CARE PROTOCOL WITH TOTALY IMPLANTED VENOUS CATHETER: A COLLECTIVE CONSTRUCTION

a convergent care research, conducted at a hospital qualified as a highly complex oncology care unit in Minas Gerais, Brazil, from September 2017 to January 2018. The construction of the protocol was guided by Evidence Based Practice. Initially, data was collected from client records. After that, five workshops were held with the nurses, aiming to verify the material and human resources available, besides the viable care to compose the protocol. The analysis involved processes of apprehension, synthesis, theorization and transference.

Results:

most of the 219 medical records evaluated from clients with fully implanted venous catheters were female (77.1%), with a mean age 49.6 years old, breast cancer, and average catheter stay of 502 days. The nurses participating in the research were female, with a mean age 30.2 years old, time since graduation of 5.2 years and experience in oncology of 4.8 years on average. During the workshops, the participants reflected on the daily routine of the service, with a theoretical and scientific basis, which allowed, considering the professionals' opinion, to verify the care evidences and the practicability of the practices in the study scenario for the construction of a protocol. Care emerged related to puncture, manipulation, salinization and catheter clearance.

Conclusion:

the protocol construction process involved the participation of all oncology nurses, and all the mentioned care has scientific evidence for its use.

DESCRIPTORS
Oncology nursing; Nursing care; Central venous catheterization; Evidence-based nursing; Oncology

Categories	Care measures related to the Fully Implanted Central Venous Catheter (CVC-TI)	Evidence level
CVC-TI puncture	Clean hands with anti-germ chlorhexidine 2%.	Level II
	Wear proper attire (mask and glasses).	Level III
	Position the client in semi-fowler and advise not to talk during the procedure; evaluate the need to provide surgical mask for use.	Level III
	Open the CVC-TI Puncture Kit and other materials with aseptic technique.	Level III
	Put on sterile procedure gloves.	Level I
	Perform antisepsis with 0.5% alcohol chlorhexidine with the aid of surgical forceps in the CVC-TI implantation region, start at the central region and make increasing circular movements up to a diameter of 10 centimeters. Repeat the procedure two more times increasing the diameter and wait for the alcoholic solution to dry for 30 seconds.	Level I
	Puncture the central region of the chamber with the dominant hand, insert the puncture device at an angle of 90° in relation to the CVC-TI until it gently touches its lower part.	Level VII
	Aspirate all the solution contained in the chamber (average, 5 mL in adults and 3 mL in children) or until blood is refluxed.	Level VII
	Attach the 10 mL syringe to the puncture device and flush the chamber with 20 mL of 0.9% PS within approximately two minutes, avoiding excessive pressure.	Level I
	Attach the puncture device: occlusive dressing with sterile gauze or clear sterile polyurethane film (in case of hospitalized client); identify the bandage with the date, time and name of the person in charge; proceed to the indication of the puncture (infusion according to the prescription).	Level I
CVC-TI handling	Clean hands with anti-germ chlorhexidine 2%.	Level II
	Perform circular motion friction three times at the needle outlet with 70% alcohol swab or 70% alcohol-soaked gauze for 5 to 15 seconds, clamp the needle extender and disconnect the system.	Level I
	Keep tip of needle extension and equipment protected with sterile gauze after disconnection.	Level III
	Keep the system closed and protect all inlet ports (study site does not use needleless connectors); after unclamping the needle extender and administering fluids or manipulating the system, reconnect the connections.	Level III
CVC-TI salinization	Salinize CVC-TI without prescription/indication of fluid infusion for up to 30 days.	Level I
	Clean hands with anti-germ chlorhexidine 2%.	Level II
	Clamp the needle extender and connect the 10 mL syringe with 0.9% PS, infuse the 20 mL in flush (positive pressure) and re-clamp the extender.	Level I
	Locate and fix the CVC-TI with a small bandage folded gauze and remove the needle. Protect the puncture site with occlusive and/or compressive dressing with sterile gauze and micropore.	Level I
CVC-TI clearance	Sanitize hands with anti-germ chlorhexidine 2% (soap).	Level III
	Note the presence of signs of obstruction: inability to aspirate at least 3 mL of blood and/or infusion of 5 mL of saline.	Level III
	Aspirate 2 mL of the reconstituted solution from the Alteplase vial and infuse into the CVC-TI.	Level III
	Wait 30 minutes and reassess CVC-TI function. Aspirate 4 mL to 5 mL of blood to remove possible residual clots (if function restored). Then gently irrigate CVC-TI with 10 mL of 0.9% PS.	Level III
	Wait 120 minutes since the last test (if CVC-TI function has not been restored); if occlusion remains, a second dose of the same volume may be administered, repeat the procedure.	Level III
	Contact doctor if CVC-TI function is still not restored. Medical evaluation will define the next conduct.	Level VII

Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
E-mail: textoecontexto@contato.ufsc.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] CORRESPONDENCE AUTHOR
Deborah Franscielle da Fonseca deborahfonseca@hotmail.com