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1.
Med. infant ; 27(2): 152-156, Diciembre 2020. ilus, Tab
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-1150596

ABSTRACT

Introducción: La cateterización venosa central es un procedimiento usual en Unidades de Cuidados Intensivos (UCI). El ultrasonido (US) para guiar la cateterización, ofrece ventajas, permitiendo tener una imagen topográfica precisa del vaso, reduciendo las complicaciones, el tiempo y el número de punciones. Objetivo: determinar, si la US en la colocación de catéteres venosos centrales (CVC), podría disminuir el número de punciones y lograr la cateterización exitosa. Población y métodos: Estudio descriptivo, prospectivo de los CVC colocados mediante punción guiada por US, en una UCI polivalente del Hospital de Pediatría Juan P. Garrahan, entre el año 2018 al 2019. Población: pacientes de 1 mes a 18 años que requirieron colocación de un CVS por US. Se consideró significativo un valor de p< 0.05. Resultados: VYI en 66 pacientes (43,5%), VF fue en 86 pacientes (56,5%). 86 (56,5%) CVC, fueron insertados en el primer intento y 66 (43,5%), requirieron más de un intento. Las inserciones en VYI fueron exitosas en el primer intento en 46 pac. (53,5%) 20 pac. requirieron más de un intento (30,3%) p 0,004 OR 0,37 (IC 95% 0,18-0,78. En <6 meses los CVC colocados en VYI tuvieron menos riesgo de requerir más de un intento, con respecto a aquellos en los cuales se eligió la VF, p 0,0026 OR 0,31 (IC 95% 0,12 -0,75). 5,2% presentaron complicaciones, no hubo mortalidad relacionada al procedimiento. Conclusiones: La inserción de CVC guiados por US fue segura y significativamente exitosa en el primer intento cuando el vaso de elección fue la VYI, especialmente en < 6 meses (AU)


IIntroduction: Central venous catheterization is a common procedure in intensive care units (ICU). The use of ultrasound (US) to guide catheterization offers advantages, allowing for an accurate topographic image of the vessel, reducing complications as well as time and number of punctures. Objective: To determine whether the use of US for the placement of central venous catheters (CVCs) may decrease the number of punctures and achieve successful catheterization. Patients and methods: A descriptive, prospective study was conducted of CVCs placed by US-guided puncture at a general ICU of Hospital de Pediatría Juan P. Garrahan between 2018 and 2019. Patients from 1 month to 18 years of age who required US-guided placement of a CVC were included. A p< 0.05 was considered significant. Results: The internal jugular vein (IJV) was used in 66 (43.5%) and the femoral vein (FV) in 86 patients (56.5%). Overall, in 86 (56.5%) CVC were inserted on the first attempt and 66 (43.5%) required more than one attempt. Insertions into the VYI were successful on the first attempt in 46 (53.5%) patients and 20 (30.3%) patients required more than one attempt, p 0.004; OR 0.37 (95% CI 0.18-0.78). In patients <6 months CVCs placed in the IJV had a lower risk of requiring more than one attempt compared to those in which the FV was chosen, p 0.0026 OR 0.31 (95% CI 0.12 -0.75). Complications occurred in 5.2%; no procedure-related mortality was observed. Conclusions: US-guided insertion of CVC was safe and significantly successful on the first attempt when the vessel of choice was the IJV, especially in patients < 6 months (AU)


Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Catheterization, Central Venous/adverse effects , Catheterization, Central Venous/methods , Intensive Care Units, Pediatric , Ultrasonography, Interventional/instrumentation , Ultrasonography, Interventional/methods , Central Venous Catheters , Prospective Studies , Femoral Vein , Jugular Veins
2.
Rev. bras. anestesiol ; 69(4): 413-416, July-Aug. 2019. graf
Article in English | LILACS | ID: biblio-1042008

ABSTRACT

Abstract Background and objectives Ultrasound-guided internal jugular vein catheterization is a common and generally safe procedure in the operating room. However, inadvertent puncture of a noncompressible artery such as the subclavian artery, though rare, may be associated with life-threatening sequelae, including hemomediastinum, hemothorax, and pseudoaneurysm. Case report We describe a case of the successful endovascular repair of right subclavian artery injury in a 75-year-old woman. Subclavian artery was injured secondary to ultrasound-guided right internal jugular vein catheterization under general anesthesia for orthopedic surgery. Conclusion Under general anesthesia several factors such as hypotension can mask the signs of subclavian artery injury. This case report indicates that clinicians should be aware of the complications of central venous catheterization and take prompt action.


Resumo Justificativa e objetivos A cateterização da veia jugular interna guiada por ultrassom é um procedimento comum e geralmente seguro em sala cirúrgica. No entanto, a punção inadvertida de uma artéria não compressível, como a artéria subclávia, embora rara, pode estar associada a sequelas e risco para vida, incluindo hemomediastino, hemotórax e pseudoaneurisma. Relato de caso Descrevemos um caso bem-sucedido da correção endovascular de lesão da artéria subclávia direita em uma paciente de 75 anos. A artéria subclávia foi lesionada após cateterização guiada por ultrassom da veia jugular interna direita sob anestesia geral para cirurgia ortopédica. Conclusão Sob anestesia geral, vários fatores, como a hipotensão, podem mascarar os sinais de lesão da artéria subclávia. Este relato de caso indica que os médicos devem estar cientes das complicações da cateterização venosa central e tomar medidas imediatas.


