Desplazamiento de catéteres venosos de punción ecodirigida. Estudio transversal sobre la influencia de la estrategia eFIX para la selección del dispositivo de fijación / Displacement of venous catheters of eco-guided puncture. Cross-sectional study on the influence of the efix strategy on the selection of the fixation device

INTRODUCCIÓN: La canulación por micropunción ecodirigida de venas profundas del brazo aumenta la tasa de éxito al primer intento y reduce la probabilidad de complicaciones1 lo que redunda en la mejora de la eficiencia del procedimiento. El desplazamiento del catéter es una complicación evitable que se relaciona con mayor riesgo de flebitis, trombosis e infecciones2, así como con mayor gasto económico y por tanto una disminución de la eficiencia del procedimiento 3-8. La estrategia de selección del dispositivo de fijación (eFIX) pretende ser una herramienta que minimize las posibilidades de desplazamiento del dispositivo de acceso vascilar (DAV). OBJETIVOS: General: Analizar la influencia de la estrategia “eFIX” para la selección del dispositivo de fijación sobre el desplazamiento de los catéteres venosos implantados con punción ecodirigida. Específico: Identificar la existencia de relación entre el desplazamiento del DAV y la aparición de trombosis, flebitis y BRC. MATERIAL Y MÉTODO: Se realizó estudio observacional analítico de corte transversal. Se incluyeron todas las inserciones exitosas realizadas en los pacientes mayores de 14 años ingresados en el Hospital Universitario de La Palma que cumplían criterios para un catéter venoso tipo Midline (ML) o Catéter Central de Inserción Periférica (CCIP) entre el 1 de julio de 2021 y el 30 de junio de 2022. Se identificó como variable dependiente el desplazamiento del catéter y como variable independiente la aplicación de la estrategia de selección del sistema de fijación (eFIX) (de elaboración propia) que incluye el uso rutinario de dispositivos adhesivos (DA) con tecnología statlock y la selección de pacientes para el uso de anclajes subtutáneos (ASC) y adhesivo tisular. Análisis de datos con estadística descriptiva con medida de efecto OR (AU)

INTRODUCTION: Ul trasound-guided micropuncture cannula tion of deep veins of the arm increases the success rate at the first attempt and reduces the probability of complications, which results in an improvement in the efficiency of the procedure. Displacement of the catheter is an avoidable complica tion that is related to a higher risk of ph lebitis, thrombosis, and infectionsb as well as greater financial costs and, there fore, a decrease in the efficiency of the procedure. OBJECTIVE: To analyze the in fluence of the "eFIX" fixation device se lection strategy on the displacement of venous catheters implanted with ultra sound-guided puncture. MATERIAL AND METHOD: A cross-sectional analytical observational study was carried out. It included all pa tients older than 14 years admitted to the University Hospital of La Palma who met the criteria for a Midline (ML) or Central Peripherally Inserted Catheter (PICC) between July 1, 2021 and June 30. 2022. Displacement of the catheter was identi fied as a dependent variable and the ap plication of the self-made fixation system selection strategy (eFIX) as an indepen dent variable, which includes the routine use of adhesive devices (AD) with statlock technology and the selection of patients for the use of subcutaneous an chors (ASC) and tissue adhesive. Data analysis with descriptive statistics with OR effect measure (AU)

Hidden chaos factors inducing random walks which reduce hospital operative efficiency.

Operative parameters of La Fuenfría Hospital such as: hospitalized patients; daily admissions and discharges were studies for the hospital as a whole, and for each hospital's service unit (henceforth called 'services'). Conventional statistical analyzes and fractal dimension analyzes were performed on daily In-Patient series. The sequence of daily admissions and patients staying on each service were found to be a kind of random series known as random walks (Rw), sequences where what happens next, depends on what happens now plus a random variable. Rw analyzed with parametric or nonparametric statistics may simulate cycles and drifts which resemble seasonal variations or fake trends which reduce the Hospital's efficiency. Globally, inpatients Rw s in LFH, were found to be determined by the time elapsed between daily discharges and admissions. The factors determining LFH R were found to be the difference between daily admissions and discharges. The discharges are replaced by admissions with some random delay and the random difference determines LFH Rw s. These findings show that if the daily difference between admissions and discharges is minimized, the number of inpatients would fluctuate less and the number of unoccupied beds would be reduced, thus optimizing the Hospital service.