Construção de barreiras para diminuir as falhas nas mensurações glicêmicas realizadas pela enfermagem em pacientes críticos com insulina intravenosa

• Autor(a) principal: Nepomuceno, Raquel de Mendonça
• Data de Publicação: 2015
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
• Texto Completo: http://www.bdtd.uerj.br/handle/1/11143
• topic: Glycemia; Insulin; Nursing; Security; Intensive care; Glicemia; Insulina; Enfermagem; Segurança; Terapia intensiva; CNPQ::CIENCIAS DA SAUDE::ENFERMAGEM

This research has as object the factors that affect the glucose measurement performed by nurses in patients receiving continuous intravenous insulin using portable glucometers at the bedside. Many factors can affect the glucose measurement, such as the blood sample, the instrument calibration, the test strips storage, the patients' hematocrit, the use of vasoactive agents, and failures caused by the operator. Taking into account the thesis that the identification of the factors that affect the glucose measurement performed by nursing using glucometers is crucial for the effectiveness of the safeguard barriers aimed to minimizing failures in its implementation, ensuring reliable glycemic results, and consequently for performing titration of insulin safely, the main objective of this study was to propose nursing actions working as barriers to reduce the failures in glucose measurements performed by nurses in patients receiving continuous infusion of insulin. This study intends to contribute with actions to ensure compliance and the strict control in administering insulin. This is an observational, cross-sectional, and prospective study with quantitative approach to data analysis, in a surgical intensive cardiac unit of a public hospital in Rio de Janeiro City, Brazil. The variables of this study were submitted to nonparametric statistical procedures and to measures of association. The survey consisted of 42 patients with observation of 417 blood glucose levels. There was a prevalence of female patients (57.14%), averaging 48 years old (±15.85), without renal failure and without dialysis (90.48%). The mean arterial pressure of 77 (±10.29) mmHg, vasoactive agents usage (80.95%), PaO2&#8805;90 mmHg in 85.71%, and hematocrit<35% at 71.42% were observed. It was found hypoglycemia incidence at 35.7%. The population was divided into two groups; the first group (G1) consisted of patients with hypoglycemia&#8804;60 mg/dl (n=15) and (2) the second group (G2) with patients without hypoglycemia (n=27). Low hematocrit was clinical feature that showed greater association with hypoglycemia. Patients under this condition were 5.60 times more susceptible to the risks of hypoglycemia. Patients using vasoactive agents had 3.3 times more the risks of hypoglycemia. Emergency surgery, presence of renal failure with dialysis, and increase in PaO2 above 90 mmHg also had a positive association with hypoglycemia. The use of blood sample of arterial origin was prevailing in the 417 observed measurements. It was observed that in all technique steps of the measurement there was implementing deviation, with the exception of the fingertip compression. The observed deviations which showed positive association (RR>1) for patients with hypoglycemia were: (1) lack of glucometer calibration; (2) verification lack of the validity and integrity of the tape test; (3) lack of hand sanitation; and (4) lack of gathering up 1 mL of blood. A review of the glycemic measurement technique was made focusing on factors that may compromise glycemic result, taking into account the hypoglycemia risk. It became clear that the proper understanding of the factors that affect blood glucose and glucose measurement is essential for nurses in obtaining reliable blood glucose results, and, thus, avoiding mistakes in titration administering insulin doses.