Detección de riesgos para la seguridad del paciente en la implementación de técnicas continuas de depuración extracorpórea / Detection of risks for the safety of the patients in the implementation of continuous techniques of extracorporeal depuration (CTED)

IntroducciónLas técnicas de depuración extracorpórea (TCDE) gestionan elevados volúmenes de intercambio de fluidos y precisa control exhaustivo de su seguridad.ObjetivoDetectar riesgos en TCDE y determinar su frecuencia por paciente.Material y métodoEstudio observacional retrospectivo. Criterios de inclusión: pacientes ingresados desde enero a diciembre de 2009 con TCDE en la Unidad de Cuidados Intensivos (UCI) Polivalente del Hospital 12 de Octubre. Identificamos previamente diez riesgos detectables en historias clínicas. Analizamos variables demográficas y del tratamiento. Las variables cuantitativas se expresan como media±desviación estándar y cualitativas, como frecuencias absolutas y relativas. Análisis: SPSS 15.0®.ResultadosSe incluyó a 54 pacientes (11,7%) con media de edad de 59,78±14,8 años; 42 (77,8%) eran varones. En el 81,4% la indicación fue fracaso renal agudo. Se trató al 80,3% con hemodiafiltración. La media de TCDE fue de 112,9±139,9 h, con una mediana [intervalo intercuartílico] de 2 [0-31] filtros por paciente. La frecuencia de riesgo/paciente fue: el 100% de los pacientes sin monitorización de Mg y P, y el 3,7% (n=2) urea; en 16 (29,6%) se produjo coagulación del circuito antes de 24 h y en 25 (46,3%) no se pudo devolver sangre; en 14 (29,3%) faltaba siempre pauta escrita en la orden de tratamiento; en gráfica del paciente no se reflejó las dosis en 2 (3,7%); en 3 pacientes (5,6%) con coagulopatía se pautó anticoagulante en el circuito; en 1 (1,9%) se evidenció sangrado y en 10 (18,5%), hipotermia leve (35-32°C).ConclusionesSe precisa monitorización protocolizada de Mg y P. Se debe pautar la terapia en el tratamiento médico. Se precisa optimizar la técnica para prolongar su duración y evitar pérdidas hemáticas (AU)

IntroductionContinuous techniques of extracorporeal depuration (CTED) manage high volumes of fluid exchange and extensive control of its safety is required.ObjectiveTo detect the risks of CTED and to determine its frequency per patient.Material and methodsAn observational, retrospective study was performed. Inclusion criteria were patients admitted from January 2009 to December 2009, with CTED in the Polyvalent Intensive Care Unit (ICU) of the Hospital 12 de Octubre. We previously identified 10 risks that were detectable in the clinical records. We analyzed demographic and treatment variables. The quantitative variables were expressed as mean±SD and the qualitative ones as absolute and relative frequencies. Analysis: SPSS 15.0®.ResultsA total of 54 patients (11.7%), with ages 59.78±14.8, 42 men (77.8%) were included. In 81.4%, the indication was acute kidney failure; 80.3% were treated with hemodiafiltration. Mean hours of CTED were 112.9±139.9 and the medium of 2 filters per patient (recommended intakes 0-31). Risk/patient rate was: 100% of patients without monitoring of the Mg and P, and 3.7% (n=2) urea; in 16 (29.6%), there was coagulation of the circuit prior to 24hours and in 25 (46.3%) the blood could not be returned; in 14 (29.3%), written regime was always lacking on the order for treatment. The dose was not reflected on the patient's chart in 2 (3.7%); in 3 patients (5.6%) with coagulation disorder, anticoagulants were prescribed in the circuit. In 1 (1.9%) bleeding was observed and in 10 (18.5%) there was mild hypothermia (35-32°C).ConclusionsA standardized monitoring of the Mg and P is required. The therapy should be prescribed in the medical treatment. The technique needs to be improved in order to prolong its duration and avoid blood losses (AU)

[Detection of risks for the safety of the patients in the implementation of continuous techniques of extracorporeal depuration (CTED)]. / Detección de riesgos para la seguridad del paciente en la implementación de técnicas continuas de depuración extracorpórea.

INTRODUCTION: Continuous techniques of extracorporeal depuration (CTED) manage high volumes of fluid exchange and extensive control of its safety is required. OBJECTIVE: To detect the risks of CTED and to determine its frequency per patient. MATERIAL AND METHODS: An observational, retrospective study was performed. Inclusion criteria were patients admitted from January 2009 to December 2009, with CTED in the Polyvalent Intensive Care Unit (ICU) of the Hospital 12 de Octubre. We previously identified 10 risks that were detectable in the clinical records. We analyzed demographic and treatment variables. The quantitative variables were expressed as mean±SD and the qualitative ones as absolute and relative frequencies. ANALYSIS: SPSS 15.0(®). RESULTS: A total of 54 patients (11.7%), with ages 59.78±14.8, 42 men (77.8%) were included. In 81.4%, the indication was acute kidney failure; 80.3% were treated with hemodiafiltration. Mean hours of CTED were 112.9±139.9 and the medium of 2 filters per patient (recommended intakes 0-31). Risk/patient rate was: 100% of patients without monitoring of the Mg and P, and 3.7% (n=2) urea; in 16 (29.6%), there was coagulation of the circuit prior to 24 hours and in 25 (46.3%) the blood could not be returned; in 14 (29.3%), written regime was always lacking on the order for treatment. The dose was not reflected on the patient's chart in 2 (3.7%); in 3 patients (5.6%) with coagulation disorder, anticoagulants were prescribed in the circuit. In 1 (1.9%) bleeding was observed and in 10 (18.5%) there was mild hypothermia (35-32°C). CONCLUSIONS: A standardized monitoring of the Mg and P is required. The therapy should be prescribed in the medical treatment. The technique needs to be improved in order to prolong its duration and avoid blood losses.