Ventricular catheter tissue obstruction and shunt malfunction in 9 hydrocephalus etiologies.

OBJECTIVE: Hydrocephalus is a neurological disorder with an incidence of 80-125 per 100,000 births in the United States. The most common treatment, ventricular shunting, has a failure rate of up to 85% within 10 years of placement. The authors aimed to analyze the association between ventricular catheter (VC) tissue obstructions and shunt malfunction for each hydrocephalus etiology. METHODS: Patient information was collected from 5 hospitals and entered into a REDCap (Research Electronic Data Capture) database by hydrocephalus etiology. The hardware samples were fixed, and each VC tip drainage hole was classified by tissue obstruction after macroscopic analysis. Shunt malfunction data, including shunt revision rate, time to failure, and age at surgery, were correlated with the degree of tissue obstruction in VCs for each etiology. RESULTS: Posthemorrhagic hydrocephalus was the most common etiology (48.9% of total cases). Proximal catheter obstruction was the most frequent cause of hardware removal (90.4%). Myelomeningocele (44% ± 29%), other congenital etiologies (48% ± 40%), hydrocephalus with brain tumors (45% ± 35%), and posthemorrhagic hydrocephalus (41% ± 35%) showed tissue aggregates in more than 40% of the VC holes. A total of 76.8% of samples removed because of symptoms of obstruction showed cellular or tissue aggregates. No conclusive etiological associations were detected when correlating the percentage of holes with tissue for each VC and age at surgery, shunt revision rates, or time between shunt implantation and removal. CONCLUSIONS: The proximal VC obstruction was accompanied by tissue aggregates in 76.8% of cases. However, the presence of tissue in the VC did not seem to be associated with hydrocephalus etiology.

Exploration of clinical predictors of the degree of ventricular catheter obstruction: a multicenter retrospective study.

OBJECTIVE: The aim of this study was to explore how clinical factors, including the number of lifetime revision surgeries and the duration of implantation, affect the degree of obstruction and failure rates of ventricular catheters (VCs) used to manage hydrocephalus. METHODS: A total of 343 VCs and their associated clinical data, including patient demographics, medical history, and surgical details, were collected from 5 centers and used for this analysis. Each VC was classified by the degree of obstruction after macroscopic analysis. Univariate, multivariate, and binned analyses were conducted to test for associations between clinical data and degree of VC obstruction. RESULTS: VCs from patients with 0 to 2 lifetime revisions had a larger proportion of VC holes obstructed than VCs from patients with 10 or more revisions (p = 0.0484). VCs implanted for less than 3 months had fewer obstructed holes with protruding tissue aggregates than VCs implanted for 13 months or longer (p = 0.0225). Neither duration of implantation nor the number of lifetime revisions was a significant predictor of the degree of VC obstruction in the regression models. In the multinomial regression model, contact of the VCs with the ventricular wall robustly predicted the overall obstruction status of a VC (p = 0.005). In the mixed-effects model, the age of the patient at their first surgery emerged as a significant predictor of obstruction by protruding tissue aggregates (p = 0.002). VCs implanted through the parietal entry site were associated with more holes with nonobstructive growth and fewer empty holes than VCs implanted via other approaches (p = 0.001). CONCLUSIONS: The number of lifetime revisions and duration of implantation are correlated with the degree of VC obstruction but do not predict it. Contact of the VC with the ventricular wall and the age of the patient at their first surgery are predictors of the degree of VC obstruction, while the entry site of the VC correlates with it.

A prospective, randomized study assessing different modalities for flushing totally implanted vascular access device in children with malignancy.

BACKGROUND: The totally implanted vascular access device (TIVAD) is commonly used in patients with malignant tumors requiring chemotherapy or long-term intravenous infusion and those with difficulty placing peripheral venous catheters. It could also be used to draw blood in pediatric patients. Thus, how to maintain the patency and longevity of TIVAD is always emphasized. METHODS: In this prospective study, TIVAD was randomly infused in patients under 18 years with three different concentrations of heparinized solutions: 10 mL with 100 U/mL heparin, 20 mL with 10 U/mL heparin, and 30 mL with 10 U/mL heparin. RESULTS: A total of 81 patients (46 males and 35 females) were enrolled in this study from August 2, 2013 to February 1, 2017. The mean age of those who received TIVAD implantation was 7.2 ± 5.3 years, and the mean duration of using TIVAD was 1027.6 ± 369.1 days. Patients without catheter occlusion events experienced significantly shorter hospitalizations, fewer admissions, and fewer punctures than those with catheter occlusion events (p < 0.05). The administration and frequency of blood transfusions, history of bacteremia, and medication history did not increase the risk of catheter occlusion, but puncture frequency increased this risk. In patients with catheter occlusion events (38/81, 46.9%), catheter patency was restored after instillation of urokinase solution. CONCLUSION: In this study, the risk of TIVAD catheter occlusion was only related to puncture frequency regardless of the heparin flush composition or patient characteristics. A high puncture frequency of TIVAD during the 3.5-year study period significantly increased the risk of catheter occlusion. Besides, flushing and locking solutions for TIVAD using heparin at 10 U/mL was effective as using heparin at 100 U/mL regardless of the flushing volume of 10, 20, or 30 mL.

