Cuidados de enfermagem a clientes com fistula arteriovenosa: uma revisão integrativa da literatura / Nursing care to clients with arteriovenous fistula: an integrative review of the literature / Atención de enfermería a clientes con fístula arteriovenosa: una revisión integrativa de la literatura

Objetivo: descrever os cuidados da equipe de enfermagem aos clientes portadores de Fistula Arteriovenosa (FAV). Método: revisão integrativa de literatura, que utilizou como questão de busca: quais são os cuidados da equipe de enfermagem aos clientes portadores de fístula arteriovenosa? A busca foi realizada na Biblioteca Virtual de Saúde, nas bases de dados: MEDLINE, LILACS e BDENF; PubMed; Portal de Periódicos da Capes, nas bases SCOPUS e CINAHL, em agosto de 2018. Resultados: foram encontrados três artigos indexados na LILACS e dois na CINAHL. Emergiu a categoria analítica do estudo intitulada: Cuidados de enfermagem aos clientes portadores de FAV, e duas unidades de decodificação: "Incorporação de evidências sobre a FAV, para se pensar os cuidados de enfermagem" e "Atuação da equipe de enfermagem na preservação da FAV: pensando o autocuidado". Conclusões: os cuidados de enfermagem aos clientes portadores de FAV perpassaram pela durabilidade e a manutenção do seu funcionamento

Objective: to describe the care of nursing staff to customers bearers of Arteriovenous Fistula (AVF). Method: integrative Review of literature, which used as search question: what are the care of nursing staff to customers bearers of arteriovenous fistula? The search was conducted in the health Virtual Library, in the databases BDENF, LILACS and MEDLINE; PubMed; Capes Journal Portal, CINAHL, SCOPUS and bases in August 2018. Results: were found three articles indexed at LILACS and two in CINAHL. Analytical category emerged the study entitled: nursing care to clients suffering from AVF, and two units of decoding: "incorporation of evidence about the FAV, to think about nursing care" and "performance of nursing staff in preservation of FAV: thinking self-care". Conclusions: the nursing care to clients suffering from perpassaram FAV durability and maintenance of your operation

Objetivo: para describir el cuidado de enfermería personal para portadores de clientes de la fístula arteriovenosa (AVF). Método: integral revisión de la literatura, que utiliza como pregunta de la búsqueda: ¿Cuáles son los cuidados de enfermería personal para portadores de fístula arteriovenosa de los clientes? La búsqueda se realizó en la Biblioteca Virtual, de la salud en las bases de datos, BDENF, LILACS y MEDLINE; PubMed; CAPES Portal diario, CINAHL, SCOPUS y en agosto de 2018. Resultados: se encontraron tres artículos indizados en LILACS y dos en CINAHL. Categoría analítica surgió el estudio titulado: atención a clientes de AVF y dos unidades de decodificación de enfermería: "incorporación de la evidencia acerca de la FAV, a pensar en cuidados de enfermería" y "rendimiento del personal de enfermería preservación de la FAV: autocuidado de pensamiento" . Conclusiones: la atención de enfermería a clientes que sufren de perpassaram FAV durabilidad y mantenimiento de su operación

Prevenção de infecções relacionadas ao cateter venoso central não implantado de curta permanência / Prevention of infections relating to the short-term, non-implanted, central-line catheter / Prevención de infecciones relacionadas con el catéter venoso central no implantado de corta permanencia

Objetivo: apresentar o estado do conhecimento científico sobre os cuidados de enfermagem relacionados à prevenção e controle de infecções relacionadas ao cateter venoso central não implantado de curta permanência. Conteúdo: destaca-se a importância dos cuidados de enfermagem baseados em evidências e amparados pela legislação do exercício profissional vigente: identificação de sinais e sintomas sugestivos de colonização e/ou infecção, cuidados relacionados ao óstio de inserção e à manutenção do dispositivo, incluindo uso de antissépticos, coberturas e infusão de soluções para manutenção da permeabilidade e prevenção de infecções. Conclusão: para evitar as complicações decorrentes da inserção e manutenção do cateter é necessário que a equipe de saúde possua capacitação técnico-científica baseada em evidências quanto às práticas de cuidado e trabalhem de forma sincronizada e consistente com o objetivo de garantir assistência efetiva e segura.

