Neonatal Transfusion Practice: Hemolysis Markers After In Vitro Infusion of Packed Red Blood Cells by the Gravitational Method or Syringe Pump in a Peripheral Catheter.

The objective of this study was to verify the influence of the gravitational infusion method or syringe infusion pump on changes in hemolysis markers of irradiated and nonirradiated packed red blood cells (PRBCs) in vitro administered in a neonate peripheral intravenous catheter. An experimental study was conducted in a laboratory under controlled environmental conditions. Irradiated and nonirradiated PRBCs were administered in triplicate by the gravitational method and 10-mL/hour syringe infusion pump, in peripheral intravenous catheter, Vialon, 24-G caliber. Aliquots were collected directly from the PRBC bag, after manual filling of the infusion system and after infusion by the catheters. The following hemolytic markers were analyzed: degree of hemolysis (%), hematocrit (Ht, %), free hemoglobin (fHb, g/dL), potassium (K, mmol/L), and lactate dehydrogenase (LDH, U/L). Mann-Whitney and Student's t tests were used, P ≤ .05. The gravitational method significantly influenced increasing fHb (P = .007), Ht (P = .002), K (P = .002), and LDH (P = .003) values after PRBC irradiated infusion. The infusion of irradiated and non-irradiated PRBCs interferes with changes in hemolytic markers with the gravitational method. Syringe infusion pump proved to be a beneficial and safe alternative to irradiated and nonirradiated PRBC transfusion in newborns.

Correlation of Premature Infant Sleep/Wakefulness and Noise Levels in the Presence or Absence of "Quiet Time".

BACKGROUND: Peak sound levels during sleep can compromise the development of hospitalized infants. Quiet time is a strategy implemented in neonatal units to promote the sleeping of neonates by reducing noise levels, luminosity, and handling during particular periods of the day. PURPOSE: To determine the impact of quiet time on reducing sound levels and increasing total sleep time. METHODS: This longitudinal study was conducted at a neonatal intermediate care unit with a convenience sample of 12 premature infants. Four times per day, 60-minute quiet times were provided in the neonatal unit. Sleep-awake states and sound levels were evaluated during quiet times as well as 60 minutes before and afterward. Polysomnography was used for sleep-awake state assessment, and a noise dosimeter was used to check sound levels every 24 hours. RESULTS: The preterm infants had a corrected gestational age of 35.0 ± 1.5 weeks and weighed 1606.0 ± 317.8 g. Total sleep time was highest during quiet time (P = .005). Premature infants remained awake for longer following quiet times (P = .005). There was also a reduction in sound level during quiet times compared with the other time frames (P = .006). No statistically significant relationship was found between total sleep time and sound levels more than 24 hours. IMPLICATIONS FOR PRACTICE: Quiet time is a nursing intervention that should be implemented in all neonatal units. IMPLICATIONS FOR RESEARCH: Future research should use a greater sample size and other factors that influence sleep should be further investigated.

[Effect of reducing sensory and environmental stimuli during hospitalized premature infant sleep]. / Efeito da redução de estímulos sensoriais e ambientais no sono de recém-nascidos pré-termo hospitalizados.

OBJECTIVE: To compare the total sleep time of premature infant in the presence or absence of reducing sensory and environmental stimuli in the neonatal unit. METHOD: Longitudinal study in a Neonatal Intermediate Care Unit of a public hospital in Sao Paulo. The sample consisted of 13 premature infants. We used polysomnograph and unstructured observation for data collection. We analyzed 240 and 1200 minutes corresponding to the periods of the presence and absence of environmental management, respectively. Data were compared in proportion to the total sleep time in the two moments proposed by the study. RESULTS: The total sleep time in periods without environmental management was on average 696.4 (± 112.1) minutes and with management 168.5 (± 27.9) minutes, proportionally premature infant slept an average of 70.2% during periods with no intervention and 58.0% without management (p=0.002). CONCLUSION: Reducing stimulation and handling of premature infant environment periods was effective to provide greater total sleep time.