A multicenter retrospective study of heterogeneous tissue aggregates obstructing ventricular catheters explanted from patients with hydrocephalus.

BACKGROUND: Implantation of ventricular catheters (VCs) to drain cerebrospinal fluid (CSF) is a standard approach to treat hydrocephalus. VCs fail frequently due to tissue obstructing the lumen via the drainage holes. Mechanisms driving obstruction are poorly understood. This study aimed to characterize the histological features of VC obstructions and identify links to clinical factors. METHODS: 343 VCs with relevant clinical data were collected from five centers. Each hole on the VCs was classified by degree of tissue obstruction after macroscopic analysis. A subgroup of 54 samples was analyzed using immunofluorescent labelling, histology and immunohistochemistry. RESULTS: 61.5% of the 343 VCs analyzed had tissue aggregates occluding at least one hole (n = 211) however the vast majority of the holes (70%) showed no tissue aggregates. Mean age at which patients with occluded VCs had their first surgeries (3.25 yrs) was lower than in patients with non-occluded VCs (5.29 yrs, p < 0.02). Mean length of time of implantation of occluded VCs, 33.22 months was greater than for non-occluded VCs, 23.8 months (p = 0.02). Patients with myelomeningocele had a greater probability of having an occluded VC (p = 0.0426). VCs with occlusions had greater numbers of macrophages and astrocytes in comparison to non-occluded VCs (p < 0.01). Microglia comprised only 2-6% of the VC-obstructing tissue aggregates. Histologic analysis showed choroid plexus occlusion in 24%, vascularized glial tissue occlusion in 24%, prevalent lymphocytic inflammation in 29%, and foreign body giant cell reactions in 5% and no ependyma. CONCLUSION: Our data show that age of the first surgery and length of time a VC is implanted are factors that influence the degree of VC obstruction. The tissue aggregates obstructing VCs are composed predominantly of astrocytes and macrophages; microglia have a relatively small presence.

British Association of Urological Surgeons (BAUS) and Nurses (BAUN) consensus document: management of the complications of long-term indwelling catheters.

OBJECTIVE: To look at best evidence and expert opinion to provide advice in the form of a consensus statement lead by Female, Neurological and Urodynamic Urology (FNUU) section of the British Association of Urological Surgeons (BAUS) in conjunction with the British Association of Urological Nurses (BAUN). METHODS: Initially a literature search was performed with incorporation of aspects of the existing guidance and further informed by UK best practice by core members of the group. The document then underwent reviews by the FNUU Executive Committee members, the BAUN executive committee, a separate experienced urologist and presented at the BAUS annual meeting 2020 to ensure wider feedback was incorporated in the document. RESULTS: Complications of long-term indwelling catheters include catheter-associated urinary tract infections (CAUTI), purple urine bag syndrome, catheter blockages, bladder spasms (causing pain and urinary leakage), loss of bladder capacity, urethral erosion ("catheter hypospadias")/dilatation of bladder outlet and chronic inflammation (metaplasia and cancer risk). CONCLUSIONS: We have provided a list of recommendations and a troubleshooting table to help with the management of the complications of long term catheters.

Risk factors for the development of venous thrombosis in patients with a central venous catheter admitted to the intensive care unit of the Roberto Gilbert Elizalde children's hospital / Factores que condicionan el desarrollo de trombosis venosa en pacientes con catéter venoso central ingresados en la unidad de cuidados intensivos del hospital de niños Roberto Gilbert Elizalde

Introduction: Advances in the management and survival of severe pediatric disease have led to an increase in thromboembolic phenomena, given the frequent need for central venous catheters (CVC). The present study describes the conditions in which venous thrombosis oc-curs in pediatric patients with CVC in a public referral center in Guayaquil. Methods: This is an observational, cross-sectional study with the objective of identifying fac-tors that are associated with the development of venous thrombosis in patients with CVC ad-mitted to the Intensive Care Unit. Information was collected in a pre-designed chart of all patients with CVC for more than 7 days. A venous Doppler ultrasound was performed to de-termine the presence or absence of thrombi. Descriptive statistics were used for univariate analysis and Odds Ratio was used for the bivariate analysis. Results: 35 patients were included in the study, 14/35 (40%) young infants, 24/35 males (69%), 19 cases (54%) with malnutrition, 10 cases (29%) with congenital heart disease, and 18 cases (51%) admitted for infections. The puncture site was femoral in 11 cases (31%), the procedure was performed by the fellow in 20 cases (57%), on a scheduled basis in 27 cases (77%), and performed in a single attempt in 28 cases (80%). The tip of the catheter was located in the superior vena cava in 23 cases (66%). The prevalence of thrombosis was 14% (95% CI 12.33-16.25). Bivariate analysis showed that none of the variables were associated with the presence of CVC thrombosis. Conclusions: 14% of patients with CVC use for more than 7 days develop secondary venous thrombosis. The factors associated with CVC including nutritional status and related proce-dures could not be determined.

