Improving a better nurse practice associated with the manipulation of CVC and needleless connectors

Rui Cruz
Artigos
15 Março, 2019
0 Comment

Autores:

José Manuel Martinez; Flávia Neves; Joana Sousa; Denise Santiago; Débora Rodrigues; Miguel Mendes; Diana Ramada; Teresa Azevedo ON 2018, 37; Novembro 2018; On-line publication: Novembro 2018

Resumo: Com o aumento do número, frequência e duração dos tratamentos de quimioterapia, o incremento do uso de cateteres centrais de longa duração permitiu a administração de terapia intravenosa, suporte transfusional e colheita sanguínea de uma forma mais segura e eficaz. Uma das recomendações para manipular o CvC em segurança foi o uso de conetores sem agulha, sendo fundamental o conhecimento das implicações desses dispositivos na prática de enfermagem.

Objetivo: este estudo visa melhorar a prática associada à manipulação do CvC, usando um duplo conector sem agulha, numa população de pessoas com leucemia aguda (lA) submetidos a quimioterapia de altas doses.

Métodos: Foi realizado um estudo comparativo prospetivo unicêntrico, incluindo uma amostra-consecutiva de todas as pessoas diagnosticadas com lA, portadoras de CvC tipo Hickman®, com conector sem agulha simples (SSnC) (grupo 1) ou duplo conector sem agulha (dSnC) (grupo 2), em fase de quimioterapia ou aplasia, desde dezembro de 2014 a dezembro de 2016, na unidade de Onco-Hematologia do Instituto Português de Oncologia do Porto.

Resultados: no total, foram estudados 17 pessoas com lA que reportaram 78 internamentos [mediana 4, intervalo 1 a 12], 1.122 dias de admissão [mediana de 12.5, intervalo 3 a 44] e 1.044 dias de CvC [mediana 12, intervalo de 3 a 35]. não foi encontrado nenhum risco estatisticamente significativo de infeção associada ao CvC entre os grupos de estudo [RR 0.4528, IC 95%, 0.1235-1.6605], no entanto, aquando da identificação de colonização da linha central esta reportava-se sempre ao grupo 1. Todas as hemoculturas positivas foram reportadas em períodos de neutrope-nia. Nenhuma infeção relacionada com o CvC foi identificada.

Conclusão: O estudo sugere que o dSnC pode ser uma boa escolha para a prática de enfermagem de forma a reduzir o risco de colonização do cvc e melhorar a segurança da sua manipulação em pessoas com lA submetidos a quimioterapia em altas doses.

Palavras – chave: Conector sem agulha; leucemia Aguda; CvC; ClABSI

Verifique o abstract completo aqui.

Link DOI

Obtenha este artigo

Pode obter este artigo gratuitamente clicando aqui.

Referências

Baskin, J. L., Pui, C. H., Reiss, U., Wilimas, J. A., Metzger, M. L., Ribeiro, R. C., & Howard, S. C. (2009). Management of occlusion and thrombosis associated with longterm indwelling central venous catheters. The Lancet, 374(9684), 159-169.
Centers for Disease Control and Prevention (CDC). (2011). Guidelines for the prevention of intravascular catheterrelated infections, 2011. Atlanta: CDC.
Chernecky, C., Zadinsky, J., Macklin, D., & Maeve, M. K. (2013). The Healthcare and Technology Synergy (HATS) framework for comparative effectiveness research as part of evidence-based practice in vascular access. Journal of the Association for Vascular Access, 18(3), 169-174.
Haddadin Y, Regunath H. Central Line Associated Bloodstream Infections (CLABSI). StatPearls Publishing; 2018 Jan-. Avaliable from: htpps://www.ncbi.nlm.nih.gov/books/NBK430891/
Hoffman, R., Benz Jr, E. J., Silberstein, L. E., Heslop, H., Anastasi, J., & Weitz, J. (2013). Hematology: basic principles and practice. Elsevier Health Sciences.
Joint Commission, Joint Commission Resources, Inc, & Joint Commission International. (2012). Preventing central line-associated bloodstream infections: a global challenge, a global perspective. Joint Commission Resources.
Levin, S. M. (2014). The first cardiac catheter. Journal of vascular surgery, 59(6), 1744-1746.
Martinez, J. M., Leite, L., França, D., Capela, R., Viterbo, L., Varajão, N & Santo, A. (2015). Bundle Approach to Reduce Bloodstream Infections in Neutropenic Hematologic. Acta medica portuguesa, 28(4), 474-479.
Martinez, J. M. F. (2017). Central-line Associated bloodstream infection rates and blood cultures collection assessment in Acute Leukemia patients: retrospective cohort study.
Martinez, J.M., Santo, A.E., Godinho, A., Azevedo, A., Felix, A., Chacim, S., Ramada, D., Mariz, J.M., Medeiros, R. (2018). Acute Leukemia Patients: A CLABSI Risk Special Population. Annals of Hematoogy &l Oncology, 5(2): 1192.
Mermel, L. A. (2011). What is the predominant source of intravascular catheter infections? Clinical Infectious Diseases, 52(2), 211-212.
Mollee, P., Jones, M., Stackelroth, J., Van Kuilenburg, R., Joubert, W., Faoagali, J., …& Clements, A. (2011). Catheter-associated bloodstream infection incidence and risk factors in adults with cancer: a prospective cohort study. Journal of Hospital Infection, 78(1), 26-30.
National Comprehensive Cancer Network. Clinical practice guidelines in oncology: prevention and treatment of cancer-related infections. (2017) NCCN Version 2.2017.
Nemoto, T., Kunishima, H., Shimizu, G., Hirose, M.Yamasaki, Y., Nishisako, H., …& Matsuda, T. (2015). Factors predicting the cause and prognosis of central line associated bloodstream infections. Journal of Infection and Chemotherapy, 21(2), 118-122
Oto, J., Nakataki, E., Hata, M., Tsunano, Y., Okuda, N.,Imanaka, H., & Nishimura, M. (2012). Comparison of bacterial contamination of blood conservation system and stopcock system arterial sampling lines used in critically ill patients. American Journal of infection control, 40(6), 530-534.
Römling, U., Kjelleberg, S., Normark, S., Nyman, L., Uhlin, B. E., & Åkerlund, B. (2014). Microbial biofilm formation: a need to act. Journal of internal medicine, 276(2), 98-110.