Objective: to present the state of scientific knowledge about nursing care in prevention and control of infections relating to the short-term, non -implanted, central-line catheter. Content: the study highlighted the importance of evidence-based nursing care supported by current legislation on professional practice: identification of signs and symptoms of colonization and/or infection, care for the insertion site and maintenance of the device, including use of antiseptics, topical products and infusion solutions for maintaining permeability and preventing infection. Conclusion: prevention of complications resulting from catheter insertion and maintenance requires that the health team have evidence-based technical and scientific training in care practices, and work in a synchronized and consistent manner for the purpose of ensuring effective, safe care.

Objetivo: presentar el estado de conocimiento científico sobre la atención de enfermería en cuanto a la prevención y el control de infecciones relacionadas con el catéter venoso central no implantado de corta permanencia. Contenido: se destaca la importancia de la atención de enfermería basada en evidencia y respaldada por la legislación actual de la práctica profesional: identificación de signos y síntomas de colonización y/o infección, cuidado relacionado con la apertura de inserción y el mantenimiento del dispositivo, incluyendo el uso de antisépticos, productos tópicos e infusión de soluciones para el mantenimiento de la permeabilidad y la prevención de infecciones. Conclusión: para evitar las complicaciones derivadas de la inserción y el mantenimiento del catéter es necesario que el equipo de salud tenga capacitación técnico-científica basada en evidencias en cuanto a las prácticas de atención y trabaje de forma sincronizada y consistente con el objetivo de garantizar una atención efectiva y segura

Proposta de um software-protótipo para uso na assistência a pacientes com cateter central de inserção periférica (PICC) / Propuesta de software-prototipo para uso en la asistencia a los pacientes con catéter central insertado periféricamente (PICC) / Proposal for a software-prototype to assist patients with peripherally inserted central catheter (PICC)

Objective: to propose a software prototype as a strategy to improve the communication process and records pertaining to the nursing care of patients undergoing Peripherally Inserted Central Catheter (PICC), and describe the steps for designing a software prototype. Methods: Intervention Research was used in the Intervention Process modality and as a method of operation the Prototyping associated to computer tools. Results: A simple graphics interface computerized model was created and designed to be used in open or private virtual networks. Conclusion: Development of the software prototype to run on web network will make the practical implementation process. It adds that validation with health staff will be carried out before use.

Objetivo: propor um software-protótipo como estratégia para melhorar o processo de comunicação e os registros relativos ao cuidado de enfermagem a pacientes com cateter central de inserção periférica (PICC) e descrever os passos para a construção de um protótipo de software. Métodos: Utilizou-se da Pesquisa de Intervenções, na modalidade de Processo de Intervenção e como método de operacionalização a Prototipação associados a instrumentos de informática. Resultado: Foi criado um modelo computadorizado de interface gráfica simples e projetado para uso em redes abertas ou fechadas. Conclusão: O desenvolvimento do software-protótipo para funcionar em rede web tornará o processo de implantação mais prático. Acrescenta-se que validação com equipe de saúde será realizada antes da utilização.

Objetivo: proponer un prototipo de software como una estrategia para mejorar el proceso de comunicación y del registro de los cuidados de enfermería a pacientes con catéter central insertado periféricamente (PICC) y describir los pasos para construir un prototipo de software. Métodos: Se utilizaron las intervenciones de investigación, en forma de proceso de intervención y cómo el método de funcionamiento de prototipos asociado con herramientas informáticas. Resultado: Se creó un modelo de ordenador de interfaz gráfica simple y diseñada para su uso en redes abiertas o cerradas. Conclusión: El desarrollo del prototipo de software se ejecute en la red web hará que el proceso de aplicación práctica. Añade que la validación con el personal de salud se llevará a cabo antes de su uso.

Reabilitação de crianças e adolescentes com mielomeningocele: relato de experiência de atuação da enfermagem / Rehabilitación de niños y adolescentes con mielomeningocele: relato de experiencia de la práctica de enfermería / Rehabilitation of children and adolescents with myelomeningocele: nursing practice report

RESUMO O artigo foi desenvolvido por enfermeiras com mais de cinco anos de atuação, em uma rede de hospitais de reabilitação no Brasil, referência em toda a América Latina. O objetivo do presente estudo é de relatar a atuação de enfermeiras na reabilitação de crianças e adolescentes com mielomeningocele. As autoras realizaram reuniões presenciais e por videoconferência, discussões e troca de experiências até o consenso e validação do conteúdo. O relato foi organizado e dividido em três tópicos: capacitação para as atividades de vida diária; capacitação para a reabilitação vesicointestinal; capacitação para as atividades de vida prática: autonomia e participação. As famílias de indivíduos com mielomeningocele enfrentam dificuldades relacionadas à condição crônica e à escassez de serviço estruturado e humanizado que garanta e capacite quanto ao cuidado domiciliar. O desafio é fornecer subsídios que orientem profissionais na manutenção do cuidado domiciliar, melhorando a comunicação e promovendo a capacitação dos familiares das crianças e adolescentes com mielomeningocele.

