Nursing protocol in transcatheter aortic valve implantation: care guideline

Silva, Giselle Cristina da; Albuquerque, Denilson Campos de; Rocha, Ronilson Gonçalves; Fernandes, Ronald Teixeira Peçanha; Lima, Luciana Cristina Lima Correia; Cabral, Ana Paula Vieira

doi:10.1590/2177-9465-EAN-2017-0260

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RESEARCH • Esc. Anna Nery 22 (3) • 2018 • https://doi.org/10.1590/2177-9465-EAN-2017-0260 copy

Nursing protocol in transcatheter aortic valve implantation: care guideline^a a This paper is part of the Master's thesis: "Nursing protocol in the percutaneous aortic valve implantation" sustained by the first author within the Graduate Program of Nursing at the State University of Rio de Janeiro. 2017

Protocolo de enfermería en el implante de válvula aórtica transcateter: un direccionamiento para el cuidado

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To validate a nursing care protocol by specialist nurses, contributing to the care delivered to patients undergoing percutaneous valve replacement.

Methods:

This cross-sectional, prospective, quantitative study adopted the Content Validity Index (CVI) to verify level of agreement regarding this protocol's total set of items.

Results:

The CVI obtained for each item of the protocol, verified using a validation instrument, was greater than the minimum required that is 0.80, on average.

Conclusion:

The development of a protocol intended to guide care provided to patients who have undergone TAVI, improves patient safety and minimizes health problems, so that the implementation of specific strategies for the development of actions performed by nurses is essential.

Keyword:
Nursing care; Aortic stenosis; Implantation of heart valve prosthesis

	Items assessed
Questions on the instrument used to validate the protocol’s content	Content validation	Relevance	Clarity	Content scope
1. Does the vital signs assessment proposed by the protocol meet the objectives proposed?	0.99	0.95	0.96	0.94
2. Does the neurological assessment comprise the assessment of level of consciousness, pupillary evaluation, sudden signs of stroke, Glasgow Coma scale, and sleep patterns?	0.96	0.89	0.94	0.78
3. Does the protocol consist of an assessment of respiratory rate, respiratory sounds, spontaneous ventilation, whether the patient is receiving oxygen therapy or mechanical ventilation, whether the patient needs his/her airways to be aspirated, care concerning leaving the headboard raised and in regard to chest drains?	0.96	0.93	0.88	0.85
4. Composed of continuous monitoring of heart activity, electric conduction and/or heart rhythm; ECG performed after the procedure, every 12 hours, and when in pain; transvenous cardiac pacing; chestpain; assessment of cardiac enzymes; and whether there was cardiorespiratory arrest after the procedure?	0.96	0.91	0.78	0.78
5. Does gastrointestinal assessment include verifying whether the patient is fasting or his/her diet has been released; checking diet characteristics, whether the patient is having an enteral diet; recording the presence of nauseas; loss of appetite; and date of the last bowel movement?	0.98	0.96	0.88	0.88
6. Does renal assessment include establishing rigorous fluid balance; assessing urine output; assessing signs of renal injury; implementing nephroprotection; and controlling intravenous infusion?	1.00	0.99	0.92	0.93
7. Does the hematologic/vascular assessment include aspects related to the description of accessing the site, whether there is a pulse is present, peripheral perfusion, hematoma, bleeding, limb’s coloration and temperature; monitoring levels of hemoglobin, hematocrit and platelet; collection of pre-transfusion blood sampling; keeping the limb extended during the first 12 hours after the procedure; and assessing bleeding in oral mucosa, feces, ecchymosis, and urine?	0.87	0.86	0.66	0.71
8. Does the pain assessment include aspects related to the presence of pain after the procedure; sudden pain; and administration of analgesics if pain is scored greater than 4 on the numerical verbal scale?	0.99	0.95	0.95	0.95
9. Does this segment include aspects related to decubitus; HGT verification; keeping the patient on bed rest for the first 24 to 48 hours after the procedure; and administrating antibiotics and antiplatelet agents?	0.94	0.95	0.79	0.91

Universidade Federal do Rio de Janeiro Rua Afonso Cavalcanti, 275, Cidade Nova, 20211-110 - Rio de Janeiro - RJ - Brasil, Tel: +55 21 3398-0952 e 3398-0941 - Rio de Janeiro - RJ - Brazil
E-mail: annaneryrevista@gmail.com

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[1] Corresponding author: Giselle Cristina da Silva. E-mail: gisellec.rj@hotmail.com