Validation of an instrument regarding nursing intervention in patients in vasoactive therapy

Paim, Ane Elisa; Nascimento, Eliane Regina Pereira do; Bertoncello, Kátia Cilene Godinho; Sifroni, Karla Gomes; Salum, Nadia Chiodelli; Nascimento, Keyla Cristiane do

doi:10.1590/0034-7167-2016-0254

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Revista Brasileira de Enfermagem

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RESEARCH • Rev. Bras. Enferm. 70 (3) • May-Jun 2017 • https://doi.org/10.1590/0034-7167-2016-0254 copy

Validation of an instrument regarding nursing intervention in patients in vasoactive therapy

Validación de instrumentos para intervención de la enfermería en el paciente pasando por terapia vasoactiva

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to validate the content of a Standard Operational Procedure, regarding nursing interventions in emergency patients treated with vasoactive drugs.

Method:

methodological study, carried out from December 2015 to January 2016. Content validity was determined by 16 experts (13 nurses, 2 pharmacists and one biomedical scientist), who judged it through a four-point Likert scale. The items were evaluated in terms of: feasibility, objectivity, simplicity, clearness, pertinence and accuracy. The Content Validity Index was applied, accepting the value ≥ 0.90.

Results:

two rounds of evaluation were required to achieve the minimum index. The items were reviewed regarding writing, dilution, indication and replacement interval. The instrument was validated with 33 items and with total Content Validity Index of 0.99.

Conclusion:

the instrument was considered appropriate, fractionally and globally, for nursing care for the patient treated with vasoactive drugs in emergency, in a safe and reliable way.

Descriptors:
Nursing Care; Validation Studies; Vasodilators; Emergency Medical Services; Method

Nursing interventions common to all five drugs
1.	Infuse only through infusion pump and execute a strict flow control.
2.	Assess the permeability of the intravenous catheter every three hours, checking the flow of the infused solution.
3.	Perform continuous monitoring of heart rate and oxygen saturation.
4.	Check blood pressure every 15 minutes during dose adjustment and every 30 minutes during maintenance dose.
5.	Replace continuous solutions every 24 hours; prepare solution immediately before completion and complete the replacement quickly.
6.	Identify the solution with a label containing: patient name; name, concentration and quantity of the drug; solution dilution, its concentration e quantity; route of administration; date e initial time; initial flow; and name of the professional who prepared it.

Requirements	Small revision		Representative		Small revision		Representative		CVI^* * Content Validity Index.
	3		4		3		4		CVI^* * Content Validity Index.
	n	%	n	%	n	%	n	%	1	2
Feasibility	38	1.47	382	14.87	35	1.30	413	15.37	0.90	1
Objectivity	31	1.20	395	15.38	20	0.74	428	15.93	0.92	1
Simplicity	20	0.77	411	16.00	20	0.74	428	15.93	0.93	1
Clearness	32	1.24	397	15.45	41	1.52	409	15.22	0.92	1
Pertinence	11	0.42	418	16.27	16	0.59	428	15.93	0.92	0.99
Accuracy	24	0.93	409	15.92	21	0.78	427	15.89	0.93	1
Total	156	6.07	2412	93.93	153	5.69	2533	94.30	0.92	0.99

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: Kátia Cilene Godinho Bertoncello. E-mail: kbertoncello@yahoo.com.br