A Randomized Clinical Trial of Low-dose Warfarin Therapy for Improving the Longevity of Permanent Arteriovenous Catheters.

BACKGROUND: The patency of a permanent arteriovenous catheter plays a significant role in the functioning of the catheter among patients dependent on the hemodialysis. Thrombosis formation is one of the most critical reasons for the short-term efficacy of the embedded catheters. The present study aimed to evaluate the efficacy and safety of warfarin for hemodialysis catheter failure prevention. METHODS: This randomized clinical trial has been conducted on patients under hemodialysis using a permanent arteriovenous catheter. The patients were randomly allocated to the control group and the intervention group. The intervention group was treated with warfarin to achieve a target international normalized ratio (INR) of 1.5-2. The control group did not receive any treatment. The patients were followed for 12 months to assess the efficacy defined as the incidence of catheter clotting and safety defined as warfarin-related hemorrhage. RESULTS: Eighty-six patients with end-stage renal disease under hemodialysis were included, among which 43 ones were allocated to the intervention group and the latter ones to the control group. The participants of both groups were similar in terms of demographic, clinical, and baseline laboratory characteristics. Four patients (9.3%) presented with warfarin-induced hematoma, among which the warfarin administration stopped for 5.33 ± 1.44 days and then restarted again. None of the patients was forced to cease warfarin therapy because of significant hemorrhages. The mean duration of catheter functioning was 8.30 ± 1.75 months in the intervention group versus 3.90 ± 1.12 months in the controls (P-value<0.001). CONCLUSIONS: Based on the findings of the present study, the use of warfarin to achieve an INR level of 1.5-2 could effectively lead to a longer duration of permanent hemodialysis catheter functioning.

Evaluating a Novel Telescoping Catheter Set for Treatment of Central Venous Occlusions.

BACKGROUND: Central venous occlusive disease (CVOD) is a prevalent problem in patients with end-stage renal disease (ESRD) and can lead to access malfunction or ligation for symptomatic relief. The purpose of this study is to evaluate the efficacy of the TriForce® Peripheral Crossing Set (Cook Medical), a novel reinforced telescoping catheter set designed to provide additional support for crossing difficult central venous occlusions. METHODS: This is a single-center retrospective study from a quaternary referral center. We identified 37 patients over a 17-month period who underwent 56 attempts at endovascular recanalization for the treatment of central venous occlusion. Technical success rates, procedural data, and outcomes were compared between those undergoing recanalization using traditional wire/catheter sets versus the TriForce catheter set. RESULTS: Average age was 48 ± 2 years. Comorbidities were similar between the two cohorts and included ESRD (61%), deep venous thrombosis (30%), and May-Thurner syndrome (7%). Forty attempts were made with traditional wire/catheter sets and 16 attempts with the TriForce catheter set to treat 2.1 ± 0.2 and 1.9 ± 0.3 occluded venous segments, respectively (P = 0.74). Technical success rates were significantly higher for the group undergoing recanalization using the TriForce catheter (69% versus 38%, P = 0.04) and 4 patients were successfully recanalized using the TriForce catheter set after a failed attempt with traditional wire/catheter sets. Mean fluoroscopy time and radiation dose were 13 ± 3 min and 14,623 ± 2,775 µGy∗m2 for traditional techniques versus 30 ± 6 min and 30,408 ± 10,433 µGy∗m2 for the novel telescoping catheter set (P = 0.01 and 0.09, respectively). Freedom from reintervention at 1 year was 60% for the TriForce cohort versus 44% for the traditional wire/catheter cohort (P = 0.25). CONCLUSIONS: The novel TriForce reinforced telescoping catheter set is a useful adjunct that may improve recanalization rates of CVOD compared with traditional wire/catheter sets.

Short Versus Long Timing of Flushing of Totally Implantable Venous Access Devices When Not Used Routinely: A Systematic Review and Meta-analysis.

