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1.
Enferm. actual Costa Rica (Online) ; (38): 230-244, Jan.-Jun. 2020. tab, graf
Article in Spanish | LILACS (Americas), BDENF | ID: biblio-1090098

ABSTRACT

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.


Subject(s)
Humans , Disinfection , Infection Control , Bacteremia , 2-Propanol , Central Venous Catheters , Anti-Infective Agents
2.
Article in English | WPRIM (Western Pacific) | ID: wprim-785424

ABSTRACT

PURPOSE: To develop and validate a clinical scoring model to predict 1-year access survival among end-stage renal disease (ESRD) patients who received a new arteriovenous fistula (AVF).METHODS: The data of 195 ESRD patients in the development cohort who underwent first-time AVF creation between January 2009 and June 2013 and who had successful cannulation for dialysis use were reviewed. The clinical features that were significantly associated with 1-year AVF survival were incorporated into a clinical scoring model. The validity of this clinical score was then tested in a validation cohort of 204 ESRD patients who received a new AVF between July 2013 and December 2017.RESULTS: Of the 195 patients in the development cohort, 168 patients (86.2%) had a well-functioning AVF at 1 year. Absence of diabetes mellitus, no previous history of central venous catheter insertion, and absence of intervention performed to achieve access maturation were positively associated with 1-year AVF survival. These 3 factors were incorporated into a clinical scoring model, which ranged from 0 to 4 points. For a cutoff score of ≥3, the sensitivity, specificity and area under the receiver operating characteristic curve to predict 1-year AVF survival were 81.5%, 70.4%, and 0.760, respectively. The predictive performance of the clinical score was confirmed in the validation cohort, with a sensitivity of 76.1%, a specificity of 64.4% and an area under the curve of 0.703.CONCLUSION: The scoring model using clinical data yielded acceptable performance in predicting 1-year access survival among patients receiving a new AVF.


Subject(s)
Arteriovenous Fistula , Catheterization , Central Venous Catheters , Cohort Studies , Diabetes Mellitus , Dialysis , Humans , Kidney Failure, Chronic , Renal Dialysis , ROC Curve , Sensitivity and Specificity , Treatment Outcome
3.
Nursing (Säo Paulo) ; 22(259): 3419-3425, dez.2019.
Article in Portuguese | LILACS (Americas), BDENF | ID: biblio-1095307

ABSTRACT

O presente estudo objetivou comparar as temperaturas axilar final de recém-nascidos (RN) submetidos à instalação do Cateter Venoso Central de Inserção Periférica (CCIP/PICC) em dois períodos distintos e de discutir os efeitos do uso desta tecnologia na temperatura axilar final de RN submetidos a este procedimento. Tratou-se de um estudo quase-experimental, transversal, com delineamento antes e depois onde foi avaliada a temperatura axilar final em dois grupos distintos: "antes do uso da manta" e "depois do uso da manta". A abordagem quantitativa mensurou variáveis pré-estabelecidas. Este estudo confirmou a hipótese de que existe diferença na temperatura axilar final de RN submetidos à instalação do CCIP e que a manta térmica pode ser uma tecnologia que previne/corrige a hipotermia em RN submetidos à instalação de CCIP.(AU)


The present study aimed at comparing the final axillary temperatures of newborns (NB) submitted to the installation of Peripherally Inserted Central Venous Catheter (PICC) in two different periods and to discuss the effects of the use of this technology on the final axillary temperature of NB submitted to this procedure. It was a quasi-experimental, cross-sectional study with a before and after design where the final axillary temperature was evaluated in two distinct groups: "before the use of the blanket" and "after the use of the blanket". The quantitative approach measured pre-established variables. This study confirmed the hypothesis that there is difference in the final axillary temperature of NB submitted to the installation of PICC and that the thermal blanket can be a technology that prevents / corrects the hypothermia in NB submitted to the installation of PICC.(AU)