RESUMEN El artículo fue desarrollado por enfermeras con más de cinco años de experiencia, en una red de hospitales de rehabilitación en Brasil, una referencia en América Latina. El objetivo de este estudio es dar a conocer la actuación de enfermeras en la rehabilitación de niños y adolescentes con mielomeningocele. Las autoras llevaron a cabo reuniones en persona y por videoconferencias, debates e intercambio de experiencias hasta el consenso y la validación del contenido. El relato fue organizado y dividido en tres temas: capacitación para las actividades de la vida diaria; capacitación para la rehabilitación vesicointestinal; capacitación para las actividades de la vida cotidiana: autonomía y participación. Las familias de las personas con mielomeningocele enfrentan dificultades relacionadas con la condición crónica y la falta de servicio estructurado y humanizado que garantice y capacite en cuanto al cuidado en el hogar. El reto es proporcionar subsidios que guíen a los profesionales en el mantenimiento de la atención domiciliaria, mejorando la comunicación y promoviendo la capacitación de los familiares de los niños y adolescentes con mielomeningocele.

ABSTRACT This article was developed by nurses with more than five years of practice, at a network of rehabilitation hospitals in Brazil, reference in Latin America. The objective of the present study is to report the activity of nurses in the rehabilitation of children and adolescents with myelomeningocele. The authors held face-to-facemeetings and videoconferences, discussions and exchange of experiences until a consensus was reached and the content was validated. The report was organized and divided into three topics: training for activities of daily living; training for vesicointestinal rehabilitation; training for activities of practical life: autonomy and participation. Families of individuals with myelomeningocele face difficulties related to the chronic condition and lack of structure and humanized services that guarantee and qualify home care. The challenge consists of providing subsidizes that guide professionals in the maintenance of home care, improving communication and training family members of children and adolescents with myelomeningocele.

[Placement of a portacath under hypnosis]. / Pose d'une chambre implantable sous hypnose.

The portacath reflects the cancer and its future treatments. Its insertion causes high levels of anxiety for patient. Thanks to medical hypnosis, he can use its internal resources to help them manage the situation and the symptoms he feels.

Conocimientos sobre el uso de la vía intraósea en situaciones de emergencia del profesional de enfermería que realiza la Especialidad de Emergencias y Desastres en la Universidad Nacional Mayor de San Marcos / Knowledge about the use of intraosseous route in emergency situations of the professional nursing who performs the Specialty of Emergencies and Disasters in the Greatest National University of San Marcos

Determinar los conocimientos sobre el uso de la vía intraósea en situaciones de emergencias en el profesional de Enfermería de la especialidad de Emergencias y Desastres en la UNMSM e identificar los conocimientos sobre la técnica de punción intraósea y el uso de los dispositivos intraóseos. Material y Método: El estudio es de nivel aplicativo, tipo cuantitativo, método descriptivo simple de corte transversal. La población estuvo conformada por 35 profesionales de Enfermería. La técnica fue la encuesta y el instrumento el cuestionario aplicado previo consentimiento informado. Resultados: Del 100 por ciento (35), 11 por ciento (4) tienen conocimiento alto, 31 por ciento (11) medio y 57 por ciento (20) bajo. En cuanto a la técnica de punción intraósea, 6 por ciento (2) poseen conocimientos alto, 14 por ciento (5) medio y 80 por ciento (28) bajo. Respecto al uso de los dispositivos de punción intraósea, 11 por ciento (4) tienen conocimiento alto, 17 por ciento (6) medio y 72 por ciento (25) bajo. Conclusiones: Los conocimientos sobre el uso de la vía intraósea en situaciones de emergencia en el profesional de Enfermería no es el adecuado por lo que la mayoría tiene de medio a bajo referido a que no reconocen el tipo de vía al que pertenece el intraóseo, las indicaciones en niños y adultos, las zonas recomendadas, las ventajas y desventajas, sustancias que se pueden infundir, complicaciones y contraindicaciones. De igual modo en lo referido a la técnica de punción intraósea no conocen acerca de los pasos a seguir para la colocación de un catéter intraóseo, las medidas de asepsia, la comprobación de la correcta colocación del catéter. Sobre el uso de dispositivos intraóseos la mayoría no conocen los existentes actualmente en el mercado y sus principales características...

