Buenas prácticas en la manutención del catéter venoso central en tiempos de COVID-19: un estudio observacional

Dias, Taís Oliveira; Assad, Luciana Guimarães; Paula, Vanessa Galdino de; Almeida, Luana Ferreira de; Moraes, Erica Brandão de; Nassar, Pedro Ruiz Barbosa

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Revista Brasileira de Enfermagem

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 75 (06) • 2022 • https://doi.org/10.1590/0034-7167-2021-0397 copiar

Buenas prácticas en la manutención del catéter venoso central en tiempos de COVID-19: un estudio observacional

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivos:

evaluar adhesión a buenas prácticas de manutención del catéter venoso central por grupo de enfermería en tiempos de COVID-19.

Métodos:

investigación observacional, transversal, cuantitativa con observación no participante. La recolecta de datos fue orientada por instrumento desarrollado para este estudio, constituido por cinco dimensiones. Ocurrió en unidad de terapia intensiva de un hospital universitario en Rio de Janeiro.

Resultados:

fueron realizadas 700 observaciones, que resultaron, en el general, en 402 (57,4%) procedimientos de adhesión a las buenas prácticas. Higiene de las manos (8%) y Realización de curativos (10%) fueron las dimensiones con menor adhesión.

Conclusiones:

las buenas prácticas de manutención del catéter venoso central se mostraron parcialmente presentes en la rutina del grupo de enfermería durante la pandemia de COVID-19. En momentos críticos, intensificar la calificación de los grupos para una mejor adaptación a los nuevos procesos laborales es una estrategia para sustentar la cultura de seguridad del paciente.

Descriptores:
Enfermería de Cuidados Críticos; Seguridad del Paciente; Infecciones Relacionadas con Catéteres; Infecciones por Coronavirus; Programa de Control de Infecciones Hospitalarias.

Dimension 1: Hand hygiene
1. Hygienize your hands correctly with soap and water for 40 to 60 seconds or with an alcohol-based preparation for 20 to 30 seconds before handling the catheter.
Dimension 2: Personal protective equipment
2. Use personal protective equipment (mask, cap, glasses, and gloves) whenever handling the catheter.
Dimension 3: Scrub the hub
3. Scrub the hub with movements to generate mechanical friction, from 5 to 15 seconds before accessing the catheters, connectors, and side ejectors.
4. Scrub the hub with 0.5% chlorhexidine solution or 70% alcohol, waiting for it to dry.
Dimension 4: Performing the dressings
5. Use sterile gloves.
6. Use 0.5% alcoholic chlorhexidine solution for antisepsis.
7. Perform only unidirectional movements; always from the ostium to the distal part.
8. Wait for the applied solution to dry spontaneously.
9. Use sterile gauze or sterile transparent dressing as a cover.
10. Change the dressing every 24 hours when sterile gauze is used, or every seven days when the sterile transparent dressing is installed.
Dimension 5: Records
11. Record the date of exchange of equipment (in medical records, nursing form or on the device, valid for up to 96 hours).
12. Record the connector replacement date (in medical records, nursing form or on the device, valid for up to 96 hours).
13. Record the dressing change (date and signature of the professional who performed it) in the medical record, nursing form or on the dressing cover.
14. Record the presence of phlogistic signs (date and signature of the professional who made the observation) in the medical chart or nursing form.

Dimensions	n	%
Hand hygiene	4	8
Soap and water (40 to 60 s) or alcohol preparation (20 to 30 s)	4	8
Personal protection equipment	47	94
Use of mask, cap, goggles, and gloves	47	94
Scrub the hub	23	46
Disinfection with 70% alcohol for 5 to 15 seconds, waiting for drying	11	22
Disinfection with 0.5% chlorhexidine for 5 to 15 seconds, waiting for drying	12	24
Performing the dressings^* * In the dimension “Records” and “the Performing the dressings”, their final sum was not presented, as the items were evaluated separately as they are not mutually exclusive.
Use sterile glove	44	88
Antisepsis of the puncture site with 0.5% chlorhexidine	43	86
Perform antisepsis with unidirectional movements	22	44
Allow the applied solution to dry spontaneously.	10	20
Maintain sterile coverage with gauze or clear film	49	98
Perform exchange according to routine	50	100
Records^* * In the dimension “Records” and “the Performing the dressings”, their final sum was not presented, as the items were evaluated separately as they are not mutually exclusive.
Connector replacement	0	0
Change of equipment	19	38
Phlogistic signs	32	64
Dressing change	36	72

Dimensions	Nurses%	Residents%	Technician%	p value
Hand hygiene	40	6.6	3.3	< 0.019^†
Personal protection equipment	100	100	89.6	0.315^‖
Scrub the hub	100	55.2	26.3	0.043^‖
Performing the dressings	60	10	2.8	< 0.001^†

	Dimension 1	Dimension 2	Dimension 3	Dimension 4	Dimension 5
Dimension 1	1.00
Dimension 2	0.074 (0.60)	1.00
Dimension 3	0.023 (0.87)	0.233 (0.01)	1.00
Dimension 4	-0.098 (0.49)	0.084 (0.56)	-0.173 (0.22)	1.00
Dimension 5	0.121 (0.48)	-0.097 (0.57)	-0.359 (0.03)	-0.071 (0.68)	1.00

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[1] Corresponding author: Taís Oliveira Dias E-mail: todtaisdias@gmail.com