[Assertiveness and peripheral intravenous catheters dwell time with ultrasonography-guided insertion in children and adolescents]. / Assertividade e tempo de permanência de cateteres intravenosos periféricos com inserção guiada por ultrassonografia em crianças e adolescentes.

Randomized controlled trial which aimed to verify whether the use of vascular ultrasound (VUS) increases assertiveness in the use of peripheral venous catheter in children, and the catheter dwell time, when compared to traditional puncture. Data were collected after approval of theethical merit. Children and adolescents undergoing VUS-guided peripheral intravenous (GVUS) or puncture guided by clinical assessment of the venous conditions(CG) were included in the study. Significance level was set at p< or =0.05. The sample was composed of 382 punctures, 188 (49.2%) in VUS Gand 194 (50.8%) in CG, performed in 335 children. Assertiveness was found in 73 (71.6%) GVUS catheters and in 84(71.8%) of the CG (p=0.970), and catheter dwell time presented a median of less than one day in both groups (p=0.121), showing nostatistically significant difference. VUS did not significantly influence the results of the dependent variables investigated. ClinicalTrials.govNCT00930254.

Transfusion Practice: Hemolysis Markers After In Vitro Infusion of Packed Red Blood Cells by the Gravitational Method in Peripheral Catheter.

The objective of this study was to compare hemolysis marker levels after in vitro infusion of red blood cells (RBCs) according to storage time, infusion rate, and peripheral intravenous catheter size. This is an experimental study with randomly administered RBCs in quintuplicate, according to storage time shorter than and longer than 14 days, as well as infusion rate (50 mL/h and 100 mL/h) using catheters with calibers of 14-, 18-, and 20-gauge. Aliquots were collected from RBCs (V1), after equipment and catheter (V2) free-flow filling and after controlled infusion through the catheter (V3). The hemolytic markers analyzed were degree of hemolysis (%), hematocrit (Ht) (%), total hemoglobin (THb) (g/dL), free hemoglobin (FHb) (g/dL), potassium (K) (mmol/L), and lactate dehydrogenase (LDH) (U/L), considering a probability of error ≤5%. Sixty experiments were performed with the analysis of 180 aliquots. When RBCs aged <14 days were used, all catheters tended to increase THb, FHb, and K; while >14 days, RBCs presented increased FHb and degree of hemolysis with catheters of 18-gauge and THb levels at 14-gauge. Among the conditions analyzed, only 20-gauge catheters (the smallest) did not influence changes in hemolysis markers, regardless of RBC storage time.

[Hydrogen potential of antibiotic solutions subjected to environmental conditions: a preliminary trial]. / Potencial hidrogeniônico de soluções de antibióticos submetidas a condições ambientais: ensaio preliminar.

This experimental study was performed to assess the hydrogen potential (pH) of the antimicrobials ceftriaxone sodium, vancomycin hydrochloride, metronidazole, penicillin G potassium, and amikacin sulphate, following reconstitution, diluted with NaCl 0.9% (SF) and glucose solution 5% (GS), at eight different time intervals and under the normal daily conditions of lighting and temperature within the hospital unit (no air conditioning). The objective of this study was to verify the changes in the acid-base behavior of the solutions, which indicate chemical instability and can be associated with complications during intravenous therapy. Of the 186 analyzed pH values, there were no variations greater than 1.0 and no physical alterations visible to the naked eye. All solutions had a pH less than 7, and there were no significant differences for clinical practice regarding the diluent. The mean pH values after dilution with SF and GS for vancomycin hydrochloride, metronidazole, and amikacin sulphate are a risk factor for the development of intravenous complications due to their extreme acidity.

Risk factors for infiltration in children and adolescents with peripheral intravenous catheters.