Objectives: To determine knowledge about using the intraosseous route in emergencies in professional nursing specialty Emergency Disaster San Marcos and identify the knowledge of intraosseous puncture technique and use of intraosseous devices. Material and Methods: The study is level application, quantitative, simple descriptive cross-sectional method. The population consisted of 35 nursing professionals. The technique was the survey instrument and the questionnaire administered prior informed consent. Results: 100 per cent (35), 11 per cent (4) have high awareness, 31 per cent (11) medium and 57 per cent (20) low. As regards the intraosseous puncture technique, 6 per cent (2) have high knowledge, 14 per cent (5) medium and 80 per cent (28) low. Regarding the use of the intraosseous needle devices, 11 per cent (4) have high awareness, 17 per cent (6) medium and 72 per cent (25) low. Conclusions: Knowledge about the use of intraosseous emergency in professional nursing is not adequate for what most have medium to low relative to not recognize the type of road to which the intraosseous part, the on-children and adults, the recommended areas, advantages and disadvantages, substances that can be infused, complications and contraindications. Similarly with regard to the technique of intraosseous puncture do not know about the steps for placing an intraosseous catheter aseptic measures, checking the correct placement of the catheter. On the use of intraosseous devices most do not know the present state of the market and its key features...

Cateter central de inserção periférica em pediatria e neonatologia: possibilidades de sistematização em hospital universitário / Peripherally inserted central catheter in pediatrics and neonatology: Possibilities of systematization in a teaching hospital

Objetivo: Descrever a sistematização do uso do cateter central de inserção periférica em neonatos e crianças, em um hospital universitário do sul do Brasil. Métodos: Estudo qualitativo, desenvolvido com o método criativo sensível. Foram desenvolvidas três dinâmicas com dez enfermeiras. Os dados foram submetidos à análise de discurso francesa. Resultados: Os resultados apontaram que, a sistematização da assistência de enfermagem deve ser aplicada durante todo o processo de utilização do cateter central de inserção periférica; deve ser criado um serviço ambulatorial articulado com o setor de internação e as famílias para que as crianças possam fazer uso do cateter ambulatorialmente. Conclusão: Os protocolos institucionais para o uso deste cateter devem ser desenvolvidos a partir da sistematização da assistência de enfermagem, tendo por base as necessidades do paciente, as evidências científicas, a realidade institucional e o diálogo entre a equipe de enfermagem e médica e a família.

Validation of a screening instrument for the fear of injection in dialysis patients.

BACKGROUND: Very little research has been conducted on the fear of injection (FOI) in patients on dialysis. However, feedback from hospital practice indicate that FOI is widespread. OBJECTIVES: The aim of this study was to develop and validate a screening instrument to assess FOI in dialysis patients. METHOD AND DESIGN: A group of patients (n = 86) completed the Dialysis Fear of Injection Questionnaire (DFIQ) and the Hospital Anxiety and Depression Scale (HADS). In semi-structured interviews, these patients were also asked about their FOI, general anxiety and depressive symptoms. Various analyses were used to examine the factor structure, sensitivity, accuracy and cut-off score. RESULTS: The most optimal set of items consists of 9 items. These items have the sensitivity of 0.88, a specificity of 0.72 and a cut-off value of 3.5. The Cronbach's α is 0.87. CONCLUSION: The DFIQ appears to be a good predictor for the presence of FOI. APPLICATION TO PRACTICE: Nurses can use this validated screening instrument to detect FOI. The cut-off score provides a good indication for psychological counselling.

Moving beyond the "perpetual novice": understanding the experiences of novice hemodialysis nurses and cannulation of the arteriovenous fistula.

Cannulation of the arteriovenous fistula (AVF) is an essential skill for hemodialysis (HD) nurses. With declining rates of AVFs, opportunities to develop expert cannulation skills have become limited. This study explored the concept of perpetual novice and AVF cannulation from the perspective of the novice cannulator. Nine hemodialysis nurses were interviewed using ethnographic methodology. The study identified the interplay between personal and environmental/contextual factors that hindered skill acquisition. Personal attributes identified by participants included HD nurses' approach to learning and previous experience, emotional reaction to stress, and interpersonal relationships with colleagues. Environmental/contextual factors identified as impediments to cannulation skill development included limited learning opportunities, attitudes and demands from patients, unit flow and time pressures, and limitations imposed by the current model of nursing care. This study will be helpful in directing future educational, operational, and supportive interventions for novice HD nurses around cannulation skill development.

