Bundle for handling peripherally inserted central catheter in newborns

Silva, Maria Paula Custódio; Bragato, Aline Guarato da Cunha; Ferreira, Débora de Oliveira; Zago, Luana Barbosa; Toffano, Silmara Elaine Malaguti; Nicolussi, Adriana Cristina; Contim, Divanice; Amaral, Jesislei Bonolo do

doi:10.1590/1982-0194201900036

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Acta Paulista de Enfermagem

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Original Articles • Acta Paul Enferm 32 (3) • May-Jun 2019 • https://doi.org/10.1590/1982-0194201900036 copy

Bundle for handling peripherally inserted central catheter in newborns

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To build a bundle for prevention of primary infection of the bloodstream related to catheter that contemplates nursing care for handling the peripherally inserted central venous catheter in newborns.

Methods

Methodological research, developed in 2017 in three stages: bibliographic survey, instrument building and content validation by five judges. The instrument for validation was composed of 21 nursing care selected in the first stage. The Content Validity Index above 80% was used to assess concordance among the judges. This step was performed in a single round.

Results

Of the 21 items assessed by the judges, ten were excluded because they had a Content Validity Index under 0.80 and three were grouped to the other care listed. The final version of bundle was composed of eight items. The care included was related to hand hygiene before and after handling; use of syringes of proper caliber; exchange and disinfection of the stopcocks and connectors using alcohol 70%; and permeability test and care with dressing.

Conclusion

The study made it possible to create and validate among judges a bundle for handling peripherally inserted central catheter in newborns aiming to prevent primary infection of the bloodstream related to peripherally inserted central venous catheter.

Patient care bundles; Infant, newborn; Catheterization; Catheter-related infections; Intensive care units

Items	Nursing Care	CVI
1	Perform hand hygiene for 40 to 60 seconds, before and after handling the catheter with antiseptic solution of chlorhexidine gluconate and/or 70% alcohol gel.	1
2	Use procedure glove to manipulate the stopcocks.	0.8
3	Use 10 and 20 ml syringes for medications.	1
4	Disinfect the connections, or lateral injector or hub before handling, with alcoholic chlorhexidine solution by means of the strict friction with at least five circular movements.	0.6
5	Disinfect the connections at each handling before they be accessed, with 70% alcohols second choice by means of the strict friction with at least five circular movements.	1
6	Change the stopcocks and connectors immediately when clots are present, and in 72h if they remain unchanged.	0.8
7	Perform the PICC permeability test before and after using it by injecting solution containing 0.9% of sodium chloride twice the minimum value of the priming of the catheter.	1
8	Apply the positive pressure technique or pulsatile flushing, before and after use to minimize the return of blood to the PICC lumen.	1
9	Perform newborn’s bed bath that is with the PICC and avoid wetting the dressing.	1
10	Use aseptic technique to change the transparent and semipermeable sterile dressing over the insertion site.	1
11	Use sterile barrier precautions to change dressings.	0.4
12	Perform the first exchange of the sterile dressing with gauze in 48 hours.	0.6
13	Perform the first exchange of the sterile dressing with gauze in 24 hours.	0.6
14	Perform a dressing exchange every 7 days.	0.4
15	Perform the dressing exchange if dirt or at risk of detachment.	1
16	Use alcoholic antiseptic solution of chlorhexidine gluconate for insertion asepsis in the exchange of the sterile dressing regardless the weight of the newborn.	0.4
17	Use alcoholic antiseptic solution of chlorhexidine gluconate, in newborn over 1500g, for insertion asepsis in the exchange of the sterile dressing.	0.6
18	Use alcoholic antiseptic solution of chlorhexidine gluconate, in newborn under 1500g, for insertion asepsis in the exchange of the sterile dressing.	0.4
19	Perform inspection of the PICC completeness and its functioning daily and when there is an adverse event or technical complaint during intravenous therapy.	1
20	Evaluate the insertion site daily, at least at each shift.	1
21	Evaluate daily the need for catheter permanence.	1

Items	Bundle for handling peripherally inserted central catheter in newborns
1	Perform hand hygiene for 40 to 60 seconds, before and after handling the PICC with antiseptic solution of chlorhexidine gluconate and/or 70% alcohol gel; use procedure gloves and take off adornments.
2	Perform inspection of the catheter completeness and its functioning daily and when there is an adverse event or technical complaint during medications infusion and serum therapy.
3	Disinfect the stopcocks and connections at each handling, with 70% alcohol by means of the strict friction with at least five circular movements.
4	Perform the access permeability test before and after using it by injecting solution containing 0.9% of sodium chloride twice the intern volume of the catheter, applying the positive pressure technique or pulsatile flushing.
5	Use 10 and 20 ml syringes for medications infusions and serum therapy.
6	Perform newborn’s bed bath that is with the PICC and never wetting the dressing.
7	Perform the dressing exchange using aseptic technique, if dirt, at risk of detachment or humidity.
8	Change the stopcocks, connectors, extenders and devices immediately when clots are present or to administrate blood products; and each 72 to 96 hours if they remain unchanged, tagging the date when the device was changed.

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author Jesislei Bonolo do Amaral E-mail: jesisleimjlo@gmail.com