El presente estudio tuvo como objetivo comparar las temperaturas axilares finales de los recién nacidos (RN) sometidos a la instalación del catéter venoso central para inserción periférica (CCIP/PICC) en dos períodos diferentes y discutir los efectos del uso de esta tecnología en la temperatura axilar final de los RN sometidos a este procedimiento. Fue un estudio transversal, casi experimental, con un diseño de antes y después, en el que se evaluó la temperatura axilar final en dos grupos distintos: "antes del uso de la manta" y "después del uso de la manta". El enfoque cuantitativo mide variables preestablecidas. Este estudio confirmó la hipótesis de que hay una diferencia en la temperatura axilar final de RN sometida a la instalación de CCIP y que la manta térmica puede ser una tecnología que previene / corrige la hipotermia en RN sometida a la instalación de CCIP.(AU)


Subject(s)
Humans , Infant, Newborn , Neonatal Nursing , Patient Safety , Central Venous Catheters , Hypothermia , Body Temperature , Infant, Newborn, Diseases
4.
J. bras. nefrol ; 41(1): 89-94, Jan.-Mar. 2019. tab, graf
Article in English | LILACS (Americas) | 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.
Article in English | WPRIM (Western Pacific) | ID: wprim-759010

ABSTRACT

Central venous disease (CVD) is difficult to treat and often resistant to treatment. In CVD, hemodialysis vascular access should sometimes be abandoned, or in serious cases, the patient's life may be threatened. Therefore, prevention is ideal. However, as the prevalence of chronic kidney disease (CKD) has increased steadily with population aging, CKD patients with a peripherally inserted central catheter (PICC) are encountered frequently. PICCs can cause CVD, and the basilic vein, which is regarded as the important last option for native arteriovenous fistula (AVF) creation in end-stage renal disease (ESRD) patients, is destroyed frequently after its use as the entry site of PICC. The most well-established risk factors for CVD are a history of central venous catheter (CVC) insertion and its duration of use. Therefore, to reduce the incidence of CVD, catheterization in the central vein (CV) should be minimized, along with its duration of use. In this review, we will first explain the basic territories of the CV and introduce its pathophysiology, clinical features, and advanced treatment options. Finally, we will emphasize prevention of CVD.


Subject(s)
Aging , Arteriovenous Fistula , Catheterization , Catheters , Central Venous Catheters , Humans , Incidence , Kidney Failure, Chronic , Ocimum basilicum , Prevalence , Renal Dialysis , Renal Insufficiency, Chronic , Risk Factors , Veins
7.
Article in English | WPRIM (Western Pacific) | ID: wprim-763089

ABSTRACT

This retrospective case-control study investigated the prevalence and risk factors of carbapenem-resistant Enterobacteriaceae (CRE) colonization in stroke patients within 6 months of onset. Forty-three patients confirmed to have CRE colonization in our hospital from January 2017 to December 2018 were included in this study. The control group included 44 stroke patients who had carbapenem-susceptible Enterobacteriaceae colonization. The patients were age- (± 3 years) and sex-matched. Their demographic and clinical characteristics were analyzed to identify the risk factors for CRE colonization using multivariate logistic regression analysis. During the study period, the prevalence of CRE was 2.9% (105/3,657). In the univariate analysis, factors associated with CRE colonization included the use and duration of antibiotic intake; admission to intensive care unit (ICU); and use of enteral feeding tube, urethral Foley catheter, tracheostomy, and central venous catheter. In the multivariate analysis, use and duration of antibiotic intake and admission to ICU persisted as independent factors. CRE should be considered when antibiotics are administered to a stroke patient, especially if the administration period is more than 2 weeks, and if the stroke patient has been admitted to the ICU. This study suggests preventing post-stroke infections and, if possible, reducing ICU admissions and preventing CRE transmission in all stroke patients admitted to the ICU.


Subject(s)
Anti-Bacterial Agents , Case-Control Studies , Catheters , Central Venous Catheters , Colon , Enteral Nutrition , Enterobacteriaceae , Humans , Intensive Care Units , Logistic Models , Multivariate Analysis , Prevalence , Retrospective Studies , Risk Factors , Stroke , Tracheostomy
8.
Article in English | WPRIM (Western Pacific) | ID: wprim-740158

ABSTRACT

Cerebral air embolism (CAE) is a rare complication of various medical procedures. It manifests with symptoms similar to those of typical acute cerebral infarction, however the treatment is quite different. We present a case of arterial CAE that was associated with a disconnected central venous catheter and appeared as punctate dark signal intensities with aliasing artifacts on the susceptibility-weighted filtered phase magnetic resonance image. The susceptibility-weighted filtered phase image can be helpful for diagnosing CAE and the magnetic resonance imaging reflects the pathophysiology of CAE.