Subject(s)
Humans , Female , Aged , Subclavian Artery/injuries , Catheterization, Central Venous/adverse effects , Vascular System Injuries/etiology , Endovascular Procedures/methods , Catheterization, Central Venous/methods , Ultrasonography, Interventional/methods , Orthopedic Procedures/methods , Jugular Veins/diagnostic imaging
3.
Rev. bras. enferm ; 72(3): 774-779, May.-Jun. 2019. tab, graf
Article in English | LILACS, BDENF | ID: biblio-1013555

ABSTRACT

ABSTRACT Objective: To evaluate the compliance of the care process involving insertion of central vascular catheter (CVC) in hemodialysis. Method: Cross-sectional quantitative approach developed at the hemodialysis service of a reference hospital in Sergipe, Brazil. Sample consisting of 1,342 actions evaluated, corresponding to 122 forms for monitoring and control of CVC insertion. Data collection was held from July to December 2016. Results: The adherence rate to the use of the insertion form was 54.9%. The procedure evaluated achieved 93% overall compliance. Of the 11 specific actions observed, seven (64%) presented 100% compliance. The density of the overall incidence of primary bloodstream infections reduced from 10.6 to 3.1 infections per 1,000 patients/day. Conclusion: Although the observed actions reached specific desired conformities, the use of the checklist was lower than expected. Strategies for monitoring, coaching and educational and organizational actions can contribute to safe care.


RESUMEN Objetivo: Evaluar la conformidad del proceso asistencial relacionada a inserción del catéter venoso central(CVC) en hemodiálisis. Método: Enfoque cuantitativo, corte transversal, realizado en el servicio de hemodiálisis de un hospital de referencia del estado de Sergipe, Brasil. Muestra constituida por 1342 acciones evaluadas, que corresponden a 122 formularios para monitoreo y control de la inserción de CVC. La recolección de datos fue realizada de julio a diciembre del 2016. Resultados: La tasa de adhesión al uso del formulario de inserción fue del 54,9%. El procedimiento evaluado obtuvo un 93% de conformidad general. De 11 acciones específicas observadas,7(64%) presentaron 100% de conformidad. Se observó reducción en la incidencia global de infecciones primarias de corriente sanguínea de 10,6 para 3,1 por 1000 pacientes/día. Conclusión: Aunque las acciones observadas tuvieron conformidades específicas, el uso de la lista de verificación fue inferior a lo esperado. Estrategias para monitoreo, coaching y acciones educativas podrian contribuir para una asistencia segura.


RESUMO Objetivo: Avaliar a conformidade do processo assistencial envolvendo a inserção do cateter vascular central (CVC) em hemodiálise. Método: Abordagem quantitativa, de corte transversal, desenvolvida no serviço de hemodiálise de um hospital de referência do estado de Sergipe, Brasil. Amostra constituída por 1.342 ações avaliadas, correspondendo a 122 formulários para monitoramento e controle da inserção de CVC. A coleta de dados ocorreu de julho a dezembro de 2016. Resultados: A taxa de adesão ao uso do formulário de inserção foi de 54,9%. O procedimento avaliado alcançou 93% de conformidade geral. Das 11 ações específicas observadas, sete (64%) apresentaram 100% de conformidade. Observou-se redução da densidade de incidência global das infecções primárias da corrente sanguínea de 10,6 para 3,1 infecções por 1.000 pacientes/dia. Conclusão: Apesar das ações observadas alcançarem conformidades específicas desejadas, a utilização do checklist foi aquém do esperado. Estratégias para monitoramento, coaching e ações educativas e organizacionais podem contribuir para uma assistência segura.


Subject(s)
Humans , Male , Female , Adult , Infection Control/standards , Guideline Adherence/standards , Central Venous Catheters/adverse effects , Quality Assurance, Health Care/methods , Brazil , Catheterization, Central Venous/adverse effects , Catheterization, Central Venous/methods , Cross-Sectional Studies , Renal Dialysis/instrumentation , Renal Dialysis/methods , Infection Control/statistics & numerical data , Guideline Adherence/statistics & numerical data , Central Venous Catheters/statistics & numerical data
4.
Rev. méd. Chile ; 147(4): 458-464, abr. 2019. tab
Article in Spanish | LILACS | ID: biblio-1014247

ABSTRACT

Background: Placing central venous lines under ultrasonographic guidance reduces the complications of the procedure. Aim: To compare prevalences of complications of central venous line placements with or without ultrasonographic guidance. Material and Methods: Descriptive study that contemplated the comparison of two groups of patients subjected to a central venous line placement at a nephrology service for renal replacement therapy. In one group of 100 patients, the line was placed without ultrasonographic guidance between 2008 and 2012. Between 2015 and 2017 the line was placed in 138 patients using ultrasonographic guidance. The prevalences of complications with both types of procedures were recorded. Results: The frequency of complications of procedures with and without ultrasonographic guidance was 0.7 and 18% respectively (prevalence ratio 0.04, 95% confidence interval 0-0.3). Ninety five percent of recorded complications were arterial puncture, followed by hematomas in 10% and pneumothorax in 5%. The higher prevalence of complications was observed in emergency line placement without ultrasonographic guidance. There was a direct association between the number of line placement attempts in a single procedure and the prevalence of complications. Conclusions: Ultrasonographic guidance is associated with a reduction in the prevalence of central venous line complications.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Catheterization, Central Venous/adverse effects , Renal Dialysis/adverse effects , Central Venous Catheters/adverse effects , Intraoperative Complications/etiology , Intraoperative Complications/epidemiology , Pneumothorax/etiology , Pneumothorax/epidemiology , Catheterization, Central Venous/instrumentation , Catheterization, Central Venous/methods , Chile/epidemiology , Prevalence , Cross-Sectional Studies , Renal Dialysis/instrumentation , Renal Dialysis/methods , Ultrasonography, Interventional/methods , Sex Distribution , Hematoma/etiology , Hematoma/epidemiology
5.
J. bras. nefrol ; 41(1): 89-94, Jan.-Mar. 2019. tab, graf
Article in English | LILACS | ID: biblio-1002420

