ABSTRACT
Resumo OBJETIVO Descrever a implantação de um indicador de qualidade assistencial associado ao diagnóstico de enfermagem de pacientes com alto risco de sangramento, com base nos resultados alarmantes de tempo de protombina (TP), tempo de tromboplastina parcialmente ativada (TTPa) e plaquetas. MÉTODOS Relato de experiência retrospectivo de ações multidisciplinares desenvolvidas em um hospital universitário. As etapas do estudo envolveram reuniões de equipes, busca de estratégias de comunicação efetiva e criação de um novo indicador de qualidade assistencial. RESULTADOS O indicador foi denominado "Conformidade do Diagnóstico de Enfermagem Risco de Sangramento", monitorado mensalmente desde junho de 2016. A ficha técnica contempla as características e atributos do indicador. Com base nas suas análises são estabelecidos planos de ações para sua qualificação. CONCLUSÃO A implantação do indicador de qualidade assistencial associado ao diagnóstico de enfermagem aprimorou o processo de comunicação, monitoramento e cuidado de enfermagem a pacientes com risco de sangramento.
Resumen OBJETIVO Describir la implementación de un indicador de calidad asistencial asociado al diagnóstico de enfermería de pacientes con alto riesgo de sangrado, con base en los resultados alarmantes de tiempo de protombina (Tp), tiempo de tromboplastina parcialmente activada (TTPa) y plaquetas. MÉTODO Relato de experiencia retrospectiva de acciones multidisciplinares desarrolladas en un hospital universitario. Las etapas del estudio involucraron reuniones de equipos, búsqueda de estrategias de comunicación efectiva y creación de un nuevo indicador de calidad asistencial. RESULTADOS El indicador se denominó "Conformidad del Diagnóstico de Enfermería Riesgo de Sangrado", y se monitoreó mensualmente desde junio de 2016. La ficha técnica contempla las características y atributos del indicador. Con base en los análisis del indicador se establecen planes de acción para su cualificación. CONCLUSIÓN La implementación del indicador de calidad asistencial asociado al diagnóstico de enfermería mejoró el proceso de comunicación, el monitoreo y el cuidado de enfermería a pacientes con riesgo de sangrado.
Abstract OBJECTIVE To describe the implantation of a care quality indicator associated to the nursing diagnosis of patients at high risk of bleeding, based on the alarming results of prothrombin time (PT), partially activated thromboplastin time (aPTT) and platelets. METHODS Retrospective experience report of multidisciplinary actions developed in a university hospital. The stages of the study involved team meetings, search for effective communication strategies and creation of a new indicator of quality of care. RESULTS The indicator was called "Compliance of Nursing Diagnosis Risk for bleeding", monitored monthly since June 2016. The technical file includes the characteristics and attributes of the indicator. Based on the analyzes of the indicator, action plans are established for its qualification. CONCLUSION The implementation of the quality of care indicator associated to the nursing diagnosis improved the communication process, the monitoring and the nursing care to patients at risk of bleeding.
Subject(s)
Humans , Male , Female , Infant, Newborn , Adult , Nursing Diagnosis , Quality Indicators, Health Care , Patient Safety , Hemorrhagic Disorders/nursing , Partial Thromboplastin Time , Patient Care Team , Platelet Count , Prothrombin Time , Quality of Health Care , Risk , Retrospective Studies , Interdisciplinary Communication , Hemorrhage/prevention & control , Hemorrhagic Disorders/blood , Hemorrhagic Disorders/epidemiology , Hospitals, UniversityABSTRACT
BACKGROUND/AIMS: This study investigated whether patients with acute promyelocytic leukemia (APL) truly fulfill the diagnostic criteria of overt disseminated intravascular coagulation (DIC), as proposed by the International Society on Thrombosis and Haemostasis (ISTH) and the Korean Society on Thrombosis and Hemostasis (KSTH), and analyzed which component of the criteria most contributes to bleeding diathesis. METHODS: A single-center retrospective analysis was conducted on newly diagnosed APL patients between January 1995 and May 2012. RESULTS: A total of 46 newly diagnosed APL patients were analyzed. Of these, 27 patients (58.7%) showed initial bleeding. The median number of points per patient fulfilling the diagnostic criteria of overt DIC by the ISTH and the KSTH was 5 (range, 1 to 7) and 3 (range, 1 to 4), respectively. At diagnosis of APL, 22 patients (47.8%) fulfilled the overt DIC diagnostic criteria by either the ISTH or KSTH. In multivariate analysis of the ISTH or KSTH diagnostic criteria for overt DIC, the initial fibrinogen level was the only statistically significant factor associated with initial bleeding (p = 0.035), but it was not associated with overall survival (OS). CONCLUSIONS: Initial fibrinogen level is associated with initial presentation of bleeding of APL patients, but does not affect OS.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Biomarkers/blood , Chi-Square Distribution , Disseminated Intravascular Coagulation/blood , Fibrinogen/analysis , Hemorrhagic Disorders/blood , Kaplan-Meier Estimate , Leukemia, Promyelocytic, Acute/blood , Logistic Models , Multivariate Analysis , Proportional Hazards Models , Republic of Korea , Retrospective Studies , Risk FactorsABSTRACT
Se describieron los efectos hemorrágicos, necróticos y edematosos de 135 pacientes provenientes de los estados Miranda, Aragua, Vargas y Distrito Capital, Venezuela, ocasionados por la mordedura de la serpiente cascabel común venezolana (Crotalus durissus cumanensis), durante los años 1998-2008. Los trastornos hemorrágicos, que tradicionalmente eran casi imperceptibles en los Crotalus venezolanos, hemos encontrado que hay evidencias francas de manifestaciones clínicas como: afibrinogenemia, alargamiento del tiempo de coagulación manual (TCM), tiempo parcial de tromboplastina (TTP) y tiempo de protrombina (TP), lo cual indica la presencia de estas fracciones hemorrágicas en el veneno de cascabeles nacionales. Se apreciaron diferencias entre ambos sexos, siendo predominante en el sexo masculino (82%). Sin embargo ha habido un aumento de incidencia significativa en el sexo femenino (17%). Por grupo etario, se observó predominancia entre 11 a 30 años de edad, en ambos sexos. El sitio de mordedura mayormente afectado fue el miembro superior (58,5%), con un porcentaje no menos significativo de miembros inferiores (40,7%). Estos hallazgos, permiten sugerir que el veneno de algunas serpientes cascabeles comunes en Venezuela, poseen un efecto sistémico sobre el músculo esquelético, y también efectos sobre capilares que generan edema, fenómenos hemorrágicos y necrosis, que habían pasado desapercibidos.