Subject(s)
Artifacts , Central Venous Catheters , Cerebral Infarction , Embolism, Air , Intracranial Embolism , Magnetic Resonance Imaging
9.
Article in Chinese | WPRIM (Western Pacific) | ID: wprim-813014

ABSTRACT

Central venous catheter (CVC) placement is an operation which can establish a fast, safe, and effective deep venous access to rescue patients under critical conditions, especially for those receiving hemodialysis. It is a simple operation with almost no complications, but different complications have been still reported, such as bleeding, infection, embolism, low blood flow, and cardiac arrhythmias. In this case, the patient with preexisting left bundle branch block suffered right bundle branch block, leading to complete heart block during CVC placement. When the patient developed complete heart block, we immediately treated him with isoproterenol, and the surgery was terminated as soon as possible. The patient gradually recovered the sinus rhythm after the treatment. This complication is rare but severe, and clinicians should recognize the risks and take strategies as early as possible. We think the cause of complete heart block in this patient may be related to mechanical trauma to the right ventricle by the guide wire or catheter insertion. Therefore, CVC placement should be performed with more caution, and the guide wire and catheter tip should be inserted less than 18 cm deep.


Subject(s)
Arrhythmias, Cardiac , Catheterization, Central Venous , Central Venous Catheters , Heart Block , Humans , Male , Renal Dialysis
10.
Article in English | WPRIM (Western Pacific) | ID: wprim-719276

ABSTRACT

BACKGROUND/AIMS: The strategy of access care at out center involves the use of ultrasound (USG) in case of physical examination (PE) abnormality. USG determines the need of angiography. This study investigated the possible association between the need for percutaneous transluminal angioplasty (PTA) and hemodynamic parameters of USG. The study also assessed the effects of this monitoring strategy on outcomes in comparison with a historical control. METHODS: A retrospective study of the medical records of 127 patients (65 PTA, 62 non-PTA) was conducted. Data were analyzed using logistic regression analysis and receiver operating characteristic curve. Fistula outcomes and intervention rates were calculated and compared with 100 historic controls. RESULTS: Logistic regression analysis showed that brachial artery flow volume (FV) 0.63 was independently associated with the need for PTA. This monitoring strategy showed an a reduction in thromboses (0.02 ± 0.11 events/arteriovenous fistula [AVF]-year vs. 0.07 ± 0.23 events/AVF-year, p = 0.046), reduction in central venous catheter placement (0.01 ± 0.05 events/AVF-year vs. 0.06 ± 0.22 events/AVF-year, p = 0.010), reduction in access loss (0.02 ± 0.13 events/AVF-year vs. 0.19 ± 0.34 events/AVF-year, p = 0.015), and increase in access selective repair (0.49 ± 0.66 events/AVF-year vs. 0.21 ± 0.69 events/AVF-year, p = 0.003), compared to historic control. CONCLUSIONS: There was significant stenosis if brachial artery FV was 0.63 for PE abnormality. These parameters should be used as markers for assessing PTA risk in hemodialysis patients. Addition of USG to determine the need of angiography after detection of PE abnormality leads to decreases in access thrombosis, catheter placement, and access loss despite increasing access intervention rates compared to clinical monitoring.


