Sobreutilização de cateter venoso central em terapia intensiva à luz da iniciativa Choosing Wisely: um estudo transversal
Autor(a) principal: | |
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Data de Publicação: | 2023 |
Outros Autores: | |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Biblioteca Digital de Teses e Dissertações da UERJ |
Texto Completo: | http://www.bdtd.uerj.br/handle/1/20176 |
Resumo: | This research focuses on the overutilization of healthcare technologies in light of the Choosing Wisely initiative, with a specific focus on the use of central line catheters (CLs) in critically ill patients. The overuse of medical devices has been increasing with the availability of new technologies. Therefore, a careful evaluation is necessary in order to optimize their use. In this regard, the indication and maintenance of any technology should be thoroughly considered and based on evidence, to avoid overutilization. The objective of this dissertation is to analyze the occurrence of CL overuse in an Intensive Care Unit (ICU) of a general hospital in Rio de Janeiro. The study follows a quantitative, documentary, cross-sectional, and retrospective design, in accordance with the recommendations of the Strengthening the Reporting of Observational Studies in Epidemiology. The study was conducted in two intensive care units of a general hospital located in the state of Rio de Janeiro. The units of analysis were catheters inserted in the units that remained in the patient for at least 48 hours. A total of 158 participants were selected for the study, generating 248 CLs for analysis. The catheters were predominantly inserted in male patients over 60 years old with cardiopulmonary alterations. The majority of the CLs were installed in the jugular vein (48.39%), with an average duration of 11.95 days. It is worth noting that 89.52% of the catheters did not have a registered therapeutic plan for their insertion. The most prevalent indication was prolonged antibiotic therapy (87.10%). The main adverse event identified was bloodstream infection (25.46%), with Klebsiella pneumoniae carbapenemase being the main agent. The strongest association was found between the length of stay in the ICU and the occurrence of adverse events (p-value < 0.001). In 2019 and 2020, each day of hospitalization increased the chance of an adverse event by 9.6% and 22.2%, respectively. The results show that the Choosing Wisely initiative can contribute to the daily practice of evaluating what is essential and what is unnecessary. The main reasons for overutilization and the occurrence of adverse events related to maintenance were associated with the length of hospitalization and the duration of CL placement. The predominant adverse event was central line association bloodstream infection and its maintenance. |
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Camerini , Flávia Gironhttp://lattes.cnpq.br/9892236925588941Schutz, Vivianhttp://lattes.cnpq.br/5052180686707412Fassarella, Cintia Silvahttp://lattes.cnpq.br/6645746568337040http://lattes.cnpq.br/1045834924618603Fortunato, Juliana Gerhardt Soaresjuliana.gersoares@gmail.com2023-08-18T17:08:46Z2026-01-012023-07-20FORTUNATO, Juliana Gerhardt Soares. Sobreutilização de cateter venoso central em terapia intensiva à luz da iniciativa Choosing Wisely: um estudo transversal. 2023. 119 f. Dissertação (Mestrado em Enfermagem) – Faculdade de Enfermagem, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2023.http://www.bdtd.uerj.br/handle/1/20176This research focuses on the overutilization of healthcare technologies in light of the Choosing Wisely initiative, with a specific focus on the use of central line catheters (CLs) in critically ill patients. The overuse of medical devices has been increasing with the availability of new technologies. Therefore, a careful evaluation is necessary in order to optimize their use. In this regard, the indication and maintenance of any technology should be thoroughly considered and based on evidence, to avoid overutilization. The objective of this dissertation is to analyze the occurrence of CL overuse in an Intensive Care Unit (ICU) of a general hospital in Rio de Janeiro. The study follows a quantitative, documentary, cross-sectional, and retrospective design, in accordance with the recommendations of the Strengthening the Reporting of Observational Studies