Uso do cateter central de inserção periférica em uma unidade de terapia intensiva neonatal na região Centro-Oeste

• Autor(a) principal: SOUSA, Júlia Carneiro Godoy de
• Data de Publicação: 2010
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UFG
• Texto Completo: http://repositorio.bc.ufg.br/tede/handle/tde/714
• topic: Cateterismo venoso centra; Recém-nascido; Terapia intensiva neonatal; Enfermagem; Cateterismo venoso central; Recém-nascido; Terapia intensiva neonatal; Enfermagem; Central venous catheterization; Newborn, Neonatal intensive care; Nursing; CNPQ::CIENCIAS DA SAUDE::ENFERMAGEM

The peripherally inserted central catheter (PICC) has been increasingly used in the Neonatal Intensive Care Units (NICU), particularly in the treatment of premature neonates who require prolonged venous access, for security in parenteral therapy and for the quality of care, avoiding the discomfort of repeated punctures. The overall aim was to analyze the use of the PICC in neonates hospitalized in the Neonatal Intensive Care Unit of a university hospital in Goiânia, Goiás. The specific objectives were: to characterize the population of neonates who received PICC during their admissions, to characterize the aspects related to inserting, maintenance and removal of the PICC and describe the complications that arise with the neonates during its use.This is a descriptive exploratory longitudinal study, with a prospective data collection, conducted during the months of May, 2008 to May, 2009. Were included 64 procedures for insertion of PICC in 56 neonates, performed by nurses and doctors of the unit. Data were obtained from medical and nursing records and in proper form accomplished by the nurses of the unit and by the researcher, respecting the ethical principles. The data were processed using Epi-Info, version 3.5.1. and presented as tables with their values absolute, relative and central tendency, dispersion and amplitude measures. For the results, 53.6% of neonates were male, 85.7% premature, gestational age at birth of 32.9 weeks, 37.5% of low birth weight, and average weight at birth of 1814.2 g. The majority (83.9%) received the first PICC still in the first week of life, with 6.5 days of life, on average. Disturbances related to the duration of pregnancy and fetal development were the most commonly diagnosed (175%). The use of vesicant drugs appeared in 100% of the indications for the PICC, mainly the use of antibiotics (98.2%) and total parenteral nutrition (83.9%). Most procedures (39.1%) were preceded by the use of intravenous sedatives and in 73.4% of cases were catheterized peripheral veins of the upper limbs. The central location of the catheter was achieved in 34.4% of procedures, however, there was an incidence of 50% of catheters in intracardiac region, although, most of them (85.9%) has not been pulled. The time of insertion of the PICC was on average 48.7 minutes and the main reason of failure in attempts peripheral venipuncture was the difficulty of visualization of the venous network (48.4%), resulting in an average of four attempts needed by procedure. The majority of catheters had an average of 16.1 days in length of stay, and 35.9% were removed by the end of therapy, followed by 28.1% of cases in which catheters were removed for breaks. In 30% of cases, investigations were carried out on the risk of infection from catheter-related bloodstream; however, none of them, the infection can be confirmed. The main complication during the procedure was the difficulty of progression and blood reflux into catheter (56.3%), whereas during the maintenance of the catheter, was the obstruction (34.4%). There were no complications during the removal of catheters. It is expected that nurses trained to do this procedure seek continuing education to acquire scientific knowledge in this area, wich would support clinical decisions and promote favorable results, improving the quality of intensive care in neonates. It is 21 also believed that this study may provide subsidies to encourage the development of this practice in health services and education institutions.