Subject(s)
Angiography , Angioplasty , Brachial Artery , Catheters , Central Venous Catheters , Constriction, Pathologic , Fistula , Hemodynamics , Humans , Logistic Models , Medical Records , Physical Examination , Renal Dialysis , Retrospective Studies , ROC Curve , Thrombosis , Ultrasonography , Ultrasonography, Doppler, Color
11.
Rev. Esc. Enferm. USP ; 53: e03462, 2019. tab, graf
Article in English | LILACS (Americas), BDENF | ID: biblio-1013183

ABSTRACT

ABSTRACT This theoretical and reflexive study analyzed the risks related to the maintenance of patency of the Peripherally Inserted Central Catheter with the use of saline solution in comparison with saline-filled syringes, through the application of the Healthcare Failure Mode and Effect Analysis - HFMEA. The process was mapped, detailing the failure modes of each step. For the calculation of the Risk Priority Number, the severity and probability of the failure modes were analyzed. This analysis gave rise to the severity and probability matrix. Finally, actions to reduce the failure modes in the maintenance of patency were proposed, considering the use of saline-filled syringes in comparison to the use of saline ampoules. It was verified that the use of saline ampoules is associated with a greater risk, since it requires four stages more than saline-filled syringe does not, increasing the risk of contamination and the level of three different risks, which would result in additional hospital costs. The use of the saline-filled syringe would avoid risks that could negatively affect the patient's health, the nursing professional and the health institution.


RESUMEN Este estudio teórico reflexivo analizó los riesgos relacionados con el proceso de mantenimiento de la permeabilidad del Catéter Central de Inserción Periférica, con el empleo de solución salina en comparación con jeringa rellena de solución salina, mediante la aplicación de la herramienta Healthcare Failure Mode and Effect Analysis - HFMEA. El proceso fue mapeado detallándose los modos de falla de cada etapa. Para el cómputo del Risk Priority Number, se analizaron los modos de falla en cuanto a la severidad y la probabilidad. Mediante dicho análisis, se confeccionó la matriz de severidad y probabilidad. Por fin, se evidenciaron las propuestas de acciones para la reducción de los modos de fallas en el proceso de mantenimiento de la permeabilidad en el caso de utilizarse la jeringa en comparación con la utilización de ampollas de solución salina. Se verificó que el uso de ampollas de solución salina representa mayor riesgo para el paciente, visto que demanda cuatro etapas más que el mantenimiento con jeringa rellena, aumentando el riesgo de contaminación y la criticidad de tres peligros, lo que resultaría en costos hospitalarios adicionales. El uso de la jeringa rellena evitaría riesgos mayores, los que podrían repercutir desfavorablemente en la salud del paciente, en el profesional enfermero y el centro sanitario.


RESUMO Este estudo teórico-reflexivo analisou os riscos relacionados ao processo de manutenção da permeabilidade do Cateter Central de Inserção Periférica, com o uso de solução salina em comparação com seringa preenchida com solução salina, por meio da aplicação da ferramenta Healthcare Failure Mode and Effect Analysis - HFMEA. O processo foi mapeado detalhando-se os modos de falha de cada etapa. Para o cálculo do Risk Priority Number, analisaram-se os modos de falha quanto à severidade e à probabilidade. A partir dessa análise, elaborou-se a matriz de severidade e probabilidade. Por fim, evidenciaram-se propostas de ações para redução dos modos de falhas no processo de manutenção da permeabilidade caso fosse utilizada a seringa preenchida em comparação com a utilização de ampolas de solução salina. Verificou-se que o uso de ampolas de solução salina representa maior risco para o paciente, visto que demanda quatro etapas a mais que do que a manutenção com seringa preenchida, aumentando o risco de contaminação e a criticidade de três perigos, o que resultaria em custos hospitalares adicionais. O uso da seringa preenchida evitaria riscos maiores, os quais poderiam repercutir, desfavoravelmente, na saúde do paciente, no profissional de enfermagem e na instituição de saúde.