Conocimientos sobre medidas de bioseguridad del profesional de enfermería en la inserción y cuidado del catéter intravascular en el Servicio de Neonatología y Pediatría en el Hospital Nacional Ramiro Prialé Prialé, Huancayo 2012 / Knowledge about biosecurity measures of nursing professional in the insertion and care of intravascular catheter in the Neonatology and Pediatrics Service at the National Hospital Ramiro Priale Priale, Huancayo 2012

Ante la creciente demanda de pacientes hospitalizados en todas las unidades, hace que los pacientes estén en constante contacto con el personal de salud incrementando la predisposición a adquirir infecciones intrahospitalarias, por lo que es necesario proponernos como objetivo evitar riesgos de infección de los pacientes hospitalizados ya que es su derecho a ser protegido contra riesgos de infecciones intrahospitalarias, ante esto la enfermera juega un rol fundamental por ser la que quien brinda cuidado humanizado al paciente neonatal. El presente estudio "Conocimientos sobre medidas de bioseguridad del profesional de enfermería en la inserción y cuidado del catéter intravascular del servicio de neonatología y pediatría del Hospital Nacional Ramiro Prialé Prialé Huancayo 2012", tiene como objetivo determinar el nivel de conocimientos sobre medidas de bioseguridad del profesional de enfermería en la inserción y cuidado del catéter intravascular en el servicio de neonatología y pediatría en el Hospital Nacional Ramiro Prialé Prialé Huancayo, tuvo como objetivo; determinar el nivel de conocimientos de las medidas de bioseguridad en la inserción y cuidados de catéteres del personal profesional de enfermería en el servicio de Neonatología y Pediatría del Hospital Nacional Ramiro Prialé Prialé Huancayo 2012. El método fue descriptivo, exploratorio de corte transversal. La población estuvo conformada por 25 enfermeras Con el propósito de proporcionar información actualizada a las autoridades del departamento de enfermería a fin de promover en el profesional de enfermería la aplicación de las medidas de bioseguridad para el control de las infecciones intrahospitalarias y prevenir enfermedades. Los resultados fueron: Acerca de los conocimientos sobre medidas de bioseguridad en la inserción y cuidado del catéter intravascular del 100 por ciento (25), 72 por ciento (18) conocen y 28 por ciento (07) no conocen. Según dimensiones en la inserción del catéter...

With the growing demand of patients hospitalized in all units, makes patients are in constant contact with health personnel increased susceptibility to acquiring nosocomial infections, so it is necessary to propose intended to prevent the risk of infection of inpatients and it is their right to be protected against the risk of nosocomial infections, before this the nurse plays a key role by being the one who gives the patient humanized neonatal care. The present study "Knowledge of biosafety measures nurse in the insertion and care of intravascular catheter in the neonatology and pediatric service of the National Hospital Prialé Ramiro Prialé Huancayo 2012", aims to determine the level of knowledge about biosafety measures nurse in the insertion and care of intravascular catheter in neonatology and pediatrics service at the National Hospital Prialé Ramiro Prialé Huancayo, aims to determine the level of knowledge of biosecurity measures in catheter insertion and care staff nurse in the Neonatal and Pediatric Service of the National Hospital Prialé Ramiro Prialé Huancayo 2012, The method was descriptive, exploratory cross section. The population consisted of 25 nurses In order to provide updated information to the nursing department authorities to pro mote nursing professional in the application of biosecurity measures to control nosocomial infections and prevent disease. The results were about knowledge of biosecurity measures in the insertion and intra vascular catheter care 100 per cent (25), 72 per cent (18) know and 28 per cent (07) do not know. According to dimensions in intravascular catheter insertion of 100 per cent (25), 20 per cent (05) do not know and 80 per cent (20) known, with respect to the dimension intravascular catheter care 100 per cent (25), 72 per cent (18) know and 28 per cent (07) do not know. Conclusion: The knowledge of: nurses regarding biosafety measures before and during insertion of peripheral venous catheter vascular intra and...

'Needle with ease': rapid stress management techniques.