The bleeding, necrotic and edematous Snake bite effects from 135 patients of Miranda, Aragua, Vargas States and Capital District (Venezuela), caused by the Venezuelan common rattlesnake (Crotalus durissus cumanensis) from 1998 to 2008 were described. In bleeding disorders, which traditionally were almost imperceptible in Venezuelan Crotalus, we have found reliable evidence of clinical manifestations such as: afibrinogenemia, lengthening of the manual time of coagulation (MTC), and Partial Time of Thromboplastin (PTT) and Prothrombin time (PT), which indicates the presence of hemorrhagic fractions in the Venezuelan rattlesnakes venoms. There were differences between the sexes, still predominant in male (82%). However, there has been an increase of significant impact on female (17%). By age, there was prevalence between 11 and 30 years old, both male and female. The mostly affected bite si te was upper limb (58,5%), with a no less significant percentage of lower limbs (40,7%). These findings, allowed us to suggest that some rattlesnake venoms have a systemic effect on skeletal muscle, and also effects on capillaries that generate swelling, hemorrhagic phenomena and necrosis.
Subject(s)
Humans , Animals , Male , Female , Snakes/classification , Crotalid Venoms/analysis , Afibrinogenemia/metabolism , Hemorrhagic Disorders/blood , Partial Thromboplastin Time , Poisons/toxicity , Prothrombin Time , Public HealthABSTRACT
One of the main indication of blood transfusion is to increase the transport of oxygen to tissue. Blood may be affected by storing. Sixty patients elected for major operations under general anesthesia was divided into 2 groups, 30 patients in each group. The patients of the 1st group aged 25-35 years, the patients of the 2nd group aged 65-75 years. Each group was subdivided into 2 subgroups, 15 patients in each. All patients received blood transfusion which was fresh in one subgroup and stored in the other. The bleeding time, clotting time, platelet count, prothrombin time, partial thromboplastin time, oxygen saturation and PH were measured. The results of this study showed that fresh blood tranfusion is more benifical than stored blood specially in geriatric patients
Subject(s)
Humans , Hemorrhagic Disorders/blood , Acid-Base Equilibrium , Metabolism , Anesthesia, GeneralABSTRACT
Hemostatic profile was studied in 25 full term, non-asphyxiated neonates with blood culture-proven septicemia. Nine (36%) of these neonates manifested bleeding. Detailed coagulation tests and platelet studies were deranged in 24 (96%) of neonates with septicemia. Abnormalities in coagulation tests did not differ in those with and without bleeding. Only platelet aggregation with ADP was deranged to a significantly greater extent in those with bleeding as compared with those without bleeding.
Subject(s)
Bacteremia/blood , Blood Coagulation Tests , Gastrointestinal Hemorrhage/blood , Hematuria/blood , Hemorrhagic Disorders/blood , Hemostasis/physiology , Humans , Infant, NewbornABSTRACT
El propósito del presente trabajo es proporcionar información sobre el comportamiento del F VIII plasmático en 181 pacientes con antecedentes hemorragíparos de la IX región, estudiados en nuestro laboratorio entre los años 1983 y 1987; además presentar la frecuencia de la enfermedad de Von Willebrand (EvW) en relación a las otras coagulopatías. Los paràmetros de laboratorio que analizamos fueron: T.S.Ivy, F VIII:C, FvW:Ag y F VIII:CoR. Obtuvimos un 72,4% de pacientes con alteraciones en los estudios. De este grupo, 84,7% correspondió a EvW, 12,2% a Hemofilias y 3,1% a disfunción plaquetaria mínima. Del grupo vW (n=111) el 46,8% correspondió a adultos y 53,2% a niños. Encontramos el T.S. prolongado 86,5% en adultos y 84,8% en niños; F VIII:C disminuido en adultos y niños 57,7% y 50,9%, respectivamente; FvW:Ag disminuido en ambos grupos 53,8 y 52,5%; F VIII:CoR disminuido 75% adultos y 71,2% niños. Aplicamos el coeficiente de Pearson revelando correlación significativa (p<0,01), en relación al F VIII:C/FvW:Ag y T.S./F VIII:CoR en adultos; hubo sólo correlación entre el estudio del F VIII:C/FvW:Ag en los niños. Concluimos que la EvW es la afección hereditaria de la hemostasis más frecuente, presentando gran variabilidad los resultados de los exámenes, por lo que es fundamental realizar el estudio del F VIII completo para lograr un diagnóstico inequívoco de laboratorio en este grupo de pacientes