BACKGROUND: Flushing and locking of totally implantable venous access devices (TIVADs) is recommended to maintain their patency when not in use. Although manufacturers' recommendations indicate monthly access for TIVAD maintenance, there is a tendency in real life to prolong this interval. OBJECTIVES: To assess the effectiveness of prolonged versus short flushing and locking intervals to prevent TIVAD occlusions in adults with cancer. METHODS: A systematic search was carried out in MEDLINE, EMBASE, CINAHL, and Web of Science. Two reviewers independently selected studies, assessed quality, and extracted data. Study findings were summarized, and a meta-analysis conducted. RESULTS: Six articles were included in the review, with a total of 1255 participants. Differences in types of cancers, flushing and locking techniques, and volume and concentration of heparin were described. Pooled results from 4 studies showed fewer catheter occlusions in favor of prolonged flushing and locking intervals (relative risk, 0.81), even if not statistically significant (95% confidence interval, 0.41-1.61) with no heterogeneity among studies (I2 = 0.00%, P = .69). The quality of evidence was very low. CONCLUSIONS: Very low-quality evidence suggests that prolonged schedule flushing and locking intervals has no effect on catheter patency. However, because of low number and poor quality of evidence derived from the studies analyzed, findings of this meta-analysis should be interpreted with caution. IMPLICATIONS FOR PRACTICE: No statistically significant difference in occlusion rate between short and long timing of flushing was found. However, further studies are necessary to strengthen the safe implementation of longer intervals in clinical practice.

Prolonging the flush-lock interval of totally implantable venous access ports in patients with cancer: A systematic review and meta-analysis.

BACKGROUND: Recently, some studies have shown that prolonging flush interval is safe and feasible for patients who complete chemotherapy. However, there is no consensus about the optimal flush interval for those patients. OBJECTIVE: The purpose of this review was to evaluate whether the flush interval could be prolonged based on monthly interval for regular maintenance and to explore the optimal flush interval. DATA SOURCES: We searched the following databases for articles published between 1 January 1982 and 21 February 2020: PubMed, Cochrane Library, Web of Science, EMBASE, CINAHL, and Ovid. STUDY ELIGIBILITY CRITERIA: Randomized controlled trials, retrospective and prospective cohort studies of flush interval less than 4 weeks versus longer than 4 weeks for patients who completed chemotherapy, were included. RESULTS: Two reviewers extracted information and assessed the quality of the articles independently. In total, 389 articles were retrieved, and 4 studies including 862 cases fulfilled the inclusion criteria. There was no statistical heterogeneity (I2 = 0, p > 0.05) among the included studies. Hence, the fixed-effects model was used for the meta-analysis. The meta-analysis showed that the total complication rate associated with longer than 4-week interval was higher than that associated with less than 4-week interval. Nevertheless, there was no significant difference between the two groups (7.2% vs 7.6%, p = 0.83). Moreover, the meta-analysis showed that the total complication and catheter occlusion rates associated with the 4-week interval were higher than those associated with the 8-week interval. However, there was no significant difference between the two groups (total complications: 11.4% vs 9.5%, p = 0.68; catheter occlusions: 4.9% vs 4.1%, p = 0.89). LIMITATIONS: Only four non-randomized controlled studies were included, and the outcomes of the included studies were reported incompletely. CONCLUSION: Extending the flush interval to longer than 4 weeks is safe and feasible. Based on previous studies, extending the flush interval to 8 weeks might not increase the incidence of total complications and catheter occlusions. However, there is no conclusion on whether the flush interval could be extended to 3 months or longer.

In defense of the use of peripherally inserted central catheters in pediatric patients.

Central venous access devices have revolutioned the care of children affected by malignancies, facilitating management of complex and prolonged infusive therapies, reducing pain and discomfort related to repeated blood samples and indiscriminate venipunctures, thus reducing also psychological stress of both patients and families. In this respect, peripherally inserted central catheters have been disseminated for use, even in pediatric oncology patients, for their many advantages: easy and non-invasive placement with no risk of insertion-related complications, as well as easy removal; reduced need for general anesthesia both for insertion and removal; adequate prolonged performance also for challenging therapies (e.g. stem cell transplantation); and low rate of late complications. Nonetheless, concerns have been recently raised about use of such devices in children with cancer, especially regarding a presumed (but not demonstrated) high risk of catheter-related venous thrombosis. Are we facing a new witch (or peripherally inserted central catheter) hunt? The choice of the central venous access device-particularly in oncologic children-should be based on an evaluation of clinical advantages and risks, as provided by appropriate and scientifically accurate clinical studies.