OBJECTIVES: to estimate the incidence of infiltration and the factors associated with its occurrence in children and adolescents in the operative period and with peripheral intravenous catheters. METHODS: a longitudinal and prospective study with children and adolescents using peripheral intravenous catheters, conducted at the surgical clinic unit of a pediatric hospital in Feira de Santana, State of Bahia, from April 2015 to December 2016. The study used Pearson's chi-square and Fisher's exact test for the analysis. It also applied multiple analyses using Poisson regression with robust variance. RESULTS: the incidence of infiltration was 31.2% and was associated with female sex (RR=0.53; CI=[0.30-0.96]), non-eutrophic children (RR=2.27; CI=[1.25-4.20]), who used non-irritating and non-vesicant drugs (RR=1.72; CI=[1.03-2.87]), vesicant drugs (RR=1.84; CI=[1.05-3.22]) and irritating/vesicant electrolytes (RR=2.35; CI=[1.38-3.97]). CONCLUSIONS: the study suggests the development of strategies that will help in the prevention of this adverse event through the knowledge of the associated factors.

Influence of Peripherally Inserted Central Catheters With Proximal Valves on Red Blood Cell Hemolysis During Transfusion.

The aim of this study was to verify the occurrence of hemolysis after infusion of packed red blood cells (PRBCs) in 12 peripherally inserted central catheters (PICCs) with a proximal valve, according to size and infusion rate. This was an experimental in vitro study performed under laboratory-controlled conditions, and the sample was composed of 12 PICCs with proximal valves (3F and 4F catheter). Twelve type A+ aliquots from 10 PRBCs were analyzed preinfusion and postinfusion according to PICC size and infusion rate. Hemolysis markers, total hemoglobin (g/dL), hematocrit (%), free hemoglobin (g/dL), potassium (mmol/L), lactate dehydrogenase (U/L), and rate of hemolysis (%) were studied. Data were analyzed using analysis of variance and Bonferroni multiple comparison tests. After the infusions in 3F PICCs, an increase was seen in rate of hemolysis (P = .003) and free hemoglobin (P = .014), in addition to a reduction in total hemoglobin (P = .002), with significant influence of minimum and maximum flow rates on the rate of hemolysis. The study finding indicated that the smaller catheter size and the infusion rate influenced variations in some hemolysis markers, but the alterations observed in the hemolysis markers would not contraindicate the infusion of PRBCs by 3F and 4F PICCs with proximal valves.

Care related to peripheral intravenous catheterism in pediatrics performed by nursing technicians.

OBJECTIVES: to evaluate the care practice adopted by nursing technicians before, during and after peripheral intravenous catheterization performed in hospitalized children. METHODS: cross-sectional and descriptive research, carried out in a pediatric hospital in Bahia through non-participatory observation of peripheral intravenous catheterizations performed in children by nursing technicians. Data was collected through an instrument containing care related to the moments before, during and after insertion of the catheter, calculating absolute and relative frequencies, measures of central tendency and dispersion. RESULTS: there were 31 nursing technicians, who performed care mainly before intravenous catheterization. Nonconformities were identified regarding hand hygiene, use of a disposable mask, selection of the catheter insertion site, antisepsis, stabilization and catheter coverage. CONCLUSIONS: most of the precautions observed regarding peripheral intravenous catheterization are not in accordance with the standards of practice recommended by the national and international literature.

Quasi-Experimental study of effects of lighting on rest, activity and melatonin in postpartum women.

OBJECTIVES: to compare the parameters of the activity/rest cycle of early postpartum breastfeeding women under a controlled and uncontrolled long wavelength ray light regimen. METHODS: quasi-experimental study with breastfeeding women and their babies during postnatal rooming-in, São Paulo, Brazil. Participants were allocated to either an experimental (intervention) or a comparison group. The intervention involved exposure of the woman in a controlled room with artificial long wavelength ray light at night. Each woman's level of 6-sulfatoxymelatonin at 24 hours and activity/rest times was analyzed. RESULTS: the mean activity/rest times of women in the experimental and comparison groups were similar. The mean percentages of total load of 6-sulfatoxymelatonin during the day and night were similar (p=0.09). At 24 hours, the experimental group presented a significantly lower mean percentage of total load compared to the comparison group (p=0.04). CONCLUSIONS: women who stayed in the room with long-wavelength artificial light showed no difference in activity/rest and 6-sulfatoxymelatonin levels in the early postpartum period.