in Epidemiology. The study was conducted in two intensive care units of a general hospital located in the state of Rio de Janeiro. The units of analysis were catheters inserted in the units that remained in the patient for at least 48 hours. A total of 158 participants were selected for the study, generating 248 CLs for analysis. The catheters were predominantly inserted in male patients over 60 years old with cardiopulmonary alterations. The majority of the CLs were installed in the jugular vein (48.39%), with an average duration of 11.95 days. It is worth noting that 89.52% of the catheters did not have a registered therapeutic plan for their insertion. The most prevalent indication was prolonged antibiotic therapy (87.10%). The main adverse event identified was bloodstream infection (25.46%), with Klebsiella pneumoniae carbapenemase being the main agent. The strongest association was found between the length of stay in the ICU and the occurrence of adverse events (p-value < 0.001). In 2019 and 2020, each day of hospitalization increased the chance of an adverse event by 9.6% and 22.2%, respectively. The results show that the Choosing Wisely initiative can contribute to the daily practice of evaluating what is essential and what is unnecessary. The main reasons for overutilization and the occurrence of adverse events related to maintenance were associated with the length of hospitalization and the duration of CL placement. The predominant adverse event was central line association bloodstream infection and its maintenance.Esta pesquisa tem como tema a sobreutilização de tecnologias em saúde à luz da iniciativa Choosing Wisely, com foco na utilização de cateter venoso central (CVC) em pacientes críticos. A sobreutilização de dispositivos assistenciais vem crescendo com o aumento das tecnologias disponíveis. Por isso, faz-se necessária uma avaliação criteriosa, a fim de otimizar seu uso. Nesse sentido, a indicação e a manutenção de qualquer tecnologia devem ser pensadas de forma ampla e embasadas em evidência, de modo que não haja sobreutilização. O objetivo da dissertação é analisar a ocorrência de sobreutilização de cateteres venosos em uma Unidade de Terapia Intensiva (UTI) de um hospital geral do Rio de Janeiro. O estudo é do tipo quantitativo, documental, transversal, retrospectivo, de acordo com as recomendações do Strengthening the reporting of observational studies in epidemiology. O cenário do estudo foram duas unidades intensivas de um hospital geral situado no estado do Rio de Janeiro. As unidades de análise foram cateteres puncionados nas unidades que tenham permanecido por pelo menos 48 horas no paciente. Foram selecionados 158 participantes para o estudo, que geraram 248 CVCs para análise. Os cateteres foram inseridos, em sua maioria, em pacientes homens, com mais de 60 anos e com alterações cardiopulmonares. A maior parte dos CVCs estava instalada em veia jugular (48,39%), com média de permanência de 11,95 dias. Destaca-se que 89,52% dos cateteres não tinham plano terapêutico registrado para sua inserção. A indicação prevalente foi a de antibioticoterapia prolongada (87,10%). O principal evento adverso identificado foi infecção de corrente sanguínea (25,46%), tendo como principal agente a Klebsiella pneumoniae carbapenase. A associação mais forte ocorreu entre o tempo de internação na UTI e a ocorrência de evento adverso (p valor < 0,001). Em 2019 e 2020, cada dia de internação aumentou a chance de evento adverso em 9,6% e 22,2%, respectivamente. Os resultados mostram que a iniciativa Choosing Wisely pode contribuir para a prática diária de avaliar o que é essencial e o que é desnecessário. Os principais motivos de sobreutilização e de ocorrência de evento adverso relacionados com a manutenção foram associados ao tempo de internação e de permanência do CVC. O evento adverso predominante foi a infecção de corrente sanguínea, associada ao CVC, evento este relacionado com a manutenção do cateter.Submitted by Pedro CB/B (pedrocmaf@gmail.com) on 2023-08-18T17:08:46Z No. of bitstreams: 2 Dissertação - Juliana Gerhardt Soares Fortunato - 2023 - Parcial.pdf: 529716 bytes, checksum: c5030a1731253d3995affbda2ed59d4a (MD5) Dissertação - Juliana Gerhardt Soares Fortunato - 2023 - Completo.pdf: 2133427 bytes, checksum: 6a66cad77c23f044326077d1c22f3d79 (MD5)Made available in DSpace on 2023-08-18T17:08:46Z (GMT). No. of