfermeiros juízes especialistas em neonatologia e a 3ª etapa finalizou com a implantação do protocolo de PICC e a elaboração da cartilha com as informações dos participantes e referencial teórico sobre o tema. O produto técnico foi um protocolo revisado e validado por enfermeiros especialistas em neonatologia.

Patient safety is one of the foundations of a hospital organization. It is a topic of wide discussion in the last decades around the world. Children are at the forefront when we consider the risk factors for incidents to occur. Primary bloodstream infection associated with a central venous catheter is the main infection in the Neonatal Intensive Care Unit. In a Neonatal Intensive Care Unit, the use of a peripherally inserted central catheter is very common. Aiming at reducing the probability of adverse events, it is necessary to identify errors and improve processes, pointing out aspects of care that can be improved by making patient care safer. Protocols are tools that contribute to the systematization of nursing care, favoring the improvement of processes in the pursuit of care excellence. In this context, the question is: can the implementation of a protocol for insertion and maintenance of peripherally inserted central catheters contribute to improving patient safety processes in the Neonatal Intensive Care Unit of a public hospital in Belo Horizonte? The study aimed to implement the protocol for insertion and maintenance of peripherally inserted central catheters in the Neonatal Intensive Care Unit of a large municipal hospital in Belo Horizonte - Minas Gerais. Methodology: To achieve the proposed objectives, the study was developed with mixed methods in three stages. In the 1st stage, as it is a search for meanings, qualitative research was chosen, of a descriptive nature, the chosen method was action research, the participants were the NICU nurses, as an instrument for data collection, the semi-structured interview and data analysis was performed through content analysis. Interviews were carried out with the participants about their knowledge and contributions about the insertion and maintenance protocol of the PICC and the critical points of the protocol were raised to be validated by the experts. In the 2nd stage, the protocol was validated by nurse judges specializing in neonatology, and the 3rd stage ended with the implementation of the PICC protocol and the preparation of a booklet with information from the participants and theoretical framework on the subject. The technical product was a protocol revised and validated by specialist nurses in neonatology.

Análisis de parámetros de calidad y de costos, de uso del catéter venoso central de inserción periférica frente al catéter de inserción central, en población pediátrica del Hospital Universitario del Valle, Cali, Colombia. 2011-2014 / Analysis of quality parameters and costs of using the central venous catheter of peripheral insertion versus the central insertion catheter in pediatric patients at Hospital Univeristario Del Valle, Cali Colombia 2011-2014

Objetivo: estimar parámetros de calidad y de costos en el procedimiento de inserción de Catéter Venoso Central y el Catéter Venoso Central de inserción periférica. Metodología: Se evaluaron las historias de niños (edad 31 días -15 años ), que ingresaron al Hospital Universitario del Valle, entre enero de 2011 y diciembre de 2014, que requirieron canalización de una vena central. Se evaluaron variables demográficas, de calidad y se estimaron costos de ambos procedimientos. Resultados: Se evaluaron 100 procedimientos de inserción Central y 100 de inserción periférica, los últimos tuvieron menor tiempo de espera, se realizaron en la habitación, no requirieron ayuno, ni traslado al quirófano, a un menor costo, lo cual impactó la oportunidad de administración de tratamiento farmacológico, la evolución y la estancia hospitalaria. Conclusiones: Se recomienda que el procedimiento de inserción periférica sea la primera elección en niños que requieran tratamientos endovenosos mayores a cinco días, para esto es necesario conformar un grupo que supervise el funcionamiento de los catéteres y brinde educación continua al personal de salud de los servicios de hospitalización y a familiares, contar con una sala de procedimiento para la inserción del PICC que brinde seguridad y adecuado manejo del dolor.

Aim: to estimate quality and cost parameters of central venous catheter insertion peripheral and central venous catheter procedures. Methods: we reviewed records of 200 children (31 days - years old), hospitalised at a University Hospital between January 2011 and December 2014 who required central vein access. We assessed demographic, quality variables and cost of both procedures. Results: we reviewed records of 100 central insertion and 100 peripheral insertion procedures. Peripheral insertions had less waiting time, were conducted next to the child's bed, without need for fasting or transfering to the operating room, at a lower cost, all of these ensured timely administration of medicaments and nutrition, which resulted in lower stance time. The peripheral insertion also freed surgeon and operating room time to perform other interventions. Conclusions: We recommend that peripheral insertion procedure should be the first choice in children requiring intravenous treatments longer than five days. In order to establish a periferal insertion procedure in a hospital, a team is required to follow-up the patients and provide continuing education to health personnel in services and to family members, there is also a need for an appropiate space for insertion procedures and pain management.