ABSTRACT

Abstract Introduction: Vascular access (VA) in hemodialysis (HD) is essential to end-stage renal disease (ESRD) patients survival. Unfortunately, after some years in HD program, a significant number of patients may develop VA failure for many reasons. In this situation, arterial venous fistula (AVF) confection or catheters placement in traditional vascular sites (jugular, femoral or subclavian) are not feasible. In this scenario, translumbar tunneled dialysis catheter (TLDC) may be a salvage option. Objectives: To describe placement technic, complications, and patency of 12 TLDC. Methods: A retrospective study was performed to analyze 12 TLDC placement in an angiography suite using fluoroscopic guidance at the University Hospital of the Rio Grande do Norte Federal University from January 2016 to October 2017. The data collected of the total procedures performed consisted of demographic characteristics, success rates, observed complications, patient survival, and catheter patency. Results: All 12 TLDC were placed with success; there were only 2 significant periprocedure complications (major bleeding and extubation failure); 41.6% of patients presented a catheter-related first infection after 98 ± 72.1 (6-201) days, but catheter withdrawal was not necessary, mean total access patency was 315.5 (range 65 - 631) catheter-days, and catheter patency at 3, 6 and 12 months was 91 %, 75%, and 45%. Conclusion: TLDC is an option for patients with VA failure, improving survival and acting as a bridge for renal transplantation.


Resumo Introdução: O acesso vascular (AV) para hemodiálise (HD) é crucial para os pacientes portadores de doença renal crônica (DRC) estágio V. Infelizmente, com o passar dos anos, um percentual não desprezível desses enfermos evolui para falência de AV por diversos motivos, o que impossibilita a confecção de novas fístulas arteriovenosas (FAV) ou o implante de cateteres venosos centrais nos sítios de punções tradicionais. Nesse cenário, o implante de cateteres translombares para hemodiálise (CTLHD) em veia cava inferior ganha destaque como medida salvadora. Objetivos: Relatar uma série de 12 casos de implante de CTLHD, sua técnica de implante, patência e complicações. Métodos: Estudo retrospectivo que analisou 12 implantes de CTLHD por radiologista intervencionista no setor de hemodinâmica do Hospital Universitário da Universidade Federal do Rio Grande do Norte (UFRN), no período de janeiro/2016 a outubro/2017. Os dados coletados consistiram em: características demográficas da população estudada, taxa de sucesso, complicações observadas, sobrevida dos pacientes, patência do cateter e desfechos clínicos. Resultados: Todos os 12 CTLHD foram implantados e utilizados com sucesso; ocorreram apenas 2 complicações associadas ao procedimento (sangramento e falha na extubação); 41,6% dos pacientes apresentaram infecção relacionada ao cateter após 98 ± 72,1 dias (6-201 dias), mas não houve necessidade de remoção; e a patência foi de 315,5 cateteres-dia (65-631 dias). Conclusão: O CTLHD é uma opção para pacientes com falência de acesso vascular, prolongando a sobrevida dos pacientes e atuando como ponte para o transplante renal.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Vascular Diseases/etiology , Vena Cava, Inferior/surgery , Catheterization, Central Venous/methods , Catheters, Indwelling/adverse effects , Renal Dialysis , Central Venous Catheters/adverse effects , Kidney Failure, Chronic/therapy , Lumbosacral Region/blood supply , Fluoroscopy , Feasibility Studies , Retrospective Studies , Arteriovenous Fistula/complications , Kidney Transplantation , Treatment Outcome , Hemorrhage/etiology
6.
Rev. bras. enferm ; 72(1): 50-56, Jan.-Feb. 2019. tab
Article in English | LILACS, BDENF | ID: biblio-990652

ABSTRACT

ABSTRACT Objective: To investigate the factors that influence the knowledge and behavior of professionals of neonatal and pediatric units about bundled strategies of insertion of central venous catheter. Method: This is a cross-sectional study, conducted in one neonatal and one pediatric intensive care units in a public hospital in Belo Horizonte, Brazil, from April to July, 2016. The sample consisted of 255 professionals who answered a structured instrument. Descriptive and comparative analyses were made using the SPSS software. Results: The category nursing professional (p = 0.010), working hours of 12×36 scale (p < 0.001), training as a form of acquiring knowledge (p < 0.001) and participation in training programs (p < 0.001) are associated to greater knowledge about the bundle. Regarding behavior, no significant associations were observed. Conclusion: The study showed that there are factors that influence the knowledge about bundled strategies of insertion of central venous catheter, reflecting the need to consider these practices for making more effective educational practices in health care.


RESUMEN Objetivo: Investigar los factores que influencian el conocimiento y comportamiento de los profesionales de unidades neonatales y pediátricas sobre el bundle de inserción del catéter venoso central. Método: Estudio transversal que se realizó en dos unidades de terapia intensiva neonatal y pediátrica de un hospital público de Belo Horizonte, en el período de abril a julio de 2016. La muestra se constituyó de 255 profesionales, que respondieron a un instrumento estructurado. Se realizaron análisis descriptivos y comparativos por medio del software SPSS. Resultados: La categoría profesional de enfermero (p = 0,010), la jornada de trabajo de 12 × 36 horas (p < 0,001), el entrenamiento como forma de adquisición del conocimiento (p < 0,001) y la participación en entrenamientos (p < 0,001) se asocian al mayor conocimiento sobre el bundle. En cuanto al comportamiento, no se observaron asociaciones significativas. Conclusión: Se ha revelado que existen factores que influencian el conocimiento sobre el bundle de inserción de catéter central, reflejando la necesidad de considerarlos para la realización de prácticas educativas más efectivas en salud.


