Retirada não planejada de dispositivos invasivos e suas implicações para a segurança do paciente crítico / La retirada no planificada dispositivos invasivos y sus implicaciones para la seguridad del paciente crítico / Unplanned removal of invasive devices and their implications for the safety of the critical patient

Objetivo: analisar a retirada não planejada de dispositivos invasivos em uma unidade de terapia intensiva. Métodos: Estudo descritivo, retrospectivo, documental com abordagem quantitativa. Os dados foram coletados a partir do registro da inserção e retirada de tubos, cateteres e drenos, instalados em pacientes críticos. Para análise, utilizou-se a estatística simples. Pesquisa aprovada pelo comitê de ética em pesquisa do Hospital Universitário Pedro Ernesto, CAAE: 55182716.8.0000.5259. Resultados: O cateter entérico para alimentação se destacou dentre aqueles dispositivos retirados de forma não planejada (42%). Os motivos pelos quais ocorreu a retirada não planejada dos dispositivos foram: retirada pelo paciente (33%), obstrução (30%) e perda acidental (21%). Conclusão: Os resultados encontrados foram semelhantes aos descritos na literatura e devem servir de base para o planejamento de ações direcionadas para uma assistência mais segura.

Objetivo: analizar la eliminación planificada de productos invasivos, en una unidad de cuidados intensivos. Métodos: estudio documental retrospectivo descriptivo con un enfoque cuantitativo. Los datos fueron recolectados a partir de lo registro de la inserción y la eliminación de tubos, catéteres y drenajes, instalado en pacientes críticamente enfermos. Para el análisis, se utilizaron las estadísticas sencillas. De investigación aprobado por el Comité de Ética en Investigación del Hospital Universitario Pedro Ernesto, CAAE: 55182716.8.0000.5259. Resultados: El catéter para la alimentación entérica se destacaban entre las tomadas de los dispositivos de manera no planificados (42%). Las razones por las que la retirada no fue dispositivos previstos fueron retiradas por el paciente (33%), obstrucción (30%) y la pérdida accidental (21%). Conclusión: Los resultados fueron similares a los descritos en la bibliografía y debe ser la base para la planificación de acciones orientadas a una atención más segura.

Objective: to analyze the unplanned removal of invasive devices in an intensive care unit. Methods: Descriptive, retrospective, documental study with a quantitative approach. The data were collected from the registry of the insertion and removal of tubes, catheters and drains, installed in critical patients. For analysis, simple statistics were used. Research approved by the research ethics committee of the Pedro Ernesto University Hospital, CAAE: 55182716.8.0000.5259. Results: The enteric catheter for feeding was highlighted among those devices withdrawn in an unplanned manner (42%). The reasons for the unplanned removal of the devices were: patient withdrawal (33%), obstruction (30%) and accidental loss (21%). Conclusion: The results were similar to those described in the literature and should serve as a basis for planning actions directed towards safer assistance.

Reuse of single-use devices: Looking back, looking forward.

The reuse of medical devices marked as ‘single use’ by manufacturers has been going on for several decades. The process has been rationalized and legislated in the West as well as in Japan. However, the practice continues in an unregulated manner in India due to a paucity of guidance from the Food and Drug Administration in India. We trace the evolution of reuse policies, look at the prevalent practices in the Indian and international contexts, analyse the available Indian literature and address the ethical and economic implications of reuse. We also suggest some guidelines which may be adopted to formulate policies.

Aplicación de técnicas de clustering para caracterizar proveedores de servicios de mantenimiento / Applying the clustering technique for characterising maintenance outsourcing

Objetivo Utilizar técnicas de clustering para caracterizar a los proveedores de servicios de mantenimiento de una institución de salud. Métodos El estudio analiza el inventario del equipamiento perteneciente a 7 áreas pilotos (264 equipos médicos). Se aplican técnicas de clustering usando 26 variables. Entre las más significativas: el tiempo de respuesta (RT), la duración de las intervenciones (DR), la disponibilidad y el tiempo de cambio de estado (TAT). Resultados La obsolescencia del equipo biomédico en promedio es de 0,78. Se identifican 4 grupos de proveedores de servicios. Grupos (1 y 3): Mejor desempeño, menores valores de TAT, RT y DR; cuyos proveedores son: O, L, C, B, I, S, H, F, G; representan el 56 por ciento del total; con valores de TAT entre: 1,4 días

Objective Using clustering techniques for characterising companies providing health institutions with maintenance services. Methods The study analysed seven pilot areas' equipment inventory (264 medical devices). Clustering techniques were applied using 26 variables. Response time (RT), operation duration (OD), availability and turnaround time (TAT) were amongst the most significant ones. Results Average biomedical equipment obsolescence value was 0.78. Four service provider clusters were identified: clusters 1 and 3 had better performance, lower TAT, RT and DR values (56 percent of the providers coded O, L, C, B, I, S, H, F and G, had 1 to 4 day TAT values:

Controle de qualidade e dosimetria em equipamentos de tomografia computadorizada / Quality control and dosimetry in computed tomography units

