Análisis de parámetros de calidad y de costos, de uso del catéter venoso central de inserción periférica frente al catéter de inserción central, en población pediátrica del Hospital Universitario del Valle, Cali, Colombia. 2011-2014 / Analysis of quality parameters and costs of using the central venous catheter of peripheral insertion versus the central insertion catheter in pediatric patients at Hospital Univeristario Del Valle, Cali Colombia 2011-2014

Objetivo: estimar parámetros de calidad y de costos en el procedimiento de inserción de Catéter Venoso Central y el Catéter Venoso Central de inserción periférica. Metodología: Se evaluaron las historias de niños (edad 31 días -15 años ), que ingresaron al Hospital Universitario del Valle, entre enero de 2011 y diciembre de 2014, que requirieron canalización de una vena central. Se evaluaron variables demográficas, de calidad y se estimaron costos de ambos procedimientos. Resultados: Se evaluaron 100 procedimientos de inserción Central y 100 de inserción periférica, los últimos tuvieron menor tiempo de espera, se realizaron en la habitación, no requirieron ayuno, ni traslado al quirófano, a un menor costo, lo cual impactó la oportunidad de administración de tratamiento farmacológico, la evolución y la estancia hospitalaria. Conclusiones: Se recomienda que el procedimiento de inserción periférica sea la primera elección en niños que requieran tratamientos endovenosos mayores a cinco días, para esto es necesario conformar un grupo que supervise el funcionamiento de los catéteres y brinde educación continua al personal de salud de los servicios de hospitalización y a familiares, contar con una sala de procedimiento para la inserción del PICC que brinde seguridad y adecuado manejo del dolor.

Aim: to estimate quality and cost parameters of central venous catheter insertion peripheral and central venous catheter procedures. Methods: we reviewed records of 200 children (31 days - years old), hospitalised at a University Hospital between January 2011 and December 2014 who required central vein access. We assessed demographic, quality variables and cost of both procedures. Results: we reviewed records of 100 central insertion and 100 peripheral insertion procedures. Peripheral insertions had less waiting time, were conducted next to the child's bed, without need for fasting or transfering to the operating room, at a lower cost, all of these ensured timely administration of medicaments and nutrition, which resulted in lower stance time. The peripheral insertion also freed surgeon and operating room time to perform other interventions. Conclusions: We recommend that peripheral insertion procedure should be the first choice in children requiring intravenous treatments longer than five days. In order to establish a periferal insertion procedure in a hospital, a team is required to follow-up the patients and provide continuing education to health personnel in services and to family members, there is also a need for an appropiate space for insertion procedures and pain management.

Direct cost of peripheral catheterization by nurses / Costo directo del paso de catéter central de inserción periférica por enfermeros / Custo direto da passagem de cateter central de inserção periférica por enfermeiros

ABSTRACT Objective: To measure the average direct cost of peripherally inserted central catheterization performed by nurses in a pediatric and neonatal intensive care unit. Method: A quantitative, exploratory-descriptive, single-case study, whose sample consisted of the non-participant observation of 101 peripherally inserted central catheter procedures. The cost was calculated by multiplying the execution time (timed using a chronometer) spent by nursing professionals, participants in the procedure, by the unit cost of direct labor, added to the cost of materials, drugs, and solutions. Results: The average direct cost of the procedure was US$ 326.95 (standard deviation = US$ 84.47), ranging from US$ 99.03 to US$ 530.71, with a median of US$ 326.17. It was impacted by material costs and the direct labor of the nurses. Conclusion: The measurement of the average direct cost of the peripherally inserted central catheter procedure shed light on the financials of consumed resources, indicating possibilities of intervention aiming to increase efficiency in allocating these resources.

RESUMEN Objetivo: Medir el costo directo promedio del paso de catéter central de inserción periférica por enfermeras en una unidad de cuidados intensivos pediátrica y neonatal. Método: Investigación cuantitativa, exploratoria-descriptiva, del tipo estudio de caso único, cuya muestra se constituyó de la observación no participante de 101 pasos de catéter central de inserción periférica. El costo se calculó multiplicando el tiempo (cronometrado) de los profesionales de enfermería, participantes en el procedimiento, por el costo unitario de mano de obra directa, sumándose al costo de materiales/medicamentos/soluciones. Resultados: El costo directo medio del procedimiento correspondió a US$ 326,95 (desviación estándar = US$ 84,47), variando entre US$ 99,03 y US$ 530,71, con mediana de US$ 326,17, habiendo sido impactados por los costos con material y mano de obra directa de los enfermeros ejecutantes. Conclusión: La medición del costo directo medio del paso del catéter central de inserción periférica confirió visibilidad financiera a los insumos consumidos, indicando posibilidades de intervención pretendiendo incrementar su eficiencia alocativa.