RESUMO Objetivo: Investigar os fatores que influenciam o conhecimento e comportamento dos profissionais de unidades neonatais e pediátricas sobre o bundle de inserção do cateter venoso central. Método: Estudo transversal, realizado em duas unidades de terapia intensiva neonatal e pediátrica de um hospital público de Belo Horizonte, no período de abril a julho de 2016. A amostra constituiu-se de 255 profissionais, que responderam a um instrumento estruturado. Foram realizadas análises descritivas e comparativas por meio do software SPSS. Resultados: A categoria profissional de enfermeiro (p = 0,010), a jornada de trabalho de 12×36 horas (p < 0,001), o treinamento como forma de aquisição do conhecimento (p < 0,001) e a participação em treinamentos (p < 0,001) estão associados ao maior conhecimento sobre o bundle. Quanto ao comportamento, não se observou associações significativas. Conclusão: Revelou-se que existem fatores que influenciam o conhecimento sobre o bundle de inserção de cateter central, refletindo a necessidade de considerá-los para a realização de práticas educativas mais efetivas em saúde.


Subject(s)
Humans , Male , Female , Adult , Aged , Catheterization, Central Venous/methods , Health Knowledge, Attitudes, Practice , Patient Care Bundles/standards , Brazil , Catheterization, Central Venous/instrumentation , Catheterization, Central Venous/trends , Intensive Care Units, Pediatric/organization & administration , Intensive Care Units, Pediatric/trends , Cross-Sectional Studies , Surveys and Questionnaires , Clinical Competence/standards , Patient Care Bundles/methods , Middle Aged
7.
Revista Digital de Postgrado ; 8(3): e165, 2019. tab
Article in Spanish | LILACS, LIVECS | ID: biblio-1049952

ABSTRACT

La inserción del catéter venoso central (CVC) ha significado un gran avance en la medicina moderna y su uso generalizado ha permitido el desarrollo de nuevas técnicas diagnósticas y tratamientos especializados. En este estudio se dan a conocer las indicaciones presentes al momento de colocar el catéter venoso central y el tiempo de colocación en los pacientes. Métodos: La investigación fue de tipo retrospectivo, descriptivo y de corte transversal, con un diseño de investigación no experimental y tuvo la finalidad de conocer, en forma directa, la realidad de la problemática. Las unidades de observación fueron(188) historias clínicas de los pacientes que ingresaron en el servicio de medicina interna en el hospital Miguel Pérez Carreño en el periodo comprendido entre enero y abril de 2017. Resultados: El 68% de la indicación del catéter venoso central es para la medición de la presión venosa central (PVC) y control de líquidos, mientras que en el 32% la indicación fue por administración de fármacos. El tiempo de colocación tuvo un predominio del 61% de los pacientes que utilizaron el catéter venoso central durante 1 a 3 semanas, en segundo lugar, el 36% utilizo el catéter por unos días, solo un 3% amerito el uso del catéter venoso central durante 1 mes. Conclusiones: La mayoría de los pacientes estudiados tuvieron como principal indicación de CVC para control de líquido y medición de presión venosa central. Con una duración de 1 a 3 semanas(AU)


The insertion of the central venous catheter (CVC) has meant a great advance in modern medicine and its widespread use has allowed the development of new diagnostic techniques and specialized treatments. In this study we present the indications present at the moment of placing the central venous catheter and the time of use in patients. Methods: The research was of a retrospective, descriptive and cross-sectional type, with a non-experimental research design and aimed to know, in a direct way, the reality of the problem. The units of observation were (188) clinical records of patients admitted to the internal medicine service in the hospital Miguel Pérez Carreño in the period between January and April 2017. Results: 68% of the indication of the central venous catheter is for the measurement of central venous pressure (CVP) and fluid control, while in 32% the indication was for drug administration. The time of use had a predominance of 61% of patients who used the central venous catheter for 1 to 3 weeks, secondly, 36% used the catheter for a few days, only 3% required the use of the central venous catheter for 1 month. Conclusions: The majority of patients studied had CVC as main indication for fluid control and central venous pressure measurement. With a duration of 1 to 3 weeks(AU)


Subject(s)
Humans , Male , Female , Adolescent , Catheterization, Central Venous/methods , Central Venous Pressure , Time Management/methods , Catheter-Related Infections/microbiology , Central Venous Catheters/adverse effects , Medical Records/statistics & numerical data , Retrospective Studies , Vascular Access Devices , Hospitalization
8.
Revista Digital de Postgrado ; 8(3): e167, 2019. graf
Article in Spanish | LILACS, LIVECS | ID: biblio-1087875

ABSTRACT

La utilización de catéter venoso central produce, en ocasiones, infecciones de tipo local o sistémico, como la bacteriemia no complicada o complicada (bacteriemia persistente, tromboflebitis séptica, endocarditis y otras complicaciones metastásicas). En este estudio se dan a conocer las infecciones ocasionadas por el uso de Catéter Venoso Central (CVC), así como los microorganismos presentes en los pacientes. Métodos: La investigación fue de tipo retrospectivo, descriptivo y de corte transversal, con un diseño de investigación no experimental y tuvo la finalidad de conocer, en forma directa, la realidad de la problemática. Las unidades de observación fueron (188) historias clínicas de los pacientes que ingresaron en el servicio de medicina interna en el hospital Miguel Pérez Carreño en el periodo comprendido entre enero y abril de 2017. Resultados: En 30 de los pacientes se realizó el cultivo de la punta del catéter venoso central. En el 67% no hubo crecimiento de microorganismos, mientras que el 33% crecieron microorganismos a las 24 horas. El 80% de las muestras cultivadas reportan la presencia de Cocos Gram positivos. Un 10% reportaron enterobacterias y un 10% reportan levaduras, finalmente con menor frecuencia pseudomona con un 0%. Conclusiones: Solo 78 pacientes ameritaron la colocación de un catéter venoso central, de los cuales se cultivaron 30 puntas de catéter, encontrándose que solo 10 de las puntas de catéteres dieron positivas para infección con crecimiento bacteriano a las 24 horas, siendo los cocos Gram positivos la principal bacteria aislada en los pacientes con CVC seguidos de enterobacterias(AU)