Standard Operating Procedure (SOP)	Title: nursing intervention in patients undergoing vasoactive pharmacotherapy (dobutamine hydrochloride, dopamine hydrochloride, nitroglycerin, sodium nitroprusside and norepinephrine hemitartrate).
Nursing Interventions
Objective: contribute to the improvement of the quality of care to severe patients undergoing vasoactive pharmacotherapy	Agents: Nurse and nursing technician
Vasoactive drugs concept: a set of drugs that have expressive pharmacodynamic properties that result in great clinical usage, since they can maintain the life of patients with serious pathologies.
Nursing interventions common to all five drugs
1. Infuse only through infusion pump and execute a strict flow control. 2. Assess the permeability of the intravenous catheter every three hours, checking the flow of the infused solution. 3. Perform continuous monitoring of heart rate and oxygen saturation. 4. Check blood pressure every 15 minutes during dose adjustment and every 30 minutes during maintenance dose. 5. Replace continuous solutions every 24 hours; prepare solution immediately before completion and complete the replacement quickly. 6. Identify the solution with a label containing: patient name; name, concentration and quantity of the drug; solution dilution, its concentration e quantity; route of administration; date e initial time; initial flow; and name of the professional who prepared it.
Dobutamine hydrochloride
Indication: it is a powerful inotropic agent. It is used in chronic low debt heart failure and ventricular failure in the acute phase of myocardial infarction.
Solution for dilution: 5% glucose or 10% glucose or 0.9% sodium chloride or lactated ringer.
1. Always infuse through intravenous catheter with a caliber diameter, preferably central 2. In an eventual use of a peripheral intravenous catheter, check for the presence of inflammatory signs in the catheter insertion. 3. Watch out for the appearance of arrhythmias such as supraventricular tachycardia, nonsustained ventricular tachycardia and atrial fibrillation and assess hemodynamic repercussion (only nurse). 4. Perform strict control of infused and eliminated fluids. 5. Watch for signs of hypovolemia: hypotension, tachycardia, low output of urine, cold and moist skin. 6. Watch out for drug incompatibility: it should not be added to solutions containing sodium bicarbonate or other alkaline solutions (eg, aminophylline and phenytoin), hydrocortisone sodium succinate, cefazolin, cefamandol, cephalothin, penicillin, ethacrynic acid and heparin sodium. If any of these medications are prescribed, infuse through another lumen of the multilumen central catheter or another intravenous catheter.
Dopamine hydrochloride
Indication: it is a powerful inotropic agent. It is used in the treatment of various types of shock and severe hypotension after acute myocardial infarction.
Solution for dilution: 5% glucose or 0.9% sodium chloride.
1. Always infuse through intravenous catheter with a caliber diameter, preferably central 2. In an eventual use of a peripheral intravenous catheter, check for the presence of inflammatory signs in the catheter insertion. 3. Constantly evaluate the peripheral perfusion. 4. Protect from light: use a bottle of solution wrapped with a protective cover for photosensitive solutions and proper equipment for photosensitive parenteral solutions. 5. Watch out for the appearance of arrhythmias such as ventricular tachycardia, ventricular and atrial fibrillation and assess hemodynamic repercussion (only nurse). 6. Perform strict control of infused and eliminated liquids. 7. Watch for signs of hypovolemia: hypotension, tachycardia, low output of urine, cold and moist skin. 8. Watch out for drug incompatibility: should not be added to solutions containing sodium bicarbonate or other alkaline solutions (eg, aminophylline and phenytoin), furosemide, thiopental sodium, insulin, ampicillin and amphotericin B; solution with gentamicin sulphate, cephalothin sodium and oxacillin sodium. If any of these medications are prescribed, infuse through another lumen of the multi-lumen central catheter or another intravenous catheter.
Nitroglycerin
Indication: it is a vasodilator agent, more intense at the venous level. Used in the treatment of acute heart failure, particularly if there is associated ischemic pain.
Solution for dilution: 5% glucose or 0.9% sodium chloride.
1. Infuse through intravenous catheter with a caliber diameter. 2. Be aware of headache and dizziness if the patient is conscious. 3. Infuse other prescribed medication through another lumen of the multi-lumen central catheter or another intravenous catheter.
Sodium nitroprusside
Indication: it is a veins and arteries fast action dilator. Used in hypertensive emergencies.
Solution for dilution: 5% glucose.
1. Infuse through intravenous catheter with a caliber diameter. 2. Watch for signs of hypovolemia: hypotension, tachycardia, low output of urine, cold and moist skin. 3. Protect from light: use a bottle of solution wrapped with a protective cover for photosensitive solutions and proper equipment for photosensitive parenteral solutions. 4. Watch out for drug incompatibility with atracurium besylate and levofloxacin. If any of these medications are prescribed, infuse through another lumen of the multi-lumen central catheter or another intravenous catheter.
Norepinephrine hemitartrate
Indication: it is a vasoconstrictor agent used in the emergency recovery of blood pressure in acute hypotensive states.
Solution for dilution: 5% glucose.
1. Always infuse through intravenous catheter with a caliber diameter, preferably central. 2. Often control peripheral perfusion, and skin color and temperature. 3. In an eventual use of a peripheral intravenous catheter, check for the presence of inflammatory signs in the catheter insertion. 4. Watch out for the appearance of arrhythmias such as ventricular tachycardia, ventricular and atrial fibrillation and assess hemodynamic repercussion (only nurse). 5. Protect from light: use a bottle of solution wrapped with a protective cover for photosensitive solutions and proper equipment for photosensitive parenteral solutions. 6. Watch out for drug incompatibility with sodium bicarbonate or other alkaline solutions (aminophylline, phenytoin and etc.). If any of these medications are prescribed, infuse through another lumen of the multi-lumen central catheter or another intravenous catheter.