Elaboration and validation of an algorithm for treating peripheral intravenous infiltration and extravasation in children.

OBJECTIVE: to elaborate and validate the content and appearance of an algorithm for treating infiltration and extravasation of non-chemotherapy drugs and solutions administered to children. METHOD: a methodological study of the technology formulation and validation type. To elaborate the algorithm, a bibliographic review was carried out to list the scientific evidence on the treatment of infiltration and extravasation. Content and appearance validation was in charge of 14 specialists in pediatric nursing, using the Delphi technique, adopting a value equal to or greater than 0.80 as Content Validation Index. RESULTS: the algorithm was validated in the third evaluation by the judges, reaching a Global Content Validation Index of 0.99, being composed by the perception of the occurrence of the complication; discontinuation of intravenous therapy infusion; verification of signs and symptoms; measurement of edema; application of an infiltration and extravasation assessment scale and conduits to be used according to the characteristics of the fluid administered and the type of complication. CONCLUSION: the algorithm was validated and can be used in a practical and objective way by health professionals, in order to promote safety in the care of hospitalized children, with regard to reducing harms caused by infiltration and extravasation.

Risk and protective factors for sudden infant death syndrome.

OBJECTIVES: To verify the occurrence of the risk and protective factors for sudden infant death syndrome during nursing consultation. METHODS: Retrospective cohort study conducted based on medical records from a primary care unit in the municipality of São Paulo. The sample consisted of 63 infants assisted from January to December 2016. RESULTS: The average age of infants was 3.2 months. The main risk factors identified were the presence of soft objects in the crib (93.6%) and bed sharing (58.7%). Predominant protective factors were breastfeeding (95.2%) followed by updated immunization (90.5%). CONCLUSIONS: Risk and protective factors for sudden infant death syndrome were identified in the study sample, indicating the importance of addressing the issue with families of children under 1 year of age to prevent the occurrence of such events.

Risk factors for site complications of intravenous therapy in children and adolescents with cancer.

OBJECTIVES: to analyze predictive factors for the incidence of complications related to peripheral venous catheters in children and adolescents with cancer. METHODS: a longitudinal follow-up study, conducted at a pediatric oncology clinic unit of a hospital in Bahia, with 333 peripheral venous catheters inserted in 77 children and 26 adolescents. Data collection took place between April 2015 and December 2016 through direct observation of peripheral intravenous catheter insertion, medical record data collection and daily observation of the puncture site. RESULTS: the incidence of complications was 18.6%. The modeling of the variables confirmed that the risk factors for complications in children/adolescents with cancer were: prolonged peripheral intravenous therapy (p=0.002), history of complications (p=0.000), non-irritating/vesicant medications (p=0.003) and vesicant solutions (p=0.000). CONCLUSIONS: the goal has been achieved. Results can contribute to the theoretical, practical and social context.

Influence of Ear Protectors on the Sleep of Preterm Newborns: A Randomized Controlled Clinical Study.

The purpose of this study was to compare the effect of ear protectors on the sleep of preterm newborns during the "quiet" times in intermediate care nursery. This was a clinical, randomized, controlled crossover study conducted in two neonatal units in São Paulo, Brazil. The sample consisted of preterm infants who met the inclusion and exclusion criteria for the study. Polysomnography and unstructured observation were used for data collection. Twenty-four preterm infants with a mean gestational age of 33.2 weeks and current weight of 1.747 g were analyzed. There was no significant difference in the total sleep time of preterm infants with and without the use of ear protectors. Newborns with lower gestational age showed a significant reduction in total sleep time with the use of ear protectors (p < .05). The use of ear protection did not increase the total sleep time for preterm infants.