Intravascular catheterization is used for hemodynamic monitoring, hemodialysis, metabolic and nutritional support, fluid administration, chemotherapy and prolonged antibiotic therapy, blood and derivatives, among others. In this study, infections caused by the use of (CVC) central venous catheter are reported, as well as the microorganisms present in patients. Methods: The research was of a retrospective, descriptive and cross-sectional type, with a non-experimental research design and aimed to know, in a direct way, the reality of the problem. The observation units were (188) clinical records of the patients admitted to the internal medicine service at the Miguel Pérez Carreño Hospital in the period between January and April 2017. Results In 30 of the patients, the culture of the tip of the central venous catheter. In 67% there was no growth of microorganisms, while 33% grew microorganisms at 24 hours. 80% of the cultivated samples report the presence of Gram-positive cocci. 10% reported enterobacteria and 10% reported yeast, finally with less frequency pseudomonas with 0%. Conclusions: Only 78 patients required placement of a central venous catheter, of which 30 catheter tips were cultured, finding that only 10 of the catheter tips were positive for infection with bacterial growth at 24 hours, with Gram-positive cocci. the main bacteria isolated in patients with CVCfollowed by enterobacteria(AU)


Subject(s)
Humans , Adolescent , Adult , Thrombophlebitis/diagnosis , Catheterization, Central Venous/methods , Gram-Positive Cocci , Endocarditis/diagnosis , Catheter-Related Infections/microbiology , Central Venous Catheters/adverse effects , Bacterial Infections , Medical Records/statistics & numerical data , Cross Infection/epidemiology , Retrospective Studies
9.
Rev. bras. ter. intensiva ; 30(4): 436-442, out.-dez. 2018. tab
Article in Portuguese | LILACS | ID: biblio-977982

ABSTRACT

RESUMO Objetivo: Determinar os fatores de risco para contrair infecções da corrente sanguínea associadas a cateter de acesso central em unidades de terapia intensiva pediátrica, e investigar a incidência e a etiologia dessas infecções nas unidades de terapia intensiva pediátrica com diferentes perfis. Métodos: Este foi um estudo prospectivo de coorte, conduzido em três hospitais. Um deles é um grande hospital público metropolitano, com duas unidades de terapia intensiva pediátrica que contabilizam 19 leitos; o segundo é um hospital regional com oito leitos em unidade de terapia intensiva pediátrica; e o terceiro é um hospital privado com 15 leitos de terapia intensiva pediátrica. Incluíram-se pacientes com idades entre 1 mês e 18 anos, que utilizaram cateter de acesso venoso central por pelo menos 24 horas. Registramos a evolução diária dos pacientes. Colheram-se dados gerais sobre o paciente e sobre o cateter, utilizados como variáveis. Todos os dados foram analisados com utilização do pacote estatístico Statistical Package for Social Science (SPSS), versão 13.0, para comparação de pacientes com infecção da corrente sanguínea associada a cateter com ou sem fatores de risco. Resultados: Durante o período do estudo admitiram-se às unidades de terapia intensiva 728 pacientes; deles, 170 tiveram cateter de acesso venoso central instalado por, no mínimo, 24 horas. A mediana de idade foi de 32 meses, e 97 (57%) dos pacientes eram do sexo masculino. A taxa de incidência de infecções da corrente sanguínea relacionadas a cateter foi de 3,9/1.000 cateteres venosos centrais-dias. A incidência variou entre os hospitais, sendo de 1,6 a 6,6. A taxa geral de mortalidade foi de 11,1%, e as taxas de mortalidade com e sem infecções da corrente sanguínea relacionadas a cateter foram, respectivamente, de 12,9% e 10,7%. Na análise multivariada, os fatores de risco para ocorrência de infecções da corrente sanguínea relacionadas a cateter foram maior tempo de uso do cateter venoso central (OR: 1,07; IC95% 1,00 - 1,14; p = 0,019) e o uso de mais de um cateter venoso central de uma vez (OR: 2,59; IC95% 1,17 - 5,73; p = 0,048). Conclusão: Maior duração do uso de cateter venoso central e mais de um cateter venoso central de uma vez foram os principais fatores de risco para infecções da corrente sanguínea associadas a cateter em unidades de terapia intensiva pediátrica.


ABSTRACT Objectives: To determine the risk factors for acquiring central line-associated blood stream infections (CLABSI) in pediatric intensive care units and to investigate the incidence and etiology of CLABSI in pediatric intensive care units with different profiles. Methods: The study was a prospective cohort study in three hospitals. One of the hospitals is a large metropolitan public hospital with two pediatric intensive care units and a total of nineteen pediatric intensive care unit beds, another is a regional hospital with eight pediatric intensive care unit beds, and the third is a private hospital with fifteen beds. Patients between the ages of 1 month old and 18 years old who used a central venous catheter for over 24 hours were included. We recorded patients' daily progress. General patient and catheter-related data were collected and used as variables. All the data were analyzed using Statistical Package for Social Science (SPSS), version 13.0, to compare patients with CLABSI with or without risk factors. Results: A total of 728 patients were admitted to the pediatric intensive care units, and 170 had a central line in place for at least 24 hours. The median age was 32 months, and 97 (57%) of the patients were males. The CLABSI incidence rate was 3.9/1000 central venous catheter-days. The incidence among hospitals varied from 1.6 to 6.6. The overall mortality rate was 11.1%, and the CLABSI and non-CLABSI mortality rates were 12.9% and 10.7%, respectively. In multivariate analysis, independent risk factors for CLABSI were a longer duration of central venous catheter use (OR: 1.07; 95%CI 1.00 - 1.14; p = 0.019) and the use of more than one central venous catheter at once (OR: 2.59; 95%CI 1.17 - 5.73; p = 0.048). Conclusion: A longer duration of central venous catheter use and the use of more than one central venous catheter at once were the main risk factors for CLABSI in pediatric intensive care units.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Catheterization, Central Venous/adverse effects , Intensive Care Units, Pediatric , Catheter-Related Infections/epidemiology , Central Venous Catheters/adverse effects , Time Factors , Catheterization, Central Venous/methods , Incidence , Multivariate Analysis , Prospective Studies , Risk Factors , Cohort Studies , Catheter-Related Infections/etiology , Catheter-Related Infections/mortality
10.
J. vasc. bras ; 17(4): 322-327, out.-dez. 2018. ilus
Article in Portuguese | LILACS | ID: biblio-969136