bitstreams: 2 Dissertação - Juliana Gerhardt Soares Fortunato - 2023 - Parcial.pdf: 529716 bytes, checksum: c5030a1731253d3995affbda2ed59d4a (MD5) Dissertação - Juliana Gerhardt Soares Fortunato - 2023 - Completo.pdf: 2133427 bytes, checksum: 6a66cad77c23f044326077d1c22f3d79 (MD5) Previous issue date: 2023-07-20application/pdfporUniversidade do Estado do Rio de JaneiroPrograma de Pós-Graduação em EnfermagemUERJBrasilCentro Biomédico::Faculdade de EnfermagemCritical careVascular access devicesPatient safetyCuidados críticosDispositivos de acesso vascularSegurança do pacienteCIENCIAS DA SAUDE::ENFERMAGEM::ENFERMAGEM MEDICO-CIRURGICASobreutilização de cateter venoso central em terapia intensiva à luz da iniciativa Choosing Wisely: um estudo transversalSobreutilização de cateter venoso central em terapia intensiva à luz da iniciativa Choosing Wisely: um estudo transversalinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/embargoedAccessreponame:Biblioteca Digital de Teses e Dissertações da UERJinstname:Universidade do Estado do Rio de Janeiro (UERJ)instacron:UERJORIGINALDissertação - Juliana Gerhardt Soares Fortunato - 2023 - Parcial.pdfDissertação - Juliana Gerhardt Soares Fortunato - 2023 - Parcial.pdfapplication/pdf529716http://www.bdtd.uerj.br/bitstream/1/20176/2/Disserta%C3%A7%C3%A3o+-+Juliana+Gerhardt+Soares+Fortunato+-+2023+-+Parcial.pdfc5030a1731253d3995affbda2ed59d4aMD52Dissertação - Juliana Gerhardt Soares Fortunato - 2023 - Completo.pdfDissertação - Juliana Gerhardt Soares Fortunato - 2023 - Completo.pdfapplication/pdf2133427http://www.bdtd.uerj.br/bitstream/1/20176/3/Disserta%C3%A7%C3%A3o+-+Juliana+Gerhardt+Soares+Fortunato+-+2023+-+Completo.pdf6a66cad77c23f044326077d1c22f3d79MD53LICENSElicense.txtlicense.txttext/plain; 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dc.title.por.fl_str_mv |
Sobreutilização de cateter venoso central em terapia intensiva à luz da iniciativa Choosing Wisely: um estudo transversal |
dc.title.alternative.eng.fl_str_mv |
Sobreutilização de cateter venoso central em terapia intensiva à luz da iniciativa Choosing Wisely: um estudo transversal |
title |
Sobreutilização de cateter venoso central em terapia intensiva à luz da iniciativa Choosing Wisely: um estudo transversal |
spellingShingle |
Sobreutilização de cateter venoso central em terapia intensiva à luz da iniciativa Choosing Wisely: um estudo transversal Fortunato, Juliana Gerhardt Soares Critical care Vascular access devices Patient safety Cuidados críticos Dispositivos de acesso vascular Segurança do paciente CIENCIAS DA SAUDE::ENFERMAGEM::ENFERMAGEM MEDICO-CIRURGICA |
title_short |
Sobreutilização de cateter venoso central em terapia intensiva à luz da iniciativa Choosing Wisely: um estudo transversal |
title_full |
Sobreutilização de cateter venoso central em terapia intensiva à luz da iniciativa Choosing Wisely: um estudo transversal |
title_fullStr |
Sobreutilização de cateter venoso central em terapia intensiva à luz da iniciativa Choosing Wisely: um estudo transversal |
title_full_unstemmed |
Sobreutilização de cateter venoso central em terapia intensiva à luz da iniciativa Choosing Wisely: um estudo transversal |
title_sort |
Sobreutilização de cateter venoso central em terapia intensiva à luz da iniciativa Choosing Wisely: um estudo transversal |
author |
Fortunato, Juliana Gerhardt Soares |
author_facet |
Fortunato, Juliana Gerhardt Soares juliana.gersoares@gmail.com |
author_role |
author |
author2 |
juliana.gersoares@gmail.com |
author2_role |
author |
dc.contributor.advisor1.fl_str_mv |
Camerini , Flávia Giron |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/9892236925588941 |
dc.contributor.referee1.fl_str_mv |
Schutz, Vivian |
dc.contributor.referee1Lattes.fl_str_mv |
http://lattes.cnpq.br/5052180686707412 |
dc.contributor.referee2.fl_str_mv |
Fassarella, Cintia Silva |
dc.contributor.referee2Lattes.fl_str_mv |
http://lattes.cnpq.br/6645746568337040 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/1045834924618603 |
dc.contributor.author.fl_str_mv |
Fortunato, Juliana Gerhardt Soares juliana.gersoares@gmail.com |
contributor_str_mv |
Camerini , Flávia Giron Schutz, Vivian Fassarella, Cintia Silva |
dc.subject.eng.fl_str_mv |
Critical care Vascular access devices Patient safety |
topic |
Critical care Vascular access devices Patient safety Cuidados críticos Dispositivos de acesso vascular Segurança do paciente CIENCIAS DA SAUDE::ENFERMAGEM::ENFERMAGEM MEDICO-CIRURGICA |