For some patients, even looking at a needle is enough to make them feel anxious. Repeated cannulation for bloods and all other intravenous therapies, such as scans and chemotherapy treatment can become so frightening that they escalate to feeling overwhelmed and panicky. If this response persists without any intervention, it may eventually become a phobia (Choy et al, 2007). Four-hundred-thousand patients are treated at The Christie NHS Foundation Trust each year, with many receiving intravenous chemotherapy treatments. The 'CALM' service was initiated over 5 years ago to enable and support patients to achieve a calm state during procedural-related anxieties and panic. Thanks to recent funding from 'Walk the Walk' Breast Cancer Charity, the service has grown, enabling more patients to access the service. Increasing skill has led to development of training courses for health professionals. The training provides easy-to-learn skills, some of which are described here, that can be used to prevent and/or interrupt panic states triggered by medical procedures.

Cuidado de enfermería al paciente con ansiedad que va a ser sometido a cateterismo cardíaco / Nursing care for patients with anxiety that will undergo a cardiac catheterization", "_i": "

La enfermedad coronaria es uno de los principales problemas de salud pública a nivel mundial, lo cual ha favorecido el desarrollo de diferentes estrategias de diagnóstico y tratamiento; dentro de éstas, se encuentra el cateterismo cardíaco, procedimiento que en la actualidad se considera como la prueba de oro de la cardiología. Debido al carácter invasivo del cateterismo cardíaco, éste puede generar un impacto emocional importante en el paciente, determinado por respuestas de ansiedad, las cuales pueden acrecentarse por el ambiente hospitalario y las creencias culturales, pero sobre todo, cuando no se recibe una adecuada y oportuna educación sobre todos los cuidados relacionados con éste. Por ello, es esencial el papel que desempeña el profesional de enfermería en la identificación de los niveles de ansiedad de los pacientes a través del uso de instrumentos validados, así como en la generación de intervenciones de enfermería basadas en la comunicación y la educación que reduzcan la ansiedad, lo cual evita la aparición de las complicaciones derivadas de la misma, favorece la satisfacción del paciente y con ello, la calidad de la atención recibida.

Coronary heart disease is a major public health problem worldwide, which has favored the development of different diagnostic and treatment strategies such as the cardiac catheterization, this procedure is now considered as the cardiology proof of gold. Due to the invasive character of the cardiac catheterization, this can generate a significant emotional impact on a patient, determined by his responses of anxiety, this aspect can increase by the hospital environment and cultural beliefs of the procedure, but especially when patient do not receive adequate and timely education about the procedure and all care related to it. It is therefore essential the role of the nurse to identify the anxiety levels of patients through the use of validated instruments and the generation of nursing interventions based on communication and education for reducing anxiety, and prevent the occurrence of complications arising from this, promoting patient satisfaction and thus the quality of care.

Validação de procedimentos operacionais padrão no cuidado de enfermagem de pacientes com cateter totalmente implantado / Validation of standard operating procedures in nursing care of patients with totally implanted catheters / Validación de los procedimientos operativos estándar en la atención de enfermería de pacientes con catéter totalmente implantado

Os protocolos de assistência são recursos tecnológicos importantes na prática de saúde e devem ser validados, para adquirirem credibilidade científica na prática profissional. O objetivo desta pesquisa foi validar os itens de proposta de procedimentos operacionais padrão (POPs) quanto à punção, heparinização e curativo do cateter totalmente implantado, por meio da análise de conceito proposta por Hoskins. O estudo se deu em duas etapas. Na primeira, elaborou-se um formulário para validação dos POPs. Na segunda, avaliou-se o conteúdo dos POPs por peritos. As sugestões versaram sobre reformulação da redação; acréscimo de ações, tornando-o mais claro e abrangente; a ordem dos passos dos procedimentos; e o material para a adequação do instrumento. Constatou-se a necessidade de outros estudos que direcionem os profissionais, principalmente, quanto à heparinização dos cateteres e à troca do primeiro curativo após punção, no sentido de uniformizar condutas embasadas em evidências científicas seguras.

Care protocols are important technological resources in health practice and should be validated for the sake of scientific credibility in professional practice. This research aimed to validate the items of the proposed standard operating procedures (SOPs) related to access, heparinization and dressing of totally implanted catheters, using concept analysis as proposed by Hoskins. The study involved two phases. In the first, a form was elaborated to validate the SOPs. In the second, the SOPs contents were subject to expert validation. Suggestions addressed aspects like reformulations, adding actions to make them clearer and more comprehensive, the order of procedure steps and the material to adapt the instrument. Further research is needed to orient professionals, mainly regarding the heparinization of catheters and the first dressing change after the access, with a view to standardizing conducts based on safe scientific evidence.