ABSTRACT

Complicações relacionadas ao acesso venoso cervicotorácico, como os pseudoaneurismas (PAs), podem ser devastadoras. Neste artigo, apresentamos dois casos semelhantes em que o avanço tecnológico impactou no diagnóstico, tratamento e resultados. Ambos pacientes apresentaram volumoso PA após a tentativa de punção venosa profunda. O primeiro caso, em 1993, diagnosticado por duplex scan , revelou grande PA oriundo da artéria subclávia direita. A artéria foi abordada por esternotomia mediana com extensão supraclavicular. O PA originava-se do tronco tireocervical, tratado com simples ligadura. No segundo caso, em 2017, angiotomografia revelou um PA originário da artéria vertebral, que foi tratado com técnica endovascular, mantendo a perviedade do vaso. Ambos evoluíram satisfatoriamente, apesar de abordagens bastante diferentes. A lesão vascular cervicotorácica representa um desafio propedêutico e terapêutico, com alto risco de ruptura. Os avanços tecnológicos diminuem os riscos de lesões vasculares com acesso cirúrgico difícil e devem estar entre as opções do cirurgião vascular


Complications such as pseudoaneurysms (PA) related to cervicothoracic venous access can be devastating. In this article, we present two similar cases in which technological advances impacted diagnosis, treatment, and results. Both patients developed massive PA after deep venous puncture attempts. The first case occurred in 1993 and was diagnosed by a duplex scan that revealed a large PA originating from the right subclavian artery. The artery was approached by median sternotomy with supraclavicular extension. The PA originated from the thyrocervical trunk and was treated with simple ligation. The second case was in 2017. Angiotomography revealed a PA originating in the vertebral artery, which was treated with endovascular techniques, maintaining vessel patency. Both patients progressed satisfactorily, despite quite different approaches. Cervicothoracic vascular lesions represent a diagnostic and therapeutic challenge, where the risk of rupture is high. Technological advances have reduced the risks involved in management of vascular injuries with difficult surgical access


Subject(s)
Humans , Female , Aged , Vertebral Artery , Aneurysm, False/therapy , Endovascular Procedures , Subclavian Artery , Catheterization, Central Venous/methods , Angiography/methods , Stents , Treatment Outcome , Echocardiography, Doppler, Color/methods , Sternotomy/methods , Hematoma
11.
Arch. argent. pediatr ; 116(3): 204-209, jun. 2018. tab, ilus, graf
Article in English, Spanish | LILACS, BINACIS | ID: biblio-950011

ABSTRACT

Introducción. La canalización vascular central en niños presenta alta complejidad técnica y dificultades. La ecografía vascular puede facilitar este procedimiento. Objetivo. Describir las características de las canalizaciones vasculares ecoguiadas en el paciente pediátrico crítico. Población y métodos. Las variables de interés registradas prospectivamente fueron los vasos más comúnmente canalizados, su localización, la medición del diámetro/profundidad, la tasa de éxito y las complicaciones presentadas, entre otras. Resultados. En 86 pacientes pediátricos, se realizaron 124 punciones vasculares. Los accesos vasculares fueron la vena femoral (39,7%), seguida de la arteria femoral (27,2%) y la vena yugular interna (14,7%). Los vasos femorales se localizaron a una profundidad de 0,75 ± 0,25 mm con un diámetro medio de 0,31 ± 0,16 mm. La profundidad de los vasos venosos yugulares fue menor (0,64 ± 0,24 mm) y su diámetro global, mayor (0,44 ± 0,19 mm). El número medio de intentos en las canalizaciones vasculares ecoguiadas fue de 2,2 ± 1,3. La tasa de éxito fue del 79% asociada a un mayor diámetro del vaso (0,39 ± 0,20 mm vs. 0,28 ± 0,13 mm, p 0,01) y un menor número de intentos (1,90 ± 1,16 vs. 3,45 ± 1,77, p= 0,001). Las complicaciones, fueron la punción accidental de otro vaso (5,3%) y el desarrollo de un hematoma durante la punción (2,3%). Conclusiones. La canalización vascular ecoguiada en los pacientes pediátricos estudiados permite visualizar los vasos y medir su profundidad y diámetro; presenta una alta tasa de éxito y se asocia a una baja tasa de complicaciones.


Introduction. Central vascular cannulation in children is a highly complex technique and poses many difficulties. Vascular ultrasound can make this procedure easier. Objective. To describe the characteristics of ultrasound-guided vascular cannulation in critically-ill pediatric patients. Population and methods. Outcome measures prospectively recorded were vessels most frequently cannulated, their localization, the measurement of their diameter/depth, the success rate and complications developed, among others. Results. One hundred and twenty four vascular punctures were performed in 86 pediatric patients. Vascular accesses were the femoral vein (39.7%), followed by the femoral artery (27.2%) and the internal jugular vein (14.7%). Femoral vessels were localized at a depth of 0.75 ± 0.25 mm, with a mean diameter of 0.31 ± 0.16 mm. The depth of jugular vein vessels was smaller (0.64 ± 0.24 mm) and their overall diameter, larger (0.44 ± 0.19 mm). The mean number of attempts in ultrasound-guided cannulations was 2.2 ± 1.3. The success rate was 79% and was associated to a larger vessel diameter (0.39 ± 0.20 mm vs. 0.28 ± 0.13 mm, p= 0.01) and a lower number of attempts (1.90 ± 1.16 vs. 3.45 ± 1.77, p= 0.001). Complications were accidental puncture of another vessel (5.3%) and hematoma formation during puncture (2.3%). Conclusions. In the pediatric patients studied, ultrasound-guided vascular cannulation allowed vessel visualization and measurement of their depth and diameter; the success rate was high and it was associated to a low complication rate.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Catheterization, Central Venous/methods , Ultrasonography, Interventional/methods , Femoral Artery/diagnostic imaging , Femoral Vein/diagnostic imaging , Jugular Veins/diagnostic imaging , Catheterization, Central Venous/adverse effects , Prospective Studies , Outcome Assessment, Health Care , Critical Illness , Hematoma/etiology , Hematoma/epidemiology
12.
Appl. cancer res ; 38: 1-6, jan. 30, 2018. tab
Article in English | LILACS, Inca | ID: biblio-910470