Time-related factors for peripheral intravenous catheterization of critical children.

OBJECTIVE: To verify characteristics related to critical children, the catheter, and the professionals that will influence the time for the success of the puncture. METHOD: Descriptive, prospective, and correlation study, collected with an unique instrument, and a sample consisting of 89 children cared for in the emergency room. Statistical analysis of the association between time and explanatory variables was performed, considering a significance of 5%. RESULT: The median time for success was 193.4 seconds. Multivariate analysis showed that hypothermic patients (p=0.009) presented prolonged times for success and that the puncture was performed in a shorter time with Vialon® 22G catheters (p=0.045). CONCLUSION: The median time for success was higher than recommended, being influenced by hypothermia and condition of veins the children. The Vialon® 22G catheter is the most suitable for puncturing critical patients. Thus, the incorporation of new practices and technologies is necessary for success to occur in less time.

Effects of Blood Transfusion Sets on Red Blood Cell Hemolysis.

This experimental randomized study compared the effects of macrodrop and microdrop blood transfusion sets on red blood cell (RBC) hemolysis. Twenty units of packed RBCs from different donors were infused through 48 infusion sets from 2 manufacturers at infusion rates of 10 and 100 mL/h. Pre- and postinfusion analysis was performed to determine total hemoglobin (g/dL), hematocrit (%), free hemoglobin (g/dL), potassium (mmol/L), haptoglobin (g/L), and degree of hemolysis (%). The results demonstrated that the level of free hemoglobin (P < .001) and degree of hemolysis (P < .001) increased postinfusion. A higher degree of hemolysis was noted when the RBCs were infused at a rate of 10 mL/h through a microdrop blood transfusion set.

Construction and application of a decision-making flowchart for difficult peripheral intravenous puncture in children / Construcción y aplicación de un diagrama de flujo de toma de decisiones para la punción intravenosa periférica difícil en niños / Construção e aplicação de fluxograma decisório para punção intravenosa periférica difícil de crianças

ABSTRACT Objectives: to construct and verify the clinical applicability of a flowchart for assessing children and adolescents who will undergo peripheral intravenous catheterization, according to risk factors for procedure failure. Method: this is a methodological and observational study, which followed the AGREEII instrument guidelines and steps for the construction of a decision-making flowchart for difficult peripheral intravenous puncture. Afterwards, clinical applicability with children and adolescents was verified after approval of ethical merit, with the main outcome being the success rate in the first puncture attempt. It was verified, through statistical analysis, the association of the outcome with the risk factors raised. Results: in the first stage of the study, a literature review was carried out to survey the risk factors for difficult puncture, and prematurity, less than three years, more pigmented skin, obesity, chronic diseases, dehydration, vein difficult to see and/or not palpable, history of multiple punctures and complications of intravenous therapy were found. After applying the flowchart, it was found that 96.3% of the children and adolescents assessed were at risk of being punctured more than once and that 43.9% underwent more than one procedure for success. Those who were unsuccessful on the first attempt were younger than three years old, had chronic disease, vein difficult to see, not palpable vein and a history of multiple punctures. Conclusion: flowchart construction was based on the risk factors for difficult puncture identified in the literature. Clinical applicability showed that it can be a useful tool to identify children and adolescents at risk for puncture failure.