Subject(s)
Patient Safety , Vascular Access Devices , Central Venous Catheters , Nursing Care , Quality of Health Care , Cost Control
12.
Revista Digital de Postgrado ; 8(3): e165, 2019. tab
Article in Spanish | LILACS (Americas), 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
13.
Revista Digital de Postgrado ; 8(3): e167, 2019. graf
Article in Spanish | LILACS (Americas), 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
14.
Article in Korean | WPRIM (Western Pacific) | ID: wprim-764190

ABSTRACT

PURPOSE: Ensuring the stability of central venous catheter placement for treating patients hospitalized in an intensive care unit is very important. Although PICC requires an ultrasound and fluoroscopy machine, it is difficult to use a fluoroscopy machine for PICC insertion in the intensive care unit. This study analyzed the cases of the insertion of a PICC under ultrasonic guidance at the bedsides in the intensive care unit to determine the usefulness of PICC in the intensive care unit. METHODS: A retrospective study was conducted on patients hospitalized in the surgical intensive care unit and received PICC using ultrasonography at their bedsides from October 2015 to January 2018. RESULTS: One hundred and twenty patients were collected. The number of successful PICCs stood at 105 patients, which was equal to 87.5%. Among them, 65 and 55 cases had left and right insertion, respectively; the corresponding success rate was 81.8%, and 92.3%. No statistically significant difference in success rates was observed between the left and right, as well as in the success rates depending on the presence of shock, sepsis, acute kidney injury, and mechanical ventilation. In the failed 15 cases, seven cases were due to the course of the procedure and eight cases were confirmed have been malpositioned after insertion. CONCLUSION: PICC at the bedside in an intensive care unit is a safe method for central venous catheterization without severe complications and death. The insertion sites, left or right, are equally acceptable. Further study of the cases of malposition will be necessary.


Subject(s)
Acute Kidney Injury , Catheterization , Catheterization, Central Venous , Catheters , Central Venous Catheters , Critical Care , Critical Illness , Fluoroscopy , Humans , Intensive Care Units , Methods , Respiration, Artificial , Retrospective Studies , Sepsis , Shock , Ultrasonics , Ultrasonography
15.
Article in English | WPRIM (Western Pacific) | ID: wprim-760191

ABSTRACT

Newborn infants, including premature infants, are high-risk patients susceptible to various microorganisms. Catheter-related bloodstream infections are the most common type of nosocomial infections in this population. Regular education and training of medical staffs are most important as a preventive strategy for central line-associated bloodstream infections (CLABSIs). Bundle approaches and the use of checklists during the insertion and maintenance of central catheters are effective measures to reduce the incidence of CLABSIs. Chlorhexidine, commonly used as a skin disinfectant before catheter insertion and dressing replacement, is not approved for infants <2 months of age, but is usually used in many neonatal intensive care units due to the lack of alternatives. Chlorhexidine-impregnated dressing and bathing, recommended for adults, cannot be applied to newborns. Appropriate replacement intervals for dressing and administration sets are similar to those recommended for adults. Umbilical catheters should not be used longer than 5 days for the umbilical arterial catheter and 14 days for the umbilical venous catheter. It is most important to regularly educate, train and give feedback to the medical staffs about the various preventive measures required at each stage from before insertion to removal of the catheter. Continuous efforts are needed to develop effective and safe infection control strategies for neonates and young infants.


Subject(s)
Adult , Bacteremia , Bandages , Baths , Catheters , Central Venous Catheters , Checklist , Chlorhexidine , Cross Infection , Education , Humans , Incidence , Infant , Infant, Newborn , Infant, Premature , Infection Control , Intensive Care Units , Intensive Care Units, Neonatal , Medical Staff , Skin
16.
Rev. bras. ter. intensiva ; 30(4): 436-442, out.-dez. 2018. tab
Article in Portuguese | LILACS (Americas) | 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
17.
Rev. enferm. UERJ ; 26: e31771, jan.-dez. 2018.
Article in Portuguese | LILACS (Americas), BDENF | ID: biblio-991142

ABSTRACT

Objetivo: apresentar o estado do conhecimento científico sobre os cuidados de enfermagem relacionados à prevenção e controle de infecções relacionadas ao cateter venoso central não implantado de curta permanência. Conteúdo: destaca-se a importância dos cuidados de enfermagem baseados em evidências e amparados pela legislação do exercício profissional vigente: identificação de sinais e sintomas sugestivos de colonização e/ou infecção, cuidados relacionados ao óstio de inserção e à manutenção do dispositivo, incluindo uso de antissépticos, coberturas e infusão de soluções para manutenção da permeabilidade e prevenção de infecções. Conclusão: para evitar as complicações decorrentes da inserção e manutenção do cateter é necessário que a equipe de saúde possua capacitação técnico-científica baseada em evidências quanto às práticas de cuidado e trabalhem de forma sincronizada e consistente com o objetivo de garantir assistência efetiva e segura.