Flushing na manutenção de cateteres intravenosos: um estudo observacional da prática de enfermagem na terapia intensiva / Flushing in the maintenance of intravenous catheters: an observational study of nursing practice in intensive care

A manutenção da permeabilidade do cateter intravenoso usado em pacientes hospitalizados é essencial para prevenir danos e garantir a segurança da terapia intravenosa. Dentre os cuidados de enfermagem preconizados para essa manutenção está o flushing, que é a aplicação de solução salina no lúmen do cateter com o objetivo de limpeza. Essa pesquisa teve como objetivos: Caracterizar a prática da equipe de enfermagem na realização do flushing para a manutenção de cateteres intravenosos utilizados por pacientes hospitalizados em cenários de cuidados intensivos; Avaliar a associação de características profissionais da equipe de enfermagem com a prática do flushing na manutenção de cateteres intravenosos em pacientes hospitalizados em cenários de cuidados intensivos; Analisar a prática do flushing em relação às melhores evidências para a manutenção dos cateteres intravenosos, na perspectiva da segurança do paciente; Elaborar, à luz dessa análise, uma tecnologia de cuidado voltada a promover as boas práticas de enfermagem na realização do flushing para a manutenção dos cateteres intravenosos. Estudo observacional, transversal e com abordagem quantitativa, realizado em quatro cenários de cuidados intensivos de um hospital universitário do município do Rio de Janeiro. Participaram 108 profissionais de enfermagem que realizavam a manutenção dos dispositivos intravenosos e estavam envolvidos na prática do flushing. Os dados foram coletados através de observação por meio checklist e aplicação de questionário estruturado, no período de novembro de 2019 a janeiro de 2020. A análise ocorreu por meio de estatística descritiva, analítica e inferencial. Foram realizadas 404 observações da prática do flushing, das quais em 23% não houve a realização do flushing e, em 77%, a prática do flushing foi realizada em algum momento da manipulação do dispositivo intravenoso. Das observações em que houve algum momento de flushing, em 52% os profissionais utilizaram frasco de grande volume no preparo; 97% utilizaram solução fisiológica; 70% aplicaram a técnica de pressão contínua no êmbolo da seringa; 64,5% não avaliaram previamente a permeabilidade. Houve predomínio da prática do flushing após a administração de medicamentos, com emprego do volume e seringa de 10 ml. Possuir formação específica ligada a acesso venoso, conhecimento de guidelines e tempo de exercício profissional inferior a cinco anos foram variáveis que aumentaram as chances de realização do flushing na prática. Quanto aos dados do questionário: 88% dos participantes responderam que efetuam o procedimento do flushing na sua prática; 93% descreveram o soro fisiológico como a solução de escolha; 49,5% relataram realizar o flushing com a pressão contínua no êmbolo da seringa, enquanto 35% aplicam a técnica push pause. No que tange à frequência, apenas 22% referiram que realizam o flushing antes, entre e após a administração de um medicamento. Entretanto, quando essa frequência foi graduada numa escala, nos dados do cateter venoso central, principal dispositivo manipulado na prática, 64% referiram que realizam muitas vezes/sempre o flushing antes da administração do medicamento, 68% realizam muitas vezes/sempre entre a administração dos medicamentos e 79% realizam muitas vezes/sempre após a administração. Concluiu-se que existiram fragilidades na prática do flushing em relação às recomendações de boas práticas que se configuram erros de medicação. Esses resultados indicam a necessidade de investimentos em melhorias nos cenários estudados em vista das boas práticas na terapia intravenosa. Em face disso, elaborou-se uma tecnologia na forma de guia de cuidado para a prática do flushing, a ser implementada na instituição como uma barreira à recorrência dos erros.

Maintaining the patency of the intravenous catheter used in hospitalized patients is essential to prevent damage and ensure the safety of intravenous therapy. Among the nursing care recommended for this maintenance is flushing, which is the application of saline solution in the lumen of the catheter with the objective of cleaning. This research aimed to: Characterize the practice of the nursing team in performing flushing for the maintenance of intravenous catheters used by hospitalized patients in intensive care settings; To evaluate the association of professional characteristics of the nursing team with the practice of flushing in the maintenance of intravenous catheters in hospitalized patients in intensive care settings; To analyze the practice of flushing in relation to the best evidence for the maintenance of intravenous catheters, from the perspective of patient safety; To develop, in the light of this analysis, a care technology aimed at promoting good nursing practices in performing flushing for the maintenance of intravenous catheters. Observational, cross-sectional study with a quantitative approach, carried out in four intensive care settings at a university hospital in the city of Rio de Janeiro. Participants were 108 nursing professionals who performed the maintenance of intravenous devices and were involved in the practice of flushing. Data were collected through observation using a checklist and application of a structured questionnaire, from November 2019 to January 2020. The analysis was carried out using descriptive, analytical and inferential statistics. A total of 404 observations of flushing were performed, of which 23% did not perform flushing and, in 77%, flushing was performed at some point during the handling of the intravenous device. Of the observations in which there was some moment of flushing, in 52% the professionals used a large volume bottle in the preparation; 97% used saline solution; 70% applied the technique of continuous pressure on the plunger of the syringe; 64.5% had not previously evaluated permeability. There was a predominance of flushing after drug administration, using the volume and 10 ml syringe. Having specific training related to venous access, knowledge of guidelines and time of professional practice of less than five years were variables that increased the chances of performing flushing in practice. As for the data from the questionnaire: 88% of the participants answered that they perform the flushing procedure in their practice; 93% described saline as the solution of choice; 49.5% reported flushing with continuous pressure on the syringe plunger, while 35% applied the push pause technique. Regarding the frequency, only 22% reported that they perform flushing before, between and after the administration of a medication. However, when this frequency was graded on a scale, in the data of the central venous catheter, the main device manipulated in practice, 64% reported that they often/always perform flushing before drug administration, 68% perform it often/always between administration of medications and 79% perform it often/always after administration. It was concluded that there were weaknesses in the practice of flushing in relation to the recommendations of good practices that configure medication errors. These results indicate the need for investments in improvements in the scenarios studied in view of good practices in intravenous therapy. In view of this, a technology was developed in the form of a care guide for the practice of flushing, to be implemented in the institution as a barrier to the recurrence of errors.

