Nursing care protocol for patients with a ventricular assist device

descriptive study, with a quantitative approach, for an instrument's methodological validation. Three stages were conducted: development of the instrument; protocol content validation according to the Delphi technique, and agreement among experts and the scientific literature.

Results:

based on the content validation, a care protocol for patients with a VAD was created and assessed by Spanish experts. Of the 15 items evaluated by means of the content validity index (CVI), 10 presented solid evidence of validation, with Kappa ranging between 0.87 and 1.

Conclusion:

the method enabled the validation of interventions that will contribute to qualified and standardized care for patients with a VAD.

Descriptors:
Heart Failure; Assisted Circulation; Validation Studies; Protocols; Nursing Care

Variables	Yes		No		Total		Kappa	CVI
Variables	n	%	n	%	n	%	Kappa	CVI
Clarification of the patient in relation to the risk-benefit ratio of the device	28	83.0	6	17	34	100.0	0.87	0.94
Equipment functionality monitoring	31	89.4	3	10.6	34	100.0	1	1
Monitoring of HR, MAP, RAP, LAP, CO, HI, SvO₂	27	78.7	7	21.3	34	100.0	0.80	0.89
Monitoring of pulse oximetry, urine output, temperature	30	87.2	4	12.8	34	100.0	0.96	0.98
Use of pressure relief mattresses to prevent pressure ulcers	31	89.4	3	10.6	34	100.0	1	1
Maintenance of the patient in horizontal decubitus position and contraindication of the changing of decubitus	28	83.0	6	17.0	34	100.0	0.77	0.87
Conducting laboratorial exams such as gasometry (arterial gas analysis), creatinine, urea, lactate, sodium, potassium, magnesium: 6∕6 hours	29	85.1	5	14.9	34	100.0	0.92	0.91
Collection of total proteins and albumin, control of bilirubin, liver enzymes and amylase, fibrinogen and D-dimer: daily	28	83.0	6	17.0	34	100.0	0.83	0.91
Collection of blood culture	25	72.3	9	27.7	34	100.0	0.76	0.87
Administration of prophylactic antibiotic therapy during the seven first days	28	83.0	6	17.0	34	100.0	0.80	0.89
Collection of tracheal secretion culture and surgical wound culture: in case of presence of secretion	27	80.9	7	19.1	34	100.0	0.92	0.96

Action	Description
1. Clarification of the patient in relation to the risk-benefit ratio of the device	Aimed at providing humanized care and reducing patient anxiety
2. Equipment functionality monitoring	Prevention of console-related problems. Prevention of possible obstruction of the system.
3. Monitoring: HR, MAP, RAP, LAP, CO, HI, SvO₂.	Aimed at obtaining appropriate monitoring and clinical compensation.
4. Monitoring of pulse oximetry, urine output, temperature.	Aimed at obtaining appropriate monitoring and clinical compensation.
5. Use of pressure relief mattresses to prevent pressure ulcers.	Redistribute and soften the pressure of a body on a surface and prevent skin injuries.
6. Maintenance of the patient in horizontal decubitus position and contraindication of changing of decubitus.	Avoid obstruction and/or rupture in the system used by the device.
7. Assessment of laboratorial exams such as gasometry, creatinine, urea, lactate, sodium, potassium, magnesium: 6∕6 hours.	Analyze the occurrence of adverse prognoses, such as renal and respiratory changes and ineffective tissue perfusion.
8. Collection of total proteins and albumin, control of bilirubin, liver enzymes and amylase, fibrinogen and D-dimer: daily.	Analyze the occurrence of liver complications and coagulopathies.
9. Administration of prophylactic antibiotic therapy during the seven first days as prescribed.	Perform the prophylaxis of infections related to the surgical wound.
10. Collection of tracheal secretion culture and surgical wound culture: in case of presence of secretion.	Identify microorganisms that cause infections in the surgical wound for an appropriate antibiotic therapy, if necessary.

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
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[1] CORRESPONDING AUTHOR: Regimar Carla Machado. E-mail: regimarmachado@gmail.com