RESUMEN Objetivos: construir y verificar la aplicabilidad clínica de un diagrama de flujo para la evaluación de niños y adolescentes que serán sometidos a cateterismo intravenoso periférico según factores de riesgo de falla del procedimiento. Método: estudio metodológico y observacional, que siguió las pautas y pasos del instrumento AGREEII para la construcción del diagrama de flujo de toma de decisiones para la punción intravenosa periférica difícil. Posteriormente, se verificó la aplicabilidad clínica con niños y adolescentes, previa aprobación del mérito ético, siendo el resultado principal la tasa de éxito en el primer intento de punción. Se verificó, a través del análisis estadístico, la asociación del desenlace con los factores de riesgo planteados. Resultado: en la primera etapa del estudio se realizó una revisión bibliográfica para relevar los factores de riesgo de la punción difícil, encontrándose prematuridad, menos de tres años, piel más pigmentada, obesidad, enfermedades crónicas, deshidratación, vasos difíciles de visualizar y/o palpar, antecedentes de múltiples punciones y complicaciones de la terapia intravenosa. Después de aplicar el diagrama de flujo, se encontró que el 96,3% de los niños y adolescentes evaluados tenían riesgo de ser puncionados más de una vez, y que el 43,9% se sometió a más de un procedimiento con éxito. Los que no tuvieron éxito en el primer intento eran menores de tres años, tenían enfermedad crónica, dificultad para la visualización y palpación de los vasos y antecedentes de múltiples punciones. Conclusión: la construcción del diagrama de flujo se basó en los factores de riesgo para punción difícil identificados en la literatura. La aplicabilidad clínica demostró que puede ser una herramienta útil para identificar a niños y adolescentes con riesgo de fracaso de la punción.

RESUMO Objetivos: construir e verificar a aplicabilidade clínica de um fluxograma para avaliação de crianças e adolescentes que serão submetidos à cateterização intravenosa periférica, segundo fatores de risco para insucesso do procedimento. Método: estudo metodológico e observacional, que seguiu diretrizes e etapas do instrumento AGREEII para a construção do fluxograma decisório para punção intravenosa periférica difícil. Depois, verificou-se a aplicabilidade clínica com crianças e adolescentes, após aprovação do mérito ético, sendo o desfecho principal o índice de sucesso na primeira tentativa de punção. Verificou-se, por análise estatística, a associação do desfecho com os fatores de risco levantados. A coleta dos dados foi realizada entre os meses de novembro de 2018 e fevereiro de 2019. Resultado: na primeira etapa do estudo realizou-se revisão de literatura para levantamento dos fatores de risco para a difícil punção sendo encontrados prematuridade, menos de três anos, pele mais pigmentada, obesidade, doenças crônicas, desidratação, vasos difíceis de serem visualizados e/ou palpados, história de múltiplas punções e complicações da terapia intravenosa. Após aplicação do fluxograma, verificou-se que 96,3% das crianças e adolescentes avaliados tinham risco para serem puncionados mais de uma vez, e que 43,9% foram submetidos a mais de um procedimento para o sucesso. Os que não obtiveram sucesso na primeira tentativa tinham menos de três anos, possuíam doença crônica, difícil visualização e palpação dos vasos e histórico de múltiplas punções. Conclusão: a construção do fluxograma foi fundamentada nos fatores de risco para a difícil punção identificados na literatura. A aplicabilidade clínica mostrou que pode ser instrumento útil para identificar crianças e adolescentes com risco para insucesso da punção.

Sucesso da punção intravenosa periférica após capacitação dos profissionais de enfermagem para o uso da transiluminação / Puncture Success after training nurses in the use of transillumination / Éxito de la punción venosa periférica después de la formación de profesionales de enfermería en el uso de la transiluminación

Objetivo: avaliar o índice de sucesso na primeira tentativa de cateterização intravenosa periférica em crianças após capacitação de profissionais de enfermagem para o uso de transiluminação. Método: estudo observacional, prospectivo, comparativo do tipo antes e depois, realizado com enfermeiros e técnicos de enfermagem que foram capacitados para a cateterização guiada pela transiluminação e observados executando 35 procedimentos antes e 35 após a capacitação, no período de novembro de 2018 a maio de 2019, após aprovação do mérito ético do protocolo de pesquisa. Os dados foram analisados de forma descritiva e analítica. Resultados: o índice de sucesso na primeira tentativa foi de 62,9% antes e 65,7% depois (p=0,803). Os técnicos de enfermagem executaram mais a punção antes da capacitação e os enfermeiros depois (p<0,01). Conclusão: a capacitação de profissionais para realizar a punção guiada pela transiluminação aumentou o índice de sucesso na primeira tentativa de punção intravenosa periférica, sem diferença estastiticamente significativa(AU)