Los protocolos de atención son recursos tecnológicos importantes en la práctica de salud y deben ser validados, a fin de adquirir credibilidad científica en la práctica profesional. La finalidad de este estudio fue validar los ítem de propuesta de procedimientos operacionales estándar (POEs) referentes a la punción, heparinización y curativo del catéter totalmente implantado, a través del análisis de contenido propuesto por Hoskins. El estudio abarcó a dos etapas. En la primera, fue elaborado un formulario para validación de POEs. En la segunda, el contenido de los POEs fue evaluado por especialistas. Las sugestiones trataron de cuestiones como la reformulación de la redacción, incremento de acciones para aumentar la claridad y el alcance, en el orden de los pasos de los procedimientos y en el material para la adecuación del instrumento. Se constató la necesidad de otros estudios que orienten los profesionales, principalmente respecto a la heparinización de los catéteres y el cambio del primer curativo tras la punción, con vistas a uniformizar conductas basadas en evidencias científicas seguras.

[Hematology-oncology port-A: improving nursing care quality].

BACKGROUND: Hospitalized hematology-oncology patients undergoing chemotherapy face a significant risk of port-A related bloodstream infections. Nurses are uniquely positioned to help adjust clinical practices necessary to prevent port-A related bloodstream infections and improve patient outcomes. Between July 1st, 2008 and June 30th, 2009, twelve patients in our ward were stricken with port-A related bloodstream infections (an infection rate of .318%). Data analysis indicated inadequate nursing competency in all aspects of port-A care. Nurses did not have adequate knowledge of port-A modified standard care protocols and did not provide dressings suited to hematology-oncology patient needs. Also, both patients and caregivers lacked adequate skin care knowledge. Our team developed a project to address and minimize port-A related bloodstream infection issues in our hospital. OBJECTS: The authors designed this project to enhance integration of both the central line insertion care and maintenance practice bundles in order to reduce port-A related bloodstream infection incidence. RESOLUTION: The plan was implemented from August 15, 2009 to December 20, 2009. It included establishing a standardization port-A care protocol, implementing a more appropriate dressing type, performing an irregular audit of port-A care techniques, holding educational training, and establishing skin care instructions for patients and their families. RESULTS: Hematology-oncology patient port-A related bloodstream infections fell from .318% pre-implementation to .099% post-implementation. The effective rate of improvement was 68.87%. CONCLUSION: Standardization of Port-A care under this project achieved infection reduction results that achieved our anticipated goals. This project furthermore enhanced the delivery and quality of patient nursing services. This experience can serve as a reference to medical organizations involved in hematology-oncology patient care.

Avaliação da perviedade precoce das fístulas arteriovenosas para hemodiálise / Evaluation of early patency of the arteriovenous fistulas for hemodialysis

CONTEXTO: A insuficiência renal crônica é uma doença de alta prevalência e morbidade, o que determina queda da qualidade de vida. Pacientes em hemodiálise necessitam de um acesso vascular que permita a conexão da circulação do paciente ao circuito externo de hemodiálise. Dentre os acessos disponíveis, as fístulas arteriovenosas (FAV) são as que mais se aproximam do acesso ideal. OBJETIVO: Avaliar a perviedade precoce das FAV, identificando os fatores relacionados ao insucesso destas. MÉTODOS: Foram acompanhados todos os pacientes submetidos à confecção das FAV no Hospital do Servidor Público Municipal de São Paulo, no período de agosto de 2008 a janeiro de 2009, avaliando-se a perviedade destas no 1º, 10º e 30º pós-operatório. Foram realizadas 31 FAV no período, apresentando-se média de idade de 63,06 anos, sendo 18 pacientes do sexo masculino e 13 do feminino. RESULTADOS: Vinte e seis FAV foram distais, todas radiocefálicas; quatro foram proximais, das quais duas braquiocefálicas e duas braquiobasílicas superficializadas; uma FAV confeccionada com alça de politetrafluoretileno (PTFE) fêmoro-femoral esquerda. A taxa de perviedade no primeiro mês foi de 71 por cento dos casos. O uso de cateteres venosos centrais apresentou-se como fator de risco para oclusão da FAV (p=0,01). As FAV continuam sendo o acesso vascular para hemodiálise mais aceito e mais seguro. A indicação precoce para confecção das FAV é de fundamental importância, evitando-se, assim, o uso de cateteres e suas complicações. CONCLUSÕES: A perviedade precoce encontrada neste estudo é semelhante à da literatura, e o uso prévio de cateteres é o fator de risco mais significativo para oclusão precoce desta.