ABSTRACT

Background: Data on renal replacement therapy (RRT) in cancer patients with acute kidney injury (AKI) in the intensive care unit (ICU) and how these factors influence the efficiency of dialysis and the outcomes of these patients are scarce. We aim to describe the predictive clinical characteristics of hemodialysis catheter-related complications in critically ill cancer patients with acute kidney injury. Methods: This is a retrospective cohort study of 62 cancer patients subjected to short-term hemodialysis catheter implants. We evaluated the clinical characteristics of patients and the complications related to catheter implantation: mild malfunction, characterized by reversal of access lines; infections; and catheter replacement due to severe malfunction or infections. The outcomes analyzed were recovery of renal function, discharge from the ICU, and death. Results: The most frequent complications were related to mild malfunction, which justified dialysis line reversal in 21.3% of the patients. The complication rate was higher in patients undergoing conventional hemodialysis, in those with coronary disease, and in those who had more than three dialysis sessions. The presence of metastasis was more frequently related to catheter reversals. Patients with mild or severe malfunction were more likely to be hospitalized for more than 18 days in the ICU. All patients with mild malfunction had hospitalization times greater than 28 days. Conclusions: Hemodialysis catheter-related complications were associated with longer ICU and hospital stays in cancer patients with AKI. Mild malfunction of the hemodialysis catheter was the most frequent complication. Patients with metastasis and sepsis, who used diuretics, and who used intermittent dialysis methods had milder catheter malfunctions


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Young Adult , Cohort Studies , Dialysis/methods , Renal Insufficiency , Intensive Care Units , Neoplasm Metastasis , Catheterization, Central Venous/methods , Catheter-Related Infections/complications
15.
Acta cir. bras ; 32(8): 680-690, Aug. 2017. tab, graf
Article in English | LILACS | ID: biblio-886228

ABSTRACT

Abstract Purpose: To compare the fixation of the central venous catheter (CVC) using two suture techniques. Methods: A clinical, analytical, interventional, longitudinal, prospective, controlled, single-blind and randomized study in adult, intensive care unit (ICU) patients. After admission and indication of CVC use, the patients were allocated to the Wing group (n = 35, catheter fixation with clamping wings and retainers) or Shoelace group (n = 35, catheter fixation using shoelace cross-tied sutures around the device). Displacement, kinking, fixation failure, hyperemia at the insertion site, purulent secretion, loss of the device, psychomotor agitation, mental confusion, and bacterial growth at the insertion site were evaluated. Results: Compared with the Wing group, the Shoelace group had a lower occurrence of catheter displacement (n=0 versus n =4; p = 0.04), kinking (n=0 versus n=8; p=0.001), and fixation failure (n=2 versus n=8; p=0.018). No significant difference was found in bacterial growth (n=20 versus n=14; p=0.267) between groups. Conclusion: The Shoelace fixation technique presented fewer adverse events than the Wing fixation technique.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Sutures , Catheterization, Central Venous/methods , Suture Techniques/instrumentation , Central Venous Catheters , Sutures/microbiology , Severity of Illness Index , Catheterization, Central Venous/adverse effects , Catheterization, Central Venous/instrumentation , Single-Blind Method , Prospective Studies , Reproducibility of Results , Risk Factors , Suture Techniques/adverse effects , Sex Distribution , Statistics, Nonparametric , Intensive Care Units
16.
Rev. bras. anestesiol ; 67(3): 314-317, Mar.-June 2017. graf
Article in English | LILACS | ID: biblio-843400

ABSTRACT

Abstract Background and objectives: Central venous catheterization of the internal jugular vein is a commonly performed invasive procedure associated with a significant morbidity and even mortality. Ultrasound-guided methods have shown to improve significantly the success of the technique and are recommended by various scientific societies, including the American Society of Anesthesiologists. The aim of this report is to describe an innovative ultrasound-guided central line placement of the internal jugular vein. Technique: The authors describe an innovative ultrasound-guided central line placement of the internal jugular vein based on an oblique approach - the "Syringe-Free" approach. This technique allows immediate progression of the guide wire in the venous lumen, while maintaining a real-time continuous ultrasound image. Conclusions: The described method adds to the traditional oblique technique the possibility of achieving a continuous real-time ultrasound-guided venipuncture and a guide wire insertion that does not need removing the probe from the puncture field, while having a single operator performing the whole procedure.


Resumo Justificativa e objetivos: A cateterização venosa central da veia jugular interna é um procedimento invasivo feito frequentemente e associado a morbilidade significativa e até mesmo mortalidade. Os métodos guiados por ultrassonografia têm demonstrado uma melhoria do sucesso desse procedimento e são recomendados por várias sociedades científicas, incluindo a American Society of Anesthesiologists. O objetivo deste artigo é descrever uma abordagem inovadora de cateterização venosa central guiada por ultrassonografia no nível da veia jugular interna. Técnica: Os autores descrevem técnica ecoguiada inovadora de cateterização venosa central da veia jugular interna, baseada numa abordagem oblíqua - a abordagem Syringe-Free. Essa técnica permite uma progressão imediata do fio-guia ao longo do lúmen venoso e manter uma visualização ecográfica em tempo real e contínua. Conclusões: A técnica descrita acrescenta à técnica oblíqua tradicional a possibilidade de, com um único operador, conseguir uma punção venosa central com visualização ecográfica contínua e em tempo real associada à inserção do fio-guia sem necessidade de afastamento do transdutor de ultrassonografia do campo de punção.


