SEGURIDAD DE PACIENTES PEDIÁTRICOS AL ADMINISTRAR HEMOCOMPONENTES

Santos, Mayane Magalhães; Souza, Verusca Soares de; Almeida, Rodrigo Guimarães dos Santos; Wegner, Wiliam; Figueira, Maura Cristiane e Silva; Machado, Cynthia Fernanda Teles

doi:10.1590/1980-265X-TCE-2022-0234en

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Original Article • Texto contexto - enferm. 32 • 2023 • https://doi.org/10.1590/1980-265X-TCE-2022-0234en linkcopiar

SEGURIDAD DE PACIENTES PEDIÁTRICOS AL ADMINISTRAR HEMOCOMPONENTES

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo: analizar la seguridad de pacientes pediátricos al administrar hemocomponentes.

Método: estudio documental y retrospectivo, desarrollado en un hospital de la región Centro-Oeste de Brasil. Los datos se recolectaron a través de historias clínicas y se identificaron 234 transfusiones, realizadas en 90 pacientes de cero a doce años de edad, internados entre los meses de julio y diciembre de 2020. Se empleó un instrumento basado en directrices de buenas prácticas de hemocomponentes. Para el análisis se utilizó estadística descriptiva e inferencial.

Resultados: las transfusiones se realizaron predominantemente en lactantes (71,1%). Hubo predominio de transfusiones sanguíneas en sectores críticos (86,3%), con indicación de orden clínico (87,2%) y prescripción de concentrado de glóbulos rojos (75,3%). En los informes de Enfermería se identificaron eventos adversos (n=05) e incidentes (n=13) que estuvieron asociados a inconsistencias entre los volúmenes prescripto e infundido y al tiempo de solicitud y administración (p<0,001), aunque no se formalizó ninguna notificación en la institución durante el período investigado.

Conclusión: la administración de hemocomponentes presentó inconformidades, lo que deriva en situaciones de riesgo para los pacientes pediátricos.

DESCRIPTORES:
Transfusión de componentes sanguíneos; Transfusión sanguínea; Niño hospitalizado; Seguridad del paciente; Enfermería pediátrica

Variables	Total n (%)	Presence of adverse events		p-value*	Incidents without harms		p-value*
Variables	Total n (%)	Yes	No	p-value*	Yes	No	p-value*
Gender
Male	111 (47.4)	3 (1.2)	108 (46.1)	0.67	71 (30.3)	40 (17.0)	0.11
Female	123 (52.6)	2 (0.8)	121 (51.7)	0.67	66 (28.2)	57 (24.3)	0.11
Race
Brown/Black	127 (54.3)	1 (0.4)	121 (51.7)	0.16	73 (31.1)	54 (23.0)	0.60
White	85 (36.3)	2 (0.8)	82 (35.0)		49 (20.9)	36 (15.3)
Indigenous	13 (5.6)	1 (0.4)	12 (5.1)		10 (4.2)	3 (1.2)
Unknown	9 (3.8)	1 (0.4)	7 (3.0)		5 (2.1)	4 (1.7)
Sectors
Critical	202 (86.3)	5 (2.1)	197 (84.2)	1.00	113 (48.2)	89 (38.0)	0.05
Non-critical	32 (13)	0 (0.0)	32 (13.7)	1.00	24 (10.2)	8 (3.4)	0.05
Reason for the transfusion
Clinical	204 (87.2)	3 (1.2)	201 (85.9)	0.12	123 (52.5)	81 (34.6)	<0.001
Surgical	21 (9)	2 (0.8)	19 (8.1)		5 (2.1)	16 (6.8)
Traumatic	9 (3.8)	0 (0.0)	9 (3.8)		9 (3.8)	0 (0.0)
Blood type
O⁺	99 (42.3)	2 (0.8)	97 (41.4)	0.85	58 (24.7)	41 (17.5)	0.24
A⁺	58 (24.8)	1 (0.4)	57 (24.3)		40 (17.1)	18 (7.7)
O^-	46 (19.7)	1 (0.4)	45 (19.2)		22 (9.4)	24 (10.2)
B⁺	25 (10.7)	1 (0.4)	24 (10.2)		14 (5.9)	11 (4.7)
A^-	4 (1.7)	0 (0.0)	4 (1.7)		1 (0.4)	3 (1.2)
AB⁺	1 (0.4)	0 (0.0)	1 (0.4)		1 (0.4)	0 (0.0)
B^-	1 (0.4)	0 (0.0)	1 (0.4)		1 (0.4)	0 (0.0)

Adverse events/Incidents	Frequency
Adverse events/Incidents	n	%
Adverse events presented
Fever	3	2.1
Cardiopulmonary arrest (CPA)	1	0.7
Emesis	1	0.7
Volume-related incidents	33	23.2
Time-related incidents	84	59.1
Volume- and time-related incidents	20	14.0
Total	142	100.0