Revista

Obtenha este artigo

Referências

Baskin, J. L., Pui, C. H., Reiss, U., Wilimas, J. A., Metzger, M. L., Ribeiro, R. C., & Howard, S. C. (2009). Management of occlusion and thrombosis associated with longterm indwelling central venous catheters. The Lancet, 374(9684), 159-169.

Centers for Disease Control and Prevention (CDC). (2011). Guidelines for the prevention of intravascular catheterrelated infections, 2011. Atlanta: CDC.

Chernecky, C., Zadinsky, J., Macklin, D., & Maeve, M. K. (2013). The Healthcare and Technology Synergy (HATS) framework for comparative effectiveness research as part of evidence-based practice in vascular access. Journal of the Association for Vascular Access, 18(3), 169-174.

Haddadin Y, Regunath H. Central Line Associated Bloodstream Infections (CLABSI). StatPearls Publishing; 2018 Jan-. Avaliable from: htpps://www.ncbi.nlm.nih.gov/books/NBK430891/

Hoffman, R., Benz Jr, E. J., Silberstein, L. E., Heslop, H., Anastasi, J., & Weitz, J. (2013). Hematology: basic principles and practice. Elsevier Health Sciences.

Joint Commission, Joint Commission Resources, Inc, & Joint Commission International. (2012). Preventing central line-associated bloodstream infections: a global challenge, a global perspective. Joint Commission Resources.

Levin, S. M. (2014). The first cardiac catheter. Journal of vascular surgery, 59(6), 1744-1746.

Martinez, J. M., Leite, L., França, D., Capela, R., Viterbo, L., Varajão, N & Santo, A. (2015). Bundle Approach to Reduce Bloodstream Infections in Neutropenic Hematologic. Acta medica portuguesa, 28(4), 474-479.

Martinez, J. M. F. (2017). Central-line Associated bloodstream infection rates and blood cultures collection assessment in Acute Leukemia patients: retrospective cohort study.

Martinez, J.M., Santo, A.E., Godinho, A., Azevedo, A., Felix, A., Chacim, S., Ramada, D., Mariz, J.M., Medeiros, R. (2018). Acute Leukemia Patients: A CLABSI Risk Special Population. Annals of Hematoogy &l Oncology, 5(2): 1192.

Mermel, L. A. (2011). What is the predominant source of intravascular catheter infections? Clinical Infectious Diseases, 52(2), 211-212.

Mollee, P., Jones, M., Stackelroth, J., Van Kuilenburg, R., Joubert, W., Faoagali, J., …& Clements, A. (2011). Catheter-associated bloodstream infection incidence and risk factors in adults with cancer: a prospective cohort study. Journal of Hospital Infection, 78(1), 26-30.

National Comprehensive Cancer Network. Clinical practice guidelines in oncology: prevention and treatment of cancer-related infections. (2017) NCCN Version 2.2017.

Nemoto, T., Kunishima, H., Shimizu, G., Hirose, M.Yamasaki, Y., Nishisako, H., …& Matsuda, T. (2015). Factors predicting the cause and prognosis of central line associated bloodstream infections. Journal of Infection and Chemotherapy, 21(2), 118-122

Oto, J., Nakataki, E., Hata, M., Tsunano, Y., Okuda, N.,Imanaka, H., & Nishimura, M. (2012). Comparison of bacterial contamination of blood conservation system and stopcock system arterial sampling lines used in critically ill patients. American Journal of infection control, 40(6), 530-534.

Römling, U., Kjelleberg, S., Normark, S., Nyman, L., Uhlin, B. E., & Åkerlund, B. (2014). Microbial biofilm formation: a need to act. Journal of internal medicine, 276(2), 98-110.