Objective: to evaluate the puncture success in the first attempt in children after training nursing professionals in the use of transillumination. Method: observational, prospective, comparative before-and-after study, carried out with nurses and nursing technicians were trained for transillumination-guided catheterization and observed performing 35 procedures before and 35 after training, from November 2018 to May 2019, after approval of the ethical merit of the research. Data were analyzed descriptively and analytically. Results: success in the first attempt was 62.9% before and 65.7% after (p=0.803). Nursing technicians performed more punctures before training and nurses after (p<0.01). Conclusion: the training professionals to perform transillumination-guided puncture increased success in the first attempt at peripheral intravenous puncture, without significant statistical difference(AU)

Objetivo: evaluar la tasa de éxito en el primer intento de cateterización venosa periférica en niños después de capacitar a los profesionales de enfermería en el uso de la transiluminación. Método: estudio observacional, prospectivo, comparativo de antes y después, realizado junto a enfermeros y técnicos de enfermería capacitados para cateterización guiada por transiluminación y observados realizando 35 procedimientos antes y 35 después del entrenamiento, de noviembre de 2018 a mayo de 2019, previa aprobación del mérito ético del protocolo de la investigación. Los datos se analizaron de forma descriptiva y analítica. Resultados: la tasa de éxito en el primer intento fue del 62,9% antes y del 65,7% después (p=0,803). Los técnicos de enfermería realizaron más punciones antes del entrenamiento y los enfermeros después (p<0,01). Conclusión: la formación de profesionales para realizar la punción guiada por transiluminación aumentó la tasa de éxito en el primer intento de punción venosa periférica, sin diferencia estadística significativa(AU)

Sleep and salivary cortisol in preterm neonates: a clinical, randomized, controlled, crossover study.

OBJECTIVE: Analyze the influence of ear protectors on the baseline levels of salivary cortisol and response and total sleep time of preterm neonates during two periods of environmental management of a neonatal intermediate care unit. METHOD: A clinical, randomized, controlled and crossover study conducted with 12 preterm neonates. The use of ear protectors was randomized in two periods. Sleep evaluation was performed using one Alice 5 Polysomnography System and unstructured observation. RESULTS: No significant difference was observed between the baseline levels of salivary cortisol and response in preterm neonates from the control and experimental groups, and no statistical significance was observed between the total sleep time of both groups. No relationship was observed between the baseline levels of cortisol and response and total sleep time. CONCLUSION: Ear protectors in preterm neonates did not influence the salivary cortisol level and total sleep time in the studied periods.

Randomized clinical study on radial artery compression time after elective coronary angiography.

OBJECTIVE: to compare two compression times of the radial artery after coronary angiography with customized compressive dressing regarding the occurrence of hemostasis and vascular complications. METHOD: a randomized clinical study was carried out in patients undergoing elective transradial coronary angiography in two study groups: (G30), whose compressive dressing was maintained for 30 minutes, and (G60), whose compressive dressing was maintained for 60 minutes, both until the first evaluation of hemostasis. Variables related to patients, procedure, occurrence of hemostasis, and vascular complications were analyzed. Patency of the radial artery was assessed with Doppler vascular ultrasonography, immediately after removing the compressive dressing and 30 days after the procedure. RESULTS: the sample consisted of 152 patients in G30 and 151 in G60. Hemostasis was evidenced in the first evaluation in 76.3% of G30 patients and 84.2% of G60 patients (p = 0.063). There were 91 immediate complications, being 53 hematomas and 38 occlusions of the radial artery. We identified 18 late occlusions, 7 (5.5%) in G30 and 11 (8.2%) in G60. CONCLUSION: the different compression times of the radial artery after coronary angiography did not significantly influence the occurrence of hemostasis and vascular complications. Brazilian Registry of Clinical Trials (Rebec): RBR-7VJYMJ.