Subject(s)
Humans , Catheterization, Central Venous/methods , Ultrasonography, Interventional , Jugular Veins/diagnostic imaging , Catheterization, Central Venous/instrumentation , Equipment Design
17.
Einstein (Säo Paulo) ; 14(4): 561-566, Oct.-Dec. 2016. graf
Article in English | LILACS | ID: biblio-840268

ABSTRACT

ABSTRACT Vascular punctures are often necessary in critically ill patients. They are secure, but not free of complications. Ultrasonography enhances safety of the procedure by decreasing puncture attempts, complications and costs. This study reviews important publications and the puncture technique using ultrasound, bringing part of the experience of the intensive care unit of the Hospital Israelita Albert Einstein, São Paulo (SP), Brazil, and discussing issues that should be considered in future studies.


RESUMO Punções vasculares são muitas vezes necessárias em pacientes gravemente enfermos. São seguras, mas não isentas de complicações. A ultrassonografia associada à técnica de punção gera diminuição do número de tentativas, de complicações e de custos. O presente artigo revisou importantes publicações sobre o tema, bem como técnicas de punções, trazendo parte da experiência do centro de terapia intensiva de adultos do Hospital Israelita Albert Einstein, em São Paulo (SP) e discutindo tópicos que devem ser melhor explorados em estudos futuros.


Subject(s)
Humans , Catheterization, Central Venous/methods , Punctures/methods , Ultrasonography, Interventional , Subclavian Vein , Axillary Vein , Catheterization, Central Venous/instrumentation , Punctures/instrumentation , Vascular Access Devices , Jugular Veins
18.
Rev. bras. ter. intensiva ; 28(1): 62-69, jan.-mar. 2016. tab, graf
Article in Portuguese | LILACS | ID: lil-780003

ABSTRACT

RESUMO Objetivo: Avaliar o custo-efetividade da inserção de cateter venoso central guiada por ultrassonografia em tempo real, em comparação com a técnica tradicional, que é baseada na técnica de reparos anatômicos externos, sob a perspectiva da fonte pagadora. Métodos: Uma simulação teórica, baseada em dados de literatura internacional foi aplicada ao contexto brasileiro, ou seja, ao Sistema Único de Saúde (SUS). Foi estruturada uma árvore de decisão, que apresentava as duas técnicas para inserção de cateter venoso central: ultrassonografia em tempo real versus reparos anatômicos externos. As probabilidades de falha e complicações foram extraídas de uma busca nas bases PubMed e Embase, e os valores associados ao procedimento e às complicações foram extraídos de pesquisa de mercado e do Departamento de Informática do Sistema Único de Saúde (DATASUS). Cada alternativa de passagem do cateter venoso central teve um custo calculado por meio do seguimento de cada um dos possíveis caminhos da árvore de decisão. A razão de custo-efetividade incremental foi calculada considerando-se a divisão do custo incremental médio da técnica de ultrassonografia em tempo real comparada à técnica de reparos anatômicos externos pelo benefício incremental médio, em termos de complicações evitadas. Resultados: O custo final médio avaliado pela árvore de decisão, considerando a incorporação da ultrassonografia em tempo real e a redução de custo por diminuição de complicações, para a técnica de reparos anatômicos externos foi de R$262,27 e, para ultrassonografia em tempo real, de R$187,94. O custo incremental final foi de -R$74,33 por cateter venoso central. A razão de custo-efetividade incremental foi -R$2.494,34 por pneumotórax evitado. Conclusão: A inserção de cateter venoso central com auxílio de ultrassonografia em tempo real esteve associada à diminuição da taxa de falhas e complicações, além de hipoteticamente reduzir custos na perspectiva da fonte pagadora, no caso o SUS.


ABSTRACT Objective: To evaluate the cost-effectiveness, from the funding body's point of view, of real-time ultrasound-guided central venous catheter insertion compared to the traditional method, which is based on the external anatomical landmark technique. Methods: A theoretical simulation based on international literature data was applied to the Brazilian context, i.e., the Unified Health System (Sistema Único de Saúde - SUS). A decision tree was constructed that showed the two central venous catheter insertion techniques: real-time ultrasonography versus external anatomical landmarks. The probabilities of failure and complications were extracted from a search on the PubMed and Embase databases, and values associated with the procedure and with complications were taken from market research and the Department of Information Technology of the Unified Health System (DATASUS). Each central venous catheter insertion alternative had a cost that could be calculated by following each of the possible paths on the decision tree. The incremental cost-effectiveness ratio was calculated by dividing the mean incremental cost of real-time ultrasound compared to the external anatomical landmark technique by the mean incremental benefit, in terms of avoided complications. Results: When considering the incorporation of real-time ultrasound and the concomitant lower cost due to the reduced number of complications, the decision tree revealed a final mean cost for the external anatomical landmark technique of 262.27 Brazilian reals (R$) and for real-time ultrasound of R$187.94. The final incremental cost of the real-time ultrasound-guided technique was -R$74.33 per central venous catheter. The incremental cost-effectiveness ratio was -R$2,494.34 due to the pneumothorax avoided. Conclusion: Real-time ultrasound-guided central venous catheter insertion was associated with decreased failure and complication rates and hypothetically reduced costs from the view of the funding body, which in this case was the SUS.


Subject(s)
Humans , Catheterization, Central Venous/methods , Ultrasonography, Interventional/methods , Models, Theoretical , Brazil , Catheterization, Central Venous/economics , Decision Trees , Cost-Benefit Analysis , Ultrasonography, Interventional/economics
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