RESUMO Objetivo: Mensurar o custo direto médio da passagem de cateter central de inserção periférica, por enfermeiros, em uma unidade de terapia intensiva pediátrica e neonatal. Método: Pesquisa quantitativa, exploratório-descritiva, do tipo estudo de caso único, cuja amostra se constituiu da observação não participante de 101 passagens de cateter central de inserção periférica. O custo foi calculado multiplicando-se o tempo (cronometrado) despendido por profissionais de enfermagem, participantes do procedimento, pelo custo unitário da mão de obra direta, somando-se ao custo dos materiais/medicamentos/soluções. Resultados: O custo direto médio do procedimento correspondeu a US$326.95 (desvio-padrão = US$ 84.47), variando entre US$99.03 e US$530.71, com mediana de US$326.17; tendo sido impactado pelos custos com material e mão de obra direta dos enfermeiros executantes. Conclusão: A mensuração do custo direto médio da passagem de cateter central de inserção periférica conferiu visibilidade financeira aos insumos consumidos, indicando possibilidades de intervenção visando o incremento da sua eficiência alocativa.

Study of histopathological changes in endometriumand myometrium of uteri treated with thermalablation using foley's catheter

Dysfunctional uterine bleeding is a disabling condition for which many women seek medicaladvice. Medical treatment is often initiated and is only effective in around 50% ofwomen.For those intolerantor unresponsive to medical therapy, and/or for whom fertility is no longer desired and/or for whom hysterectomy isan unaccepted choice, a number of minimally invasive surgical options now exist and are collectively termedendometrial ablation. Endometrial ablation may be performed with or without hysteroscopic guidance.This work is designed to evaluate the possible safety and efficacy of the use of Foley's catheter as anew method of endometrial thermal ablation in the treatment of DUB through the study of immediatehistopathological changes occurring in endometrium and myometrium of uteri treated with thermal ablation usingFoley's catheter with its balloon filled with boiling saline just before hysterectomy. The study included twenty pre-menopausal women with DUB, selected from the outpatient clinic ofShatby Maternity Hospital. Foley's catheter was inserted into the uterine cavity up to thefundus, its balloon was inflated by boilingsaline by a 20 ml syringe through a three way cannula till the point when the side tube just started to bulge at thetip of the syringe and as the cavity could accommodate. The catheter was left inside the uterine cavity for 9minutes. Then hysterectomy was done and the uterus was sent immediately to the histopathology laboratory tostudy histopathologlical changes in the endometrium and myometrium. On the basis of inclusion criteria of this study, and to select twenty patients fulfilling those criteria, thestudy started with a number of 149 patients complaining of abnormally excessive uterine bleeding, and afterevaluation of the cause of their bleeding we found that ninety seven patients had DUB twenty five patients hadfibroids, two patients had cervical polyps, three patients had cervical ulcers, five patients had ovarian cysts, onepatient had solid ovarian tumour, two patients were on anticoagulant therapy due to medical conditions. Twopatients had hepatic dysfunction, one patient had Von- Willbrand diease, one patient had chronic renal failure, onepatient was thyrotoxic, and nine patients were dropped out from the study.On gross cut section of specimens, there was a zone ot hyperaemia in 19 out of 20 cases [95%]. The depth of thiszone ranged from 2 to 7 mm, the corresponding histological picture of the hyperaemic zone was fragmentation ofglands and heamorrhage in the endometrium extending into the underlying myometrium at places.Fragmentationof endometrial glands involving the entire endometrium was seen in 75% of specimens. The rest showed onlypatchy fragmentation. The myometrium was also affected in 60% of biopsies by foci of haemorrhage, and in 55%of biopsies by dilated blood vessels. Thermal endometrial ablation using hot saline in balloon of Foley's catheter is simple, safe and easy.The level of difficulty of performing the balloon procedure is similar to that required for inserting an intrauterinecontraceptive device.The technique does not require the direct use of endometrial visualization, distending solutions and high energysources with their possible dangerous complications met with hysteroscopy