dc.subject.por.fl_str_mv |
Cuidados críticos Dispositivos de acesso vascular Segurança do paciente |
dc.subject.cnpq.fl_str_mv |
CIENCIAS DA SAUDE::ENFERMAGEM::ENFERMAGEM MEDICO-CIRURGICA |
description |
This research focuses on the overutilization of healthcare technologies in light of the Choosing Wisely initiative, with a specific focus on the use of central line catheters (CLs) in critically ill patients. The overuse of medical devices has been increasing with the availability of new technologies. Therefore, a careful evaluation is necessary in order to optimize their use. In this regard, the indication and maintenance of any technology should be thoroughly considered and based on evidence, to avoid overutilization. The objective of this dissertation is to analyze the occurrence of CL overuse in an Intensive Care Unit (ICU) of a general hospital in Rio de Janeiro. The study follows a quantitative, documentary, cross-sectional, and retrospective design, in accordance with the recommendations of the Strengthening the Reporting of Observational Studies in Epidemiology. The study was conducted in two intensive care units of a general hospital located in the state of Rio de Janeiro. The units of analysis were catheters inserted in the units that remained in the patient for at least 48 hours. A total of 158 participants were selected for the study, generating 248 CLs for analysis. The catheters were predominantly inserted in male patients over 60 years old with cardiopulmonary alterations. The majority of the CLs were installed in the jugular vein (48.39%), with an average duration of 11.95 days. It is worth noting that 89.52% of the catheters did not have a registered therapeutic plan for their insertion. The most prevalent indication was prolonged antibiotic therapy (87.10%). The main adverse event identified was bloodstream infection (25.46%), with Klebsiella pneumoniae carbapenemase being the main agent. The strongest association was found between the length of stay in the ICU and the occurrence of adverse events (p-value < 0.001). In 2019 and 2020, each day of hospitalization increased the chance of an adverse event by 9.6% and 22.2%, respectively. The results show that the Choosing Wisely initiative can contribute to the daily practice of evaluating what is essential and what is unnecessary. The main reasons for overutilization and the occurrence of adverse events related to maintenance were associated with the length of hospitalization and the duration of CL placement. The predominant adverse event was central line association bloodstream infection and its maintenance. |
publishDate |
2023 |
dc.date.accessioned.fl_str_mv |
2023-08-18T17:08:46Z |
dc.date.issued.fl_str_mv |
2023-07-20 |
dc.date.available.fl_str_mv |
2026-01-01 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/masterThesis |
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masterThesis |
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publishedVersion |
dc.identifier.citation.fl_str_mv |
FORTUNATO, Juliana Gerhardt Soares. Sobreutilização de cateter venoso central em terapia intensiva à luz da iniciativa Choosing Wisely: um estudo transversal. 2023. 119 f. Dissertação (Mestrado em Enfermagem) – Faculdade de Enfermagem, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2023. |
dc.identifier.uri.fl_str_mv |
http://www.bdtd.uerj.br/handle/1/20176 |
identifier_str_mv |
FORTUNATO, Juliana Gerhardt Soares. Sobreutilização de cateter venoso central em terapia intensiva à luz da iniciativa Choosing Wisely: um estudo transversal. 2023. 119 f. Dissertação (Mestrado em Enfermagem) – Faculdade de Enfermagem, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 2023. |
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http://www.bdtd.uerj.br/handle/1/20176 |
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Universidade do Estado do Rio de Janeiro |
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Programa de Pós-Graduação em Enfermagem |
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UERJ |
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Brasil |
dc.publisher.department.fl_str_mv |
Centro Biomédico::Faculdade de Enfermagem |
publisher.none.fl_str_mv |
Universidade do Estado do Rio de Janeiro |
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