Variables	Sectors		p-value*	Presence of adverse events		p-value*	Incidents		p- value*
Variables	Critical	Non-critical	p-value*	Yes	No	p-value*	Yes	No	p- value*
Type of request
Emergency	3 (1.2)	1 (0.4)	0.45	0 (0.0)	4 (1.7)	0.19	1 (0.4)	3 (1.2)	0.31
Urgency (3h)	199 (85.0)	31 (13.2)	0.45	5 (2.1)	225 (96.1)	0.19	136 (58.1)	94 (40.1)	0.31
Blood component prescribed
Red blood cell concentrate	152 (64.9)	23 (9.8)	0.04	3 (1.2)	172 (73.5)	0.37	98 (41.8)	77 (32.9)	0.15
Platelet concentrate	28 (11.9)	9 (3.8)	0.04	1 (0.4)	36 (15.4)	0.37	27 (11.5)	10 (4.2)	0.15
Fresh frozen plasma	21 (8.9)	0 (0.0)	0.0	1 (0.4)	20 (8.5)	0.0	11 (4.7)	10 (4.2)	0.0
Cryoprecipitate	1 (0.4)	0 (0.0)	0.0	0 (0.0)	1 (0.4)	0.0	1 (0.4)	0 (0.0)	0.0
Adequate time between request and administration
Yes	117 (50.0)	12 (6.0)	0.03	4 (1.7)	125 (53.4)	0.25	32 (13.6)	97 (41.4)	<0.001
No	85 (36.3)	20 (8.1)	0.03	1 (0.4)	104 (44.4)	0.25	105 (44.8)	0 (0.0)	<0.001
Adequacy between prescribed and infused volumes
Yes	161 (68.8)	20 (8.5)	0.04	4 (1.7)	177 (75.6)	0.88	86 (36.7)	95 (40.5)	<0.001
No	41 (17.5)	12 (5.1)	0.04	1 (0.4)	52 (22.2)	0.88	51 (21.7)	2 (0.8)	<0.001

Variables	Service sector		p- value*	Adverse events		p- value*	Incidents		p- value*
Variables	Critical	Non-critical	p- value*	Yes	No	p- value*	Yes	No	p- value*
To whom the procedure was intended
Health professionals	191 (81.2)	30 (12.8)	0.16	5 (2.1)	216 (92.3)	1.00	127 (54.2)	94 (40.1)	0.19
Health professionals and companions	3 (1.2)	2 (0.8)		0 (0.0)	5 (2.1)		5 (2.1)	0 (0.0)
Not explained	8 (3.4)	0 (0.0)		0 (0.0)	8 (3.4)		5 (2.1)	3 (1.2)
Vital data before and after the procedure
Heart rate before	195 (83.3)	31 (13.2)	1.00	5 (2.1)	221 (94.4)	1.00	131 (55.9)	95 (40.5)	0.47
Heart rate after	170 (72.6)	30 (12.8)	0.59	4 (1.7)	196 (83.7)	0.54	116 (49.5)	84 (35.8)	0.27
Respiratory rate before	59 (25.2)	23 (9.8)	<0.001	3 (1.2)	7 (2.9)	0.54	56 (23.93)	26 (11.1)	0.02
Respiratory rate after	3 (1.28)^†	2 (0.8)	0.21	0 (0.0)	222 (92.3)	1.00	134 (57.2)	93 (39.7)	0.47
Temperature before	195 (83.3)	31 (13.2)	1.00	5 (2.1)	221 (94.0)	1.00	16 (6.8)	210 (89.7)	1.00
Temperature after	163 (69.6)	27 (11.5)	1.00	3 (1.2)	185 (79.0)	0.30	113 (48.2)	75 (32.0)	0.30
Blood pressure before	174 (74.3)	15 (6.41)	<0.001	4 (1.7)	185 (79.9)	1.00	109 (46.5)	80 (34.1)	0.61
Blood pressure after	136 (58.1)	15 (6.41)	0.03	2 (0.8)	147 (62.8)	1.00	90 (38.4)	59 (25.2)	0.57
Infusion time
Adequate	147 (62.8)	26 (11.1)	0.30	3 (1.2)	170 (72.6)	0.49	103 (44.0)	70 (29.9)	0.62
Inadequate	14 (5.98)	3 (1.2)		0 (0.0)	17 (7.2)		11 (4.7)	6 (2.5)
Not recorded	41 (17.5)	3 (1.2)		2 (0.8)	42 (17.9)		23 (9.8)	21 (8.9)

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[TFN1] Note: p*: Fisher’s Exact Test;