BACKGROUND: Chronic renal failure is a disease of high prevalence and high morbidity, which impairs the patients' quality of life. Patients on hemodialysis need a vascular access for connection with the hemodialysis equipment. Arteriovenous fistulas (AVF) are the best option for this purpose. OBJECTIVE: To evaluate the early patency of AVFs and to identify the causes of their failure. METHODS: All patients AVF underwent operations for dialysis from August, 2008 to January, 2009. The AVF patency was evaluated on the 1st, 10th and 30th postoperative days. Thirty-one operations for AVF were performed in our hospital in the period; 18 patients were males and the mean age was 63.03 years. RESULTS: Twenty-six AVF were distal, all radial-cephalic; four were proximal, out of which two were brachiocephalic and two were brachiobasilic; one AVF was a femoral-femoral loop PTFE graft. The patency rate in the first month was of 71 percent. The use of central venous catheters was a risk factor for AVF occlusion (p=0.01). AVF remains the most accepted and safe vascular access. Early performance of the AVF is very important to avoid the complications resulting from long-term use of central venous catheters. CONCLUSIONS: Data regarding early patency found in this study were similar to those found in literature, and the use of central venous catheters before performing AVF is an important risk factor for occlusion.

Flebitis postinfusión en catéteres venosos periféricos: Una actualización del arte / Post infusion phlebitis in peripheral venous catheters; An actualization of the art

Las diferentes patologías y su manejo actual hacen que la terapia endovenosa sea frecuentemente utilizada en un gran número de pacientes admitidos en unidades de hospitalización, y más aún, sean fundamentales en las unidades de cuidados intensivos. No obstante, pesar de los beneficios, su utilización no está exenta de complicaciones, siendo una de las más frecuentes la flebitis post infusión o flebitis química, asociándose a una alta incidencia (alrededor de un 15 a 80% de los pacientes con accesos venosos periféricos) y se atribuye principalmente a la irritación provocada por medicamentos administrados por esta vía. Es responsabilidad de enfermería la instalación de una vía venosa periférica y sus cuidados, por lo que es de suma importancia conocer los signos y síntomas de flebitis para su detección precoz y, además, formas de prevención y su manejo una vez que esté presente. Sin embargo, pese a que existen numerosos estudios referentes a su prevención y tratamiento, aún no hay resultados concluyentes que permitan recomendar una medida determinada.

Different pathologies and their current management make intravenous therapy frequently used for the majority of patients admitted to hospital units and are even more critical in intensive care units. Still, despite of the benefits, Its use is not free of complications, being one of the most frequent post infusion phlebitis or chemical phlebitis, associated with a high incidence (around 15 to 80% of patients with peripheral venous access) and is mainly attributed to the irritation caused by medication administered by this route. Is responsibility of nursing staff the installation of peripheral venous catheters and its care, so it is important to recognize the signs and symptoms of phlebitis for early detection and also forms of prevention and handling this once it is present. However, while there are numerous studies concerning the prevention and treatment, there are no conclusive results yet to recommend a particular measure.

Cannulation practice patterns in haemodialysis vascular access: predictors for unsuccessful cannulation.

BACKGROUND: Little is known about the relationship of cannulation practices in dialysis facilities with the frequency of failed cannulations, complications and subsequent vascular access (VA) failure. METHODS: In an observational study the incidence of mis-cannulations and related complications were observed. Patient characteristics, comorbidities and VA characteristics like type of VA were correlated with occurrence of cannulation-related complications. In addition, the cannulation technique and practice patterns like needle direction, tourniquet use and years of experience of dialysis nurses were registered. RESULTS: During the study period, 37% of patients with autogenous arteriovenous fistulae (AVF), and 19% of patients with arteriovenous grafts (AVG) had more than 10 miscannulations. Cannulation-induced haematoma resulted into single-needle (SN) and catheter dialysis in 40% of the patients. The use of central venous catheters (CVC) and SN dialysis were significant predictors of VA failure (p <0.0001). CONCLUSION: This study demonstrated a high incidence of unsuccessful cannulation procedures and cannulation-related complications necessitating catheter and SN dialysis. The type and location of the VA is significantly related to occurrence of unsuccessful and complicated cannulation.

Transcatheter and transapical aortic valve replacement.

Minimally invasive valve replacement is limited to bioprosthetic aortic and pulmonary valves for use in very specific populations of patients. Replacement via trans-catheter and transapical techniques should be used only in patients in whom traditional surgical replacement is deemed an unacceptable risk. Nursing management will focus heavily on care for comorbid conditions because of the high-risk nature of the patients in whom these valves will initially be implanted.