ABSTRACT
ABSTRACT Objective: To report the experience of the training in home parenteral nutrition (PN) directed to family members of children and adolescents participating in a multidisciplinary intestinal rehabilitation program of a tertiary public hospital. Methods: Cross-sectional descriptive study with family caregivers of patients from the Intestinal Rehabilitation Program of Hospital de Clínicas de Porto Alegre, RS, Brazil, from July/2014 to January/2017. Inclusion criteria: family members of children aged 30 days to 17 years and estimated PN use ≥8 weeks; and family members motivated to care for the child. The training covered: hand washing and disinfection; infusion pump handling; and central venous catheter (CVC) and PN care. Outcomes assessed: catheter-related bloodstream infection (CRBSI) rate, accidental CVC exit, end of PN infusion with more than 60minutes of delay or advance compared to the time predicted, mechanical obstruction, bleeding in the CVC insertion site, and death. Results: Twenty-seven family members of 17 children were trained. Their median age was 28 (18-60) years, and 63% were mothers. The mean CRBSI rate was 1.7/1,000 days of CVC use, and 29.4% of patients had at least one episode of accidental CVC exit. There were no complications related to PN infusion, bleeding, or death. Conclusions: The training of family caregivers allowed the safe implementation of home PN, with the active participation of families, making the procedure feasible in the public health system in Brazil.
RESUMO Objetivo: Apresentar a experiência da capacitação de familiares de crianças e adolescentes participantes de um programa multiprofissional de reabilitação intestinal de um hospital público terciário para uso de nutrição parenteral (NP) no domicílio. Métodos: Estudo descritivo transversal com familiares cuidadores de pacientes do Programa de Reabilitação Intestinal do Hospital de Clínicas de Porto Alegre, RS, Brasil, entre julho/2014 e janeiro/2017. Critérios de inclusão: familiares das crianças com idades entre 30dias e 17 anos e previsão de uso de NP≥8 semanas; e familiares que demonstrassem motivação para os cuidados da criança. Acapacitação contemplou: lavagem e higienização das mãos; manuseio da bomba de infusão; cuidados com cateter venoso central (CVC) e com solução de NP. Desfechos avaliados foram: taxa de infecção de corrente sanguínea relacionada ao CVC (ICSRC), saída acidental do CVC, término da infusão da NP com atraso ou adiantamento maior que 60minutos em comparação ao previsto, obstrução mecânica, sangramento do sítio de inserção do CVC e óbito. Resultados: Foram capacitados 27 familiares de 17 crianças, com mediana de idade de 28 (18-60) anos, dos quais 63% eram mães. A taxa média de ICSRC observada foi 1,7/1.000 dias de uso de CVC, e a saída acidental do CVC ocorreu em 29,4% dos pacientes. Não foram observadas complicações referentes à infusão da NP, a sangramento ou a óbito. Conclusões: A capacitação de familiares cuidadores possibilitou a execução de maneira segura da NP no domicílio com participação ativa das famílias, tornando o procedimento viável no sistema público de saúde no Brasil.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Young Adult , Family , Health Education/methods , Caregivers/education , Parenteral Nutrition, Home , Brazil , Cross-Sectional Studies , Outcome Assessment, Health Care , Middle AgedABSTRACT
OBJECTIVE: To report the experience of the training in home parenteral nutrition (PN) directed to family members of children and adolescents participating in a multidisciplinary intestinal rehabilitation program of a tertiary public hospital. METHODS: Cross-sectional descriptive study with family caregivers of patients from the Intestinal Rehabilitation Program of Hospital de Clínicas de Porto Alegre, RS, Brazil, from July/2014 to January/2017. Inclusion criteria: family members of children aged 30 days to 17 years and estimated PN use ≥8 weeks; and family members motivated to care for the child. The training covered: hand washing and disinfection; infusion pump handling; and central venous catheter (CVC) and PN care. Outcomes assessed: catheter-related bloodstream infection (CRBSI) rate, accidental CVC exit, end of PN infusion with more than 60minutes of delay or advance compared to the time predicted, mechanical obstruction, bleeding in the CVC insertion site, and death. RESULTS: Twenty-seven family members of 17 children were trained. Their median age was 28 (18-60) years, and 63% were mothers. The mean CRBSI rate was 1.7/1,000 days of CVC use, and 29.4% of patients had at least one episode of accidental CVC exit. There were no complications related to PN infusion, bleeding, or death. CONCLUSIONS: The training of family caregivers allowed the safe implementation of home PN, with the active participation of families, making the procedure feasible in the public health system in Brazil.