Mantener la permeabilidad del catéter intravenoso utilizado en pacientes hospitalizados es esencial para prevenir daños y garantizar la seguridad de la terapia intravenosa. Entre los cuidados de enfermería recomendados para ese mantenimiento está el flushing, que es la aplicación de solución salina en la luz del catéter con el objetivo de limpiarlo. Esta investigación tuvo como objetivo: Caracterizar la práctica del equipo de enfermería en la realización de lavados para el mantenimiento de los catéteres intravenosos utilizados por pacientes hospitalizados en cuidados intensivos; Evaluar la asociación de las características profesionales del equipo de enfermería con la práctica de lavado en el mantenimiento de catéteres intravenosos en pacientes hospitalizados en cuidados intensivos; Analizar la práctica del flushing en relación a la mejor evidencia para el mantenimiento de catéteres intravenosos, desde la perspectiva de la seguridad del paciente; Desarrollar, a la luz de este análisis, una tecnología asistencial dirigida a promover buenas prácticas de enfermería en la realización de lavados para el mantenimiento de catéteres intravenosos. Estudio observacional, transversal, con abordaje cuantitativo, realizado en cuatro unidades de cuidados intensivos de un hospital universitario de la ciudad de Rio de Janeiro. Participaron 108 profesionales de enfermería que realizaban el mantenimiento de los dispositivos intravenosos y participaban en la práctica del flushing. Los datos fueron recolectados a través de la observación mediante una lista de cotejo y aplicación de un cuestionario estructurado, de noviembre de 2019 a enero de 2020. El análisis se realizó mediante estadística descriptiva, analítica e inferencial. Se realizaron un total de 404 observaciones de lavado, de las cuales el 23% no realizó lavado y en el 77% se realizó lavado en algún momento durante la manipulación del dispositivo intravenoso. De las observaciones en las que hubo algún momento de rubor, en 52% los profesionales utilizaron un biberón de gran volumen en la preparación; 97% utilizó solución salina; el 70% aplicó la técnica de presión continua sobre el émbolo de la jeringa; El 64,5% no había evaluado previamente la permeabilidad. Predominó el rubor tras la administración del fármaco, utilizando el volumen y jeringa de 10 ml. Tener formación específica relacionada con el acceso venoso, el conocimiento de las guías y un tiempo de ejercicio profesional inferior a cinco años fueron variables que aumentaron las posibilidades de realizar lavados en la práctica. En cuanto a los datos del cuestionario: el 88% de los participantes respondieron que realizan el procedimiento de lavado en su práctica; el 93% describió la solución salina como la solución de elección; El 49,5% refirió enjuagar con presión continua sobre el émbolo de la jeringa, mientras que el 35% aplicó la técnica de empujar pausa. En cuanto a la frecuencia, solo el 22% informó que realiza lavados antes, entre y después de la administración de un medicamento. Sin embargo, cuando se graduó esta frecuencia en una escala, en los datos del catéter venoso central, el principal dispositivo manipulado en la práctica, el 64% informó que a menudo/siempre realiza lavado antes de la administración del medicamento, el 68% lo realiza a menudo/siempre entre administración de medicamentos y el 79% lo realiza seguido/siempre después de la administración. Se concluyó que existieron debilidades en la práctica del flushing en relación a las recomendaciones de buenas prácticas que configuran errores de medicación. Estos resultados indican la necesidad de inversiones en mejoras en los escenarios estudiados en vista de las buenas prácticas en terapia intravenosa. Ante esto, se desarrolló una tecnología en forma de guía de cuidados para la práctica del rubor, para ser implementada en la institución como barrera a la reincidencia de errores.