Efecto del uso de protectores puerto desinfectantes para la disminución de las bacteriemias asociadas a catéteres venosos centrales / Effect of the use of antiseptic barrier caps for the reduction of bacteremia associated with central venous catheters / Efeito do uso de protetores desinfetantes portuários para a redução da bacteremia associada a cateteres venosos centrais

Resumen Identificar el efecto del uso de protectores puerto desinfectantes en los conectores sin aguja en la disminución de las bacteriemias asociadas a catéter venoso central. Se realizó una revisión rápida de la literatura a través de una búsqueda de artículos en idiomas inglés y español en Pubmed, Medline, Cochrane Library y Science Direct, de diciembre del año 2018 a febrero del año 2019. Esta revisión se centró en identificar ensayos: clínicos aleatorizados, cohorte longitudinal, revisiones sistemáticas y meta-análisis. Los criterios de inclusión fueron: usuarios hospitalizados, desinfección pasiva con protectores puerto desinfectantes y reporte de disminución de las bacteriemias asociadas a catéter venoso central con su uso. Un total de 2479 artículos se identificaron como potencialmente relevantes; después de eliminar los duplicados, quedaron 1622 artículos, los cuales fueron evaluados según título y resumen. Posteriormente, 59 artículos fueron analizados en texto completo; se seleccionaron 3 artículos correspondientes a tres revisiones sistemáticas, de las cuales dos realizaron metaanálisis. La evidencia disponible sugiere que estudios no aleatorizados han demostrado que el uso de los protectores puerto desinfectantes con alcohol isopropílico al 70% en los conectores sin aguja, puede generar una reducción de las bacteriemias asociadas al catéter venoso central y podría considerarse como una medida costo efectiva; no obstante, se requieren estudios aleatorizados que confirmen estos resultados.

Abstract Identify the effect of the use of disinfectant port protectors on needleless connectors in the reduction of bacteraemias associated with central venous catheters. A quick review of the literature was carried out through a search of articles in English and Spanish in Pubmed, Medline, Cochrane Library and Science Direct; from December 2018 to February 2019. It focused on identifying randomized clinical trials, longitudinal cohort, reviews and meta-analysis. The inclusion criteria were: hospitalized users, passive disinfection with disinfectant port protectors and report of decrease in bacteraemias associated with central venous catheter with its use. A total of 2479 articles were identified as potentially relevant, after eliminating duplicates, 1622 articles were evaluated according to inclusion criteria were: hospitalized users, passive disinfection with disinfectant port protectors and report of decrease in bacteraemias associated with central venous catheter with its use. The available evidence suggests that non-randomized studies have shown that the use of disinfectant port protectors with 70% isopropyl alcohol in needleless connectors can lead to a reduction in bacteraemias associated with central venous catheters and could be considered as a cost measure. effective, however, randomized studies are required to confirm these results.

Resumo Identificar o efeito do uso de protetores de porta desinfetantes nos conectores sem agulha na redução de bacteremias associadas aos cateteres venosos centrais. Uma rápida revisão da literatura foi realizada através de uma pesquisa de artigos em inglês e espanhol no Pubmed, Medline, Cochrane Library e Science Direct; de dezembro de 2018 a fevereiro de 2019. Concentrou-se na identificação de ensaios clínicos randomizados, coorte longitudinal, revisões sistemáticas e metanálise. Os critérios de inclusão foram: usuários hospitalizados, desinfecção passiva com protetores de porta desinfetantes e relato de diminuição de bacteremias associadas ao cateter venoso central com seu uso. Um total de 2479 artigos foi identificado como potencialmente relevante; após eliminação de duplicatas, 1622 artigos foram avaliados de acordo com o título e o resumo, depois 59 artigos foram analisados ​​em texto completo, foram selecionados 3 artigos correspondentes a três revisões sistemáticas, dos quais dois realizaram meta-análise. As evidências disponíveis sugerem que estudos não randomizados demonstraram que o uso de protetores de porta desinfetantes com álcool isopropílico a 70% em conectores sem agulha pode levar a uma redução nas bacteremias associadas aos cateteres venosos centrais e pode ser considerado como uma medida de custo. estudos eficazes, no entanto, são necessários para confirmar esses resultados.