Objective: to present the state of scientific knowledge about nursing care in prevention and control of infections relating to the short-term, non -implanted, central-line catheter. Content: the study highlighted the importance of evidence-based nursing care supported by current legislation on professional practice: identification of signs and symptoms of colonization and/or infection, care for the insertion site and maintenance of the device, including use of antiseptics, topical products and infusion solutions for maintaining permeability and preventing infection. Conclusion: prevention of complications resulting from catheter insertion and maintenance requires that the health team have evidence-based technical and scientific training in care practices, and work in a synchronized and consistent manner for the purpose of ensuring effective, safe care.


Objetivo: presentar el estado de conocimiento científico sobre la atención de enfermería en cuanto a la prevención y el control de infecciones relacionadas con el catéter venoso central no implantado de corta permanencia. Contenido: se destaca la importancia de la atención de enfermería basada en evidencia y respaldada por la legislación actual de la práctica profesional: identificación de signos y síntomas de colonización y/o infección, cuidado relacionado con la apertura de inserción y el mantenimiento del dispositivo, incluyendo el uso de antisépticos, productos tópicos e infusión de soluciones para el mantenimiento de la permeabilidad y la prevención de infecciones. Conclusión: para evitar las complicaciones derivadas de la inserción y el mantenimiento del catéter es necesario que el equipo de salud tenga capacitación técnico-científica basada en evidencias en cuanto a las prácticas de atención y trabaje de forma sincronizada y consistente con el objetivo de garantizar una atención efectiva y segura


Subject(s)
Humans , Catheterization/nursing , Infection Control , Central Venous Catheters/adverse effects , Nursing Care , Nursing Process
18.
J. vasc. bras ; 17(3)jul.-set. 2018. ilus
Article in Portuguese | LILACS (Americas) | ID: biblio-915844

ABSTRACT

O implante de cateter venoso central para hemodiálise é comumente realizado em grandes centros e suas complicações estão, por vezes, associadas ao treinamento insuficiente de quem o realiza, mas também às condições clínicas do próprio doente. O presente estudo relata dois casos de intercorrências relacionadas ao uso do cateter de curta permanência para hemodiálise. No primeiro caso, houve inserção inadvertida da cânula na artéria subclávia esquerda e consequente trombose arterial, que foi conduzida conservadoramente, documentando-se uma boa perfusão colateral com ecografia vascular. O segundo caso ilustra o achado incidental de uma trombose venosa séptica central em paciente que havia feito uso do cateter por uma semana, optando-se por tratá-la com antibioticoterapia, anticoagulação plena e controle ecográfico. Em ambos os casos, a intervenção cirúrgica seria de alto risco devido ao prognóstico reservado dos doentes. A ultrassonografia vascular permitiu o monitoramento das situações clínicas e o emprego de terapêutica menos agressiva


Central venous catheter implantation for hemodialysis is commonly performed in large centers and its complications are sometimes associated with insufficient training of those who perform it, but may also be related to the patient's clinical condition. The present study reports two cases of complications related to use of a short-stay catheter for hemodialysis. In the first case, the cannula was inadvertently inserted into the left subclavian artery, causing arterial thrombosis, which was conservatively managed and good collateral perfusion was documented with vascular echography. The second case illustrates an incidental finding of Central Venous Septic Thrombosis in a patient who had used a catheter for a week, which was treated with antibiotic therapy, anticoagulation, and ultrasound control. In both cases, surgical intervention would have been high risk because of the patients' poor prognosis. Vascular ultrasonography enabled monitoring of these clinical situations and use of less aggressive treatments