Heparin solution in the prevention of occlusions in Hickman® catheters a randomized clinical trial / Solução de heparina na prevenção de oclusão do Cateter de Hickman® ensaio clínico randomizado / Solución de heparina para prevenir oclusiones en catéteres de Hickman® un ensayo clínico aleatorizado

Objective: to evaluate the effectiveness of the 50 IU/mL heparin solution compared to the 0.9% isotonic saline solution in preventing occlusion of the double lumen Hickman® catheter, 7 and 9 French, in patients undergoing hematopoietic stem cell transplantation. Method: a triple-blind randomized clinical trial. 17 double-lumen catheters (heparin group: n=7 and 0.9% isotonic saline group: n=10) were analyzed in which the two catheter routes were evaluated separately, totaling 34 lumens. The outcome variables were occlusion without reflux and complete occlusion. Descriptive analyses were performed using the Chi-square test and, of survival, according to the Kaplan-Meier test. Results: the mean number of days until the occlusion outcome was 52 in the heparin group and 13.46 in the 0.9% isotonic saline group in the white catheter route (p<0.001). In the red route, the mean follow-up days in the heparin group were 35.29, with no occlusion and 22.30 in the 0.9% isotonic saline group until the first occlusion (p=0.030). Conclusion: blocking with 50 IU/mL heparin solution is more effective than 0.9% isotonic saline in preventing occlusion of the Hickman® catheter. Brazilian Registry of Clinical Trials: RBR-3ht499.

Objetivo: avaliar a efetividade da solução de heparina 50 UI/mL comparada à solução salina isotônica 0,9% na prevenção de oclusão do Cateter de Hickman® duplo lúmen, 7 e 9 french, em pacientes submetidos ao transplante de células-tronco hematopoéticas. Método: ensaio clínico randomizado triplo cego. Foram analisados 17 cateteres duplo lúmen (grupo heparina n=7 e grupo solução salina isotônica 0,9% n=10) nos quais as duas vias do cateter foram avaliadas separadamente, totalizando 34 lúmens. As variáveis de desfecho foram oclusão sem refluxo e oclusão completa. As análises descritivas foram realizadas mediante o teste Qui-quadrado e, de sobrevida, sob o teste de Kaplan-Meier. Resultados: a média de dias até o desfecho oclusão foi de 52 no grupo heparina e de 13,46 no grupo solução salina isotônica 0,9% na via branca do cateter (p<0,001). Na via vermelha, a média de dias de acompanhamento do grupo heparina foi de 35,29, sem ocorrência de oclusão, e de 22,30 no grupo solução salina isotônica 0,9% até a primeira oclusão (p=0,030). Conclusão: o bloqueio com solução de heparina 50 UI/mL é mais efetivo em relação à solução salina isotônica 0,9% na prevenção da oclusão do Cateter de Hickman®. Registro Brasileiro de Ensaios Clínicos: RBR-3ht499.

Objetivo: evaluar la eficacia de la solución de heparina 50 UI/mL comparada con la solución salina isotónica al 0,9% para prevenir oclusiones en catéteres de Hickman® doble lumen, 7 y 9 French, en pacientes sometidos a trasplante de células madre hematopoyéticas. Método: ensayo clínico aleatorizado triple ciego. Se analizaron 17 catéteres de doble lumen (grupo de heparina: n=7 y grupo de solución salina isotónica al 0,9%: n=10) en los que se evaluaron por separado las dos vías del catéter, totalizando 34 lúmenes. Las variables de resultado fueron oclusión sin reflujo y oclusión completa. Los análisis descriptivos se realizaron mediante el test de Chi-cuadrado y, los de sobrevida, con el test de Kaplan-Meier. Resultados: la media de días hasta el resultado de oclusión fue de 52 en el grupo de heparina y de 13,46 en el grupo de la solución salina isotónica al 0,9% en la vía blanca del catéter (p<0,001). En la vía roja, la media de días de seguimiento del grupo de heparina fue de 35,29 sin oclusión y de 22,30 en el del grupo solución salina isotónica al 0,9% hasta la primera oclusión (p=0,030). Conclusión: el bloqueo con solución de heparina 50 UI/mL es más eficaz en relación con la solución salina isotónica al 0,9% para prevenir oclusiones en catéteres de Hickman®. Registro Brasileño de Ensayos Clínicos: RBR 3ht499.