OBJETIVO: Avaliação de condições dos equipamentos e dosimetria em setores de tomografia computadorizada utilizando protocolos de cabeça, abdome e coluna lombar em pacientes adultos (em três equipamentos distintos) e pediátricos com até um ano e meio de vida (em um dos equipamentos avaliados). MATERIAIS E MÉTODOS: Foram estimados o índice de dose em tomografia computadorizada e a dose média em cortes múltiplos, em exames com pacientes adultos, em três distintos equipamentos. Ainda foram estimadas as doses na superfície de entrada e as doses absorvidas em exame de cabeça para pacientes adultos e pediátricos em um dos equipamentos avaliados. RESULTADOS: Foram realizados testes de controle de qualidade, mecânicos, demonstrando que os equipamentos satisfazem as especificações de uso estabelecidas pelas normas vigentes. Os resultados da dosimetria mostraram que valores de dose média em cortes múltiplos excederam em até 109,0% os valores de níveis de referência, apresentando consideráveis variações entre os equipamentos avaliados neste estudo. As doses absorvidas obtidas com protocolos pediátricos são inferiores aos de pacientes adultos, apresentando redução de até 51,0% na tireoide. CONCLUSÃO: Neste estudo foram avaliadas as condições de operação de três equipamentos tomográficos, estabelecendo quais parâmetros devem ser trabalhados para a implantação de um programa de controle de qualidade nas instituições onde esta pesquisa foi desenvolvida.

OBJECTIVE: Evaluation of equipment conditions and dosimetry in computed tomography services utilizing protocols for head, abdomen, and lumbar spine in adult patients (in three different units) and pediatric patients up to 18 months of age (in one of the units evaluated). MATERIALS AND METHODS: Computed tomography dose index and multiple-scan average dose were estimated in studies of adult patients with three different units. Additionally, entrance surface doses as well as absorbed dose were estimated in head studies for both adult and pediatric patients in a single computed tomography unit. RESULTS: Mechanical quality control tests were performed, demonstrating that computed tomography units comply with the equipment-use specifications established by the current standards. Dosimetry results have demonstrated that the multiple-scan average dose values were in excess of up to 109.0% the reference levels, presenting considerable variation amongst the computed tomography units evaluated in the present study. Absorbed doses obtained with pediatric protocols are lower than those with adult patients, presenting a reduction of up to 51.0% in the thyroid gland. CONCLUSION: The present study has analyzed the operational conditions of three computed tomography units, establishing which parameters should be set for the deployment of a quality control program in the institutions where this study was developed.

Comparative accuracy of glucose monitors

Background. Self-monitoring of blood glucose levels has become an important instrument for the management of patients with diabetes mellitus. Both patients and physicians expect that monitors will provide reliable results. Numerous environmental, physiologic, and operational factors can affects system performance, yielding results that are inaccurate or unpredictable. Methods. This study examined the effect of one factor -high altitude- on the performance of seven blood glucose monitoring systems. The following monitors were compared. two One Touch II; two One Touch Basic; two Reflolux II (Accu-Chec in the USA); two Glucometer 3; one Glucometer 2, and one Accutrend Alpha. Double blood glucose level values were compared with a cotrolled reference laboratory test values, which was unknown to the investigator until the end of the study because the study was double blind. Blood glucose values were obtained using each of the monitors in 200 patients; 150 with diabetes mellitus, and 50 healthy subjects. Results. The One Touch monitors were the only monitors that reported adjusted straight lines (Y0a+bX) that were very similar for all three techniques. In addition, these adjusted straight lines are those closest to the ideal line, Y=X. These same monitors were the only ones that did not reject the null hypothesis Ho: a=0. The relative deviation index at the 20 percent level was less than 3.5 percent for the One Touch II and One Touch Basic monitors; for the rest of the monitors the index was over 14 percent. The clinically accepted EGA region was similar for all study monitors. Conclusions. In conclusion, the One Touch II and One touch Basic Monitors showed greater accuracy in comparison to the other devices. The evaluation of the clinically acceptable region shows practical reliability for all of the monitor used

Evaluacion de la precision de los cronometros de los aparatos de Rayos X de una facultad de odontologia / Evaluation of the precision of the devices marking the time of the X-ray machines of an faculty of dentistry

En los aparatos de rayos X odontologicos, que existen en el mercado brasileño, el unico factor de exposicion regulable es el dispositivo indicador de tiempo en que estos aparatos emiten durante el procedimiento radiografico. La propuesta de este estudio es evaluar los aparatos de rayos X que son habitualmente utilizados en las clinicas y laboratorios de la Facultad de Odontologia de Ribeirao Preto de USP, respecto al grado de precision de sus marcadores de tiempo de exposicion. Se analizaron 23 aparatos de rayos X de FORP/USP, en intervalos de tiempo de 0,25 segundos, 0,40 segundos y 1,00 segundo. Para eso se ha utilizado un cronometro de rayos X. Todos los aparatos controlados presentaron mal funcionamiento del marcador de tiempo; mas del 5 por ciento de error aceptable. Cuanto menor el "set" de exposicion, mayor es el equivoco registrado. El error medio fue entre el 11 por ciento y el 50 por ciento, lo que es altamente significativo cuando se utilizan filmes radiograficos del grupo E