Subject(s)
Humans , Male , Middle Aged , Aged , Neoplasms/therapy , Renal Dialysis/methods , Ultrasonography/methods , Vascular Access Devices/adverse effects , Anticoagulants/therapeutic use , Central Venous Catheters/adverse effects , Echocardiography, Doppler/methods , Endovascular Procedures/methods , Jugular Veins/diagnostic imaging , Renal Insufficiency/diagnosis , Subclavian Artery/diagnostic imaging , Upper Extremity , Venous Thrombosis
19.
Biosci. j. (Online) ; 34(3): 810-817, mai/jun. 2018.
Article in English | LILACS (Americas) | ID: biblio-967009

ABSTRACT

The ICU is a highly complex sector, and among the wide range of interventions performed in the intensive care patient, we highlight the use of the central venous catheter (CVC). Maintaining the CVC requires knowledge and ability to ensure safe and long-lasting vascular access. However, during the permanence time of the device, some complications related to the catheter material, caliber, puncture site, dressing used, type of medication administered and length of stay may occur. Knowing the possible complications that occur with the catheter during its stay and the outcome of these complications favors the health professional in the elaboration of prevention strategies. Therefore, this research aims to elucidate the occurrence of non-elective removal, the main complications and outcomes related to the use of CVC in clients hospitalized in the ICU. This is a descriptive, observational, prospective study with a quantitative approach. The study was carried out in a teaching hospital in Uberaba-MG, from March to August 2016. The population of the study consisted of CVCs inserted in clients hospitalized in the ICUs. As a result, 75 (38.3%) catheters presented complications, being the outcome of 55 (73.3%) non-elective removal when the complication was discovered. The other 121 (61.7%) catheters had the outcome of removal on discharge from the client to the ward 59 (48.7%), death of the client 25 (20.6%), discharge from the client to the ward with the device (Risk benefit) 27 (22.3%) and removal at the physician's discretion 10 (8.2%). The permanence time of the device was 7.65. The greater the number of complications the catheter presented, the greater the chances of catheter loss (63.4). This study emphasizes the importance of conducting other studies that may contribute to the reduction of complications resulting from the use of CVC, and emphasize that complications demand higher expenses for the health system and increase the risk of infection of clients hospitalized in the ICU.


A UTI é um setor de alta complexidade, dentre a vasta gama de intervenções realizadas no cliente dentro da terapia intensiva destacamos o uso do cateter venoso central (CVC). A manutenção do CVC exige conhecimento e habilidade para garantir um acesso vascular seguro e duradouro. No entanto, durante o tempo de permanência do dispositivo algumas complicações relacionadas ao material do cateter, calibre, local de punção, curativo utilizado, tipo de medicamento administrado e tempo de permanência podem acontecer. Conhecer as possíveis complicações que ocorrem com o cateter durante a sua permanência e o desfecho dessas complicações favorece o profissional de saúde na elaboração de estratégias de prevenção. Diante disso, essa pesquisa tem por objetivo elucidar a ocorrência de retirada não eletiva, as principais complicações e os desfechos relacionados à utilização do CVC nos clientes internados na UTI. Trata-se de um estudo descritivo, observacional, prospectivo, com abordagem quantitativa. A pesquisa foi desenvolvida em um Hospital de ensino de Uberaba-MG no período de março a agosto de 2016. A população do estudo foi constituída por CVC inseridos em clientes internados nas UTI's. Como resultado 75 (38,3%) cateteres apresentaram complicações, onde o desfecho de 55 (73,3%) foi à retirada não eletiva frente à descoberta da complicação. Os outros 121 (61,7%) cateteres tiveram como desfecho a retirada na alta do cliente para enfermaria 59 (48,7%), o óbito do cliente 25 (20,6%), a alta do cliente para enfermaria com o dispositivo (risco benefício) 27 (22,3%) e a retirada a critério médico 10 (8,2%). O tempo de permanência do dispositivo foi de 7,65. Quanto maior foi o número de complicações que o cateter apresentou, maiores foram às chances de perda do cateter (63,4). Este estudo vem destacar a importância da realização de outras pesquisas que possam contribuir para redução de complicações advindas do uso do CVC, e ressaltar que as complicações demandam maiores gastos para o sistema de saúde e aumentam os riscos de infecção dos clientes internados na UTI.


Subject(s)
Device Removal , Central Venous Catheters , Intensive Care Units , Maintenance
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