Subject(s)
Caregivers/education , Family , Health Education/methods , Parenteral Nutrition, Home , Adolescent , Adult , Brazil , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Infant , Male , Middle Aged , Outcome Assessment, Health Care , Young AdultABSTRACT
MLVI has been used to assess adherence. To determine the MLVI in children <12 years of age at transplantation and to identify demographic correlates and consequences for the graft. This is a retrospective study of 50 outpatients (4.0 ± 3.5 years), at least 13-month post-liver transplantation. The outcomes evaluated were MLVI, ALT > 60 IU/L, ACR, death, and graft loss. We analyzed demographic and socioeconomic characteristics, indication for transplantation, and type of donor. Student's t test and the chi-square test were used. Statistical significance was set at P ≤ .05. Seventy-two percent were infants or preschoolers, 62% biliary atresia. Seventy-four percent of the mothers had middle-school education, and 54% of the families had an income ≤3632.4 US$/y. Twenty-two (44%) patients had a MLVI ≥ 2 SD; this was more prevalent in families with higher incomes (P = .045). ALT levels > 60 IU/L were more common in MLVI ≥ 2 SD group (P = .035). ACR episodes were similar between groups (P = 1.000). No patient died or lost the graft. MLVI ≥ 2 SD may be an indicator of the risk of medication non-adherence.
Subject(s)
Immunosuppressive Agents/blood , Liver Transplantation , Medication Adherence , Tacrolimus/blood , Age Factors , Child , Child, Preschool , Female , Follow-Up Studies , Graft Rejection/diagnosis , Graft Rejection/prevention & control , Humans , Immunosuppressive Agents/pharmacokinetics , Immunosuppressive Agents/therapeutic use , Infant , Male , Outcome Assessment, Health Care , Retrospective Studies , Risk Assessment , Risk Factors , Tacrolimus/pharmacokinetics , Tacrolimus/therapeutic useABSTRACT
OBJECTIVE: To verify the association between nutritional statuses, exclusive breastfeeding and the hospital stay of children. METHOD: Cross-sectional study. Convenience sample of 146 children aged 1-48 months and their caregivers. Data were collected in paediatric units at a university hospital of southern Brazil from January to August 2012. Pearson's and Spearman's correlation coefficients were used for data analysis. RESULTS: The children were classified as: eutrophic (71.9%), risk for overweight (13.0%) obese (6.2%); thin (4.1%); overweight (2.7%) and extremely thin (2.1%). Exclusive breastfeeding proved to be a protective factor for extremely thin (P = 0.029); and currently breastfeeding (P = 0.024) and previous breastfeeding (P = 0.000) were protective factors for overweight, risk for overweight and obese. The hospital stay was 3.29 ± 0.18 days. The stay was longer for the classifications overweight/obese and shorter for extremely thin/thin (P = 0.785). CONCLUSION: Nutritional status and exclusive breastfeeding were not risk factors for a longer hospital stay in this sample.
Subject(s)
Breast Feeding , Length of Stay/statistics & numerical data , Nutritional Status , Child, Preschool , Cross-Sectional Studies , Female , Humans , Infant , MaleABSTRACT
RESUMO Objetivo Verificar a associação entre estado nutricional, aleitamento materno exclusivo e tempo de internação hospitalar de crianças. Método Estudo transversal. Amostra por conveniência, com 146 crianças de 1-48 meses e seus responsáveis. Dados coletados em unidades pediátricas de um hospital do sul do Brasil, entre janeiro e agosto de 2012. Para análise, utilizaram-se os coeficientes de correlação de Pearson e de Spearman. Resultados As crianças foram classificadas em: eutróficas (71,9%), risco para sobrepeso (13,0%); obesidade (6,2%); magreza (4,1%); sobrepeso (2,7%) e magreza acentuada (2,1%). O aleitamento materno exclusivo demonstrou ser um fator de proteção contra a magreza acentuada (P=0,029); estar sendo amamentado (P=0,024) ou ter sido amamentado (P=0,000) foram identificados como fatores de proteção contra sobrepeso, risco para sobrepeso e obesidade. O tempo de internação hospitalar foi maior para sobrepeso/obesidade e menor para magreza acentuada/magreza (P=0,785). Conclusão Inadequado estado nutricional e desmame precoce não foram fatores de risco para o maior tempo de internação nesta amostra.