Práticas de enfermagem relacionadas ao flushing em cateter venoso periférico: estudo descritivo / Prácticas de enfermería relacionadas com el lavado en catéteres venosos periféricos: estudio descriptivo / Nursing practices related to flushing in peripheral venous catheters: a descriptive study

Objetivo: Analisar as práticas de enfermagem relacionadas ao flushing para prevenção da obstrução do cateter venoso periférico. Método: Estudo descritivo com aplicação de questionário aos 78 profissionais de enfermagem e checklist durante a observação das práticas de enfermagem numa clínica médica, durante 30 dias. Resultados: 89,7% dos profissionais de enfermagem realizavam o flushing na prática clínica. A técnica de pushpause era realizada por 12,86% dos participantes. A seringa mais utilizada foi de 10ml (85,72%), com 10ml de solução fisiológica 0,9% (52,86%). A técnica push-pause foi realizada em 10,7% das observações e a avaliação da permeabilidade do cateter em 3,6%. Conclusão: O flushing é utilizado para prevenção da obstrução do cateter nas práticas de enfermagem, entretanto, verificou-se diferenças na técnica, tamanho da seringa, volume de solução fisiológica utilizada e momentos para realização entre os profissionais e o recomendado pela literatura(AU)

Objective: To analyze nursing practices related to flushing to prevent peripheral venous catheter obstruction. Method: Descriptive study, with application of a semi-structured questionnaire to 78 members of the nursing team, and observation of the clinical practices of medical clinic professionals regarding prevention of obstruction, during 30 days, using a checklist. Results: 89.7% of nursing professionals performed flushing in clinical practice. The push-pause technique was performed by 12.86% of the participants. The most used syringe was the 10ml (85.72%) one with 10ml of 0.9% saline solution (52.86%). The push-pause technique was performed in 10.7% of the observations and catheter permeability evaluation in 3.6%. Conclusion: Flushing is used to prevent catheter obstruction in nursing practices, however, differences in technique, syringe size, volume of saline solution used, and times of performance were observed among professionals and those recommended by the literature(AU)

Objetivo: Analizar las prácticas de enfermería relacionadas con el flushing para prevenir la obstrucción del catéter venoso periférico. Método: Estudio descriptivo con aplicación de cuestionario a 78 profesionales de la enfermería y checklist durante la observación de las prácticas en una clínica médica, durante 30 días. Resultados: El 89,7% de los profesionales realizó el flushing en la práctica. El 12,86% de los participantes realizó la técnica de empuje-pausa. La jeringa más utilizada fue la de 10 ml (85,72%), con 10 ml de solución salina (52,86%). La técnica de empuje-pause se realizó en el 10,7% de las observaciones, y la evaluación de la permeabilidad del catéter en el 3,6%. Conclusión: El flushing se utiliza para prevenir la obstrucción del catéter en las prácticas de enfermería, sin embargo, se verificaron diferencias en la técnica, el tamaño de la jeringa, el volumen de solución salina y los momentos de realización entre los profesionales y lo recomendado por la literatura.(AU)

Dosage of heparin for patency of the totally implanted central venous catheter in cancer patients.

OBJECTIVE: to analyze the evidence available in the literature about the lowest necessary dose of heparin to maintain the patency of the totally implanted central venous catheter in adult cancer patients. METHOD: an integrative literature review, carried out in the following databases: Literatura Latino-Americana e do Caribe em Ciências de Saúde, Sciverse Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, including thirteen studies. RESULTS: the evidence showed that the dose of heparin (300 IU/ml) is the most used in maintaining the patency of the totally implanted central venous catheter. CONCLUSION: according to the selected studies, the lowest dose of heparin found in maintaining the patency of the totally implanted central venous catheter in cancer patients was 10 UN/ml with a volume of 5 ml of the heparin solution.

Peritoneal dialysis catheter intraluminal fibrin cast: A complication after prolonged placement. Case series with a review of literature and the management of this complication.

Peritoneal dialysis is a renal substitutive therapy used in an increasing number of patients with end-stage renal failure as it allows greater freedom to perform daily activities. Peritoneal dialysis catheter obstruction is a significant non-infectious complication of peritoneal dialysis. We describe three cases of peritoneal dialysis catheter obstruction with complete fibrin casts, its surgical management and a review of the literature in management techniques and have proposed an algorithm to guide clinical practise when a complete intraluminal peritoneal dialysis catheter obstruction is suspected.

Experimental study of the POP technique: focus on the physical basis of the process.

INTRODUCTION: Central or peripheral vascular access devices have been in use for many decades. However, despite adequate care and maintenance, complete occlusion may occur, and its impact cannot be overlooked. A new procedure using a percussion technique has been published and referred as 'the POP technique'. METHODS: A hydrodynamic bench was used permitting both the recording of the movement of the piston with a fast camera and the pressure variations in the polyurethane and silicone catheters while connected to 2- and 3-piece syringes. RESULTS: The results are twofold. First the upward movement of the piston leads to the installation of a saturation vapour pressure in the body of the syringe. During this sequence, the clot is submitted to a force of aspiration. Then the release of the plunger leads to a pulse pressure whose dynamics and intensity are dependent of the types of syringes and catheters. CONCLUSIONS: The experiments bring to light the importance of practical features such as the orientation of the syringe and the nature of the polyurethane or silicone catheters. Then the analysis enables the definition of practical rules for safe practice of the POP technique. This study will impact clinicians as many may be tempted to use the technique in hope to resolve the occlusion safely, in a timely manner.