RESUMEN Objetivo Investigar la asociación entre el estado nutricional, la lactancia materna exclusiva y el tiempo de hospitalización de los niños. Método Estudio transversal. Muestra de conveniencia, con 146 niños de 1-48 meses y sus cuidadores. Los datos fueron recogidos en las unidades pediátricas de un hospital en el sur de Brasil, entre enero y agosto de 2012. Para el análisis, se utilizaron los coeficientes de correlación lineal de Pearson y Spearman. Resultados Los niños fueron clasificados como de peso normal (71,9%), en riesgo de sobrepeso (13,0%); obesidad (6,2%); delgadez (4,1%); sobrepeso (2,7%) y delgadez severa (2,1%). La lactancia materna exclusiva resultó ser factor protector para la delgadez severa (P=0,029); y estar en periodo de lactancia materna (P=0,024) o haber amamantado (P=0,000) como un factor protector para el sobrepeso, el riesgo de sobrepeso y obesidad. La estancia hospitalaria fue mayor en el sobrepeso/obesidad y menor para delgadez severa/delgadez (P=0,785). Conclusión El estado nutricional inadecuado y el destete precoz no fueron factores de riesgo para la mayor duración de la estancia hospitalaria en esta muestra.
ABSTRACT Objective To verify the association between nutritional statuses, exclusive breastfeeding and the hospital stay of children. Method Cross-sectional study. Convenience sample of 146 children aged 1-48 months and their caregivers. Data were collected in paediatric units at a university hospital of southern Brazil from January to August 2012. Pearson’s and Spearman’s correlation coefficients were used for data analysis. Results The children were classified as: eutrophic (71.9%), risk for overweight (13.0%) obese (6.2%); thin (4.1%); overweight (2.7%) and extremely thin (2.1%). Exclusive breastfeeding proved to be a protective factor for extremely thin (P = 0.029); and currently breastfeeding (P = 0.024) and previous breastfeeding (P = 0.000) were protective factors for overweight, risk for overweight and obese. The hospital stay was 3.29 ± 0.18 days. The stay was longer for the classifications overweight/obese and shorter for extremely thin/thin (P = 0.785). Conclusion Nutritional status and exclusive breastfeeding were not risk factors for a longer hospital stay in this sample.
Subject(s)
Child, Preschool , Female , Humans , Infant , Male , Breast Feeding , Length of Stay/statistics & numerical data , Nutritional Status , Cross-Sectional StudiesABSTRACT
OBJECTIVE: To identify the vulnerabilities of children admitted to a pediatric inpatient unit of a university hospital. METHODS: Cross-sectional, descriptive study from April to September 2013 with 36 children aged 30 days to 12 years old, admitted to medical-surgical pediatric inpatient units of a university hospital and their caregivers. Data concerning sociocultural, socioeconomic and clinical context of children and their families were collected by interview with the child caregiver and from patients' records, and analyzed by descriptive statistics. RESULTS: Of the total sample, 97.1% (n=132) of children had at least one type of vulnerability, the majority related to the caregiver's level of education, followed by caregiver's financial situation, health history of the child, caregiver's family situation, use of alcohol, tobacco, and illicit drugs by the caregiver, family's living conditions, caregiver's schooling, and bonding between the caregiver and the child. Only 2.9% (n=4) of the children did not show any criteria to be classified in a category of vulnerability. CONCLUSIONS: Most children were classified has having a social vulnerability. It is imperative to create networks of support between the hospital and the primary healthcare service to promote healthcare practices directed to the needs of the child and family.
Subject(s)
Disease Susceptibility/epidemiology , Adult , Child , Child, Preschool , Cross-Sectional Studies , Family Health , Female , Hospital Units , Hospitalization , Humans , Infant , Male , Pediatrics , Prospective Studies , Young AdultABSTRACT
OBJECTIVE: To identify the vulnerabilities of children admitted to a pediatric inpatient unit of a university hospital. METHODS: Cross-sectional, descriptive study from April to September 2013 with36 children aged 30 days to 12 years old, admitted to medical-surgical pediatric inpatient units of a university hospital and their caregivers. Data concerning sociocultural, socioeconomic and clinical context of children and their families were collected by interview with the child caregiver and from patients, records, and analyzed by descriptive statistics. RESULTS: Of the total sample, 97.1% (n=132) of children had at least one type of vulnerability, the majority related to the caregiver's level of education, followed by caregiver's financial situation, health history of the child, caregiver's family situation, use of alcohol, tobacco, and illicit drugs by the caregiver, family's living conditions, caregiver's schooling, and bonding between the caregiver and the child. Only 2.9% (n=4) of the children did not show any criteria to be classified in a category of vulnerability. CONCLUSIONS: Most children were classified has having a social vulnerability. It is imperative to create networks of support between the hospital and the primary healthcare service to promote healthcare practices directed to the needs of the child and family...
OBJETIVO: Identificar as vulnerabilidades de crianças admitidas em unidade de internação pediátrica de um hospital universitário. MÉTODOS: Estudo transversal, descritivo, realizado de abril a setembro de 2013. A amostra foi constituída por 136 crianças de 30 dias a 12 anos incompletos admitidas em unidades clínico-cirúrgicas de internação pediátrica de um hospital universitário, e seus responsáveis. Dados referentes ao contexto sociocultural, socioeconômico e clínico das crianças e suas famílias foram coletados por entrevista com o responsável da criança e por prontuário dos pacientes, sendo analisados por estatística descritiva. RESULTADOS: Do total da amostra, 97,1% (n=132) das crianças tinham pelo menos um tipo de vulnerabilidade, relacionadas, na sua maioria, ao nível de escolaridade do responsável da criança, seguida por: situação financeira do responsável, histórico de saúde da criança, situação familiar do responsável, uso de álcool, tabaco e drogas ilícitas pelo responsável, condições de moradia da família, nível de escolaridade da criança e vínculo do responsável com a criança. Apenas 2,9% (n=4) das crianças não apresentaram critérios que as classificassem como pertencentes a um tipo de vulnerabilidade, conforme pesquisado. CONCLUSÕES: A maioria das crianças foi classificada com vulnerabilidade social. A criação de redes de apoio entre o ambiente hospitalar e a atenção básica, promovendo a utilização de práticas direcionadas para as necessidades de cada criança e sua família, torna-se imperativa...
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Family , Inpatient Care Units , Health VulnerabilityABSTRACT
The objective was to characterize puerperal women in relation to gestational weight gain and their newborns in accordance with the nutritional state at birth. This is a descriptive, quantitative and retrospective study approved by the Ethics Committee at the institution responsible. The collection of data was from December 2012 to May 2013. The sample was composed of 24 puerperal women and their children. The participants presented an average age of 26.5 (DP=5.4) years, 79.2% white; 91.7% married; 58.3% multiparous; 75% with a level of education between secondary school and higher education; 58.3% with a low family income; 54.1% presented an altered pre-gestational nutritional state and 75% obtained an inadequate gestational weight gain. 79.2% of the newborns were classified as Adequate for Gestational Age (AIG). The newborns classified as Large for Gestational Age (GIG) were from pregnant women that had excessive weight gain or were overweight. It was concluded that health professionals should be attentive to nutritional deviations with the intention of avoiding complications for maternal/fetal health.
Subject(s)
Nutritional Status , Weight Gain , Adult , Cross-Sectional Studies , Female , Humans , Infant, Newborn , Pregnancy , Retrospective Studies , Young AdultABSTRACT
The objective was to characterize puerperal women in relation to gestational weight gain and their newborns in accordance with the nutritional state at birth. This is a descriptive, quantitative and retrospective study approved by the Ethics Committee at the institution responsible. The collection of data was from December 2012 to May 2013. The sample was composed of 24 puerperal women and their children. The participants presented an average age of 26.5 (DP=5.4) years, 79.2% white; 91.7% married; 58.3% multiparous; 75% with a level of education between secondary school and higher education; 58.3% with a low family income; 54.1% presented an altered pre-gestational nutritional state and 75% obtained an inadequate gestational weight gain. 79.2% of the newborns were classified as Adequate for Gestational Age (AIG). The newborns classified as Large for Gestational Age (GIG) were from pregnant women that had excessive weight gain or were overweight. It was concluded that health professionals should be attentive to nutritional deviations with the intention of avoiding complications for maternal/fetal health.
El objetivo fue caracterizar las puérperas sobre el aumento de peso gestacional y sus hijos recién nacidos, como estado nutricional de nacimiento. Estudio descriptivo, cuantitativo, retrospectivo, aprobado por la Comité de Ética de la institución responsable. La recolección de datos fue entre diciembre 2012/mayo 2013. La muestra estuvo conformada por 24 madres y sus hijos. Las mujeres mostraron: promedio de edad de 26,5 (SD = 5,4) años, 79,2% blancos, 91,7% casadas o viven en pareja, 58,3% multíparas, 75% educación entre escuela y universidad, 58,3% una situación de bajos ingresos; 54,1% tenía antes del embarazo estado nutricional cambiado, 75% tenía inadecuada ganancia de peso. 79,2% de los recién nacidos se clasificaron como adecuado para edad gestacional/AIG. Los neonatos grandes para edad gestacional/GIG fueron de mujeres embarazadas con ganancia excesiva o sobrepeso. Se concluye que los profesionales de la salud deben ser conscientes de problemas nutricionales para evitar daños a la salud materna/fetal.
O objetivo foi caracterizar puérperas quanto ao ganho de peso gestacional e seus neonatos conforme estado nutricional de nascimento. Consiste em estudo descritivo, quantitativo, retrospectivo, aprovado pelo comitê de ética da instituição responsável. A coleta dos dados foi de dezembro de 2012 a maio de 2013. A amostra foi de 24 puérperas e seus filhos. As puérperas apresentaram: média de idade de 26,5 (DP=5,4) anos, 79,2% cor branca; 91,7% casadas; 58,3% multíparas; 75% com escolaridade entre ensino médio e superior; 58,3% em situação de baixa renda familiar; 54,1% apresentaram estado nutricional pré-gestacional alterado e 75% obtiveram ganho ponderal gestacional inadequado. Dos neonatos, 79,2% foram classificados como Adequados para a Idade Gestacional (AIG). Os neonatos Grandes para a Idade Gestacional (GIG) foram de gestantes com ganho ponderal excessivo ou com sobrepeso. Conclui-se que os profissionais de saúde devem estar atentos aos desvios nutricionais, com o intuito de evitar agravos à saúde materna/fetal.
Subject(s)
Humans , Female , Pregnancy , Infant, Newborn , Adult , Young Adult , Nutritional Status , Weight Gain , Cross-Sectional Studies , Retrospective StudiesABSTRACT
OBJECTIVE: To compare two systems of arterial catheters maintenance in postoperative pediatric surgery using intermittent or continuous infusion of heparin solution and to analyze adverse events related to the site of catheter insertion and the volume of infused heparin solution. METHODS: Randomized control trial with 140 patients selected for continuous infusion group (CIG) and intermittent infusion group (IIG). The variables analyzed were: type of heart disease, permanence time and size of the catheter, insertion site, technique used, volume of heparin solution and adverse events. The descriptive variables were analyzed by Student's t-test and the categorical variables, by chi-square test, being significant p<0.05. RESULTS: The median age was 11 (0-22) months, and 77 (55%) were females. No significant differences between studied variables were found, except for the volume used in CIG (12.0±1.2mL/24 hours) when compared to IIG (5.3±3.5mL/24 hours) with p<0.0003. CONCLUSIONS: The continuous infusion system and the intermittent infusion of heparin solution can be used for intra-arterial catheters maintenance in postoperative pediatric surgery, regardless of patient's clinical and demographic characteristics. Adverse events up to the third postoperative day occurred similarly in both groups. However, the intermittent infusion system usage in underweight children should be considered, due to the lower volume of infused heparin solution [ClinicalTrials.gov Identifier: NCT01097031]. .
OBJETIVOS: Comparar dos sistemas de mantenimiento de catéteres arteriales en post-operatorio de cirugía cardíaca pediátrica, utilizando infusión continua o intermitente de solución de heparina, y analizar los eventos adversos relacionados al local de inserción del catéter y el volumen de solución de heparina infundido. MÉTODOS: Ensayo clínico randomizado controlado, con 140 pacientes seleccionados para el Grupo Infusión Continua (GIC) y el Grupo Infusión Intermitente (GII). Las variables analizadas fueron: tipo de cardiopatía, tiempo de permanencia y tamaño del catéter, local de inserción, técnica empleada, volumen de solución de heparina y eventos adversos. Se utilizó la prueba t de Student para variables descriptivas y la prueba del chi-cuadrado para variables categóricas, siendo significante p<0,05. RESULTADOS: La mediana de edad fue de 11 (0-22,1) meses, siendo 77 (55%) del sexo femenino. No hubo diferencia significativa en las variables analizadas, excepto por el volumen infundido en el GIC (12,0±1,2mL/24 horas), cuando comparado al del GII (5,3±3,5mL/24 horas), con p<0,0003. CONCLUSIONES: Tanto el sistema de infusión continua cuanto el sistema intermitente de solución de heparina pueden ser utilizados en el mantenimiento de catéter intra-arterial en post-operatorio de cirugía pediátrica, independiente de las características clínicas y demográficas de los pacientes, así como de la ocurrencia de eventos adversos hasta el tercer día del post-quirúrgico. Sin embargo, se debe considerar la utilización del sistema de infusión intermitente en niños de bajo peso, debido al menor volumen de solución de heparina infundido (registro en el Clinical Trials bajo el nº NCT01097031). .
OBJETIVOS: Comparar dois sistemas de manutenção de cateteres arteriais em pós-operatório de cirurgia cardíaca pediátrica, utilizando infusão contínua ou intermitente de solução de heparina, e analisar os eventos adversos relacionados ao local de inserção do cateter e o volume de solução de heparina infundido. MÉTODOS: Ensaio clínico randomizado controlado, com 140 pacientes selecionados para o Grupo Infusão Contínua (GIC) e o Grupo Infusão Intermitente (GII). As variáveis analisadas foram: tipo de cardiopatia, tempo de permanência e tamanho do cateter, local de inserção, técnica empregada, volume de solução de heparina e eventos adversos. Utilizou-se o teste t de Student para variáveis descritivas e o teste do qui-quadrado para variáveis categóricas, sendo significante p<0,05. RESULTADOS: A mediana de idade foi de 11 (0-22) meses, sendo 77 (55%) do sexo feminino. Não houve diferença significativa nas variáveis analisadas, com exceção do volume infundido no GIC (12,0±1,2mL/24 horas), quando comparado ao do GII (5,3±3,5mL/24 horas), com p<0,0003. CONCLUSÕES: Tanto o sistema de infusão contínua quanto o sistema intermitente de solução de heparina podem ser utilizados na manutenção de cateter intra-arterial em pós-operatório de cirurgia pediátrica, independentemente das características clínicas e demográficas dos pacientes, bem como da ocorrência de eventos adversos até o terceiro dia pós-cirúrgico. Entretanto, deve-se considerar a utilização do sistema de infusão intermitente em crianças de baixo peso, devido ao menor volume de solução de heparina infundido [registro no Clinical Trials sob o nº NCT01097031]. .
Subject(s)
Female , Humans , Infant , Infant, Newborn , Male , Anticoagulants/administration & dosage , Catheterization, Peripheral , Heparin/administration & dosage , Catheters, Indwelling , Infusions, Intra-Arterial , Postoperative PeriodABSTRACT
OBJECTIVE: To compare two systems of arterial catheters maintenance in postoperative pediatric surgery using intermittent or continuous infusion of heparin solution and to analyze adverse events related to the site of catheter insertion and the volume of infused heparin solution. METHODS: Randomized control trial with 140 patients selected for continuous infusion group (CIG) and intermittent infusion group (IIG). The variables analyzed were: type of heart disease, permanence time and size of the catheter, insertion site, technique used, volume of heparin solution and adverse events. The descriptive variables were analyzed by Student's t-test and the categorical variables, by chi-square test, being significant p<0.05. RESULTS: The median age was 11 (0-22) months, and 77 (55%) were females. No significant differences between studied variables were found, except for the volume used in CIG (12.0±1.2mL/24 hours) when compared to IIG (5.3±3.5mL/24 hours) with p<0.0003. CONCLUSIONS: The continuous infusion system and the intermittent infusion of heparin solution can be used for intra-arterial catheters maintenance in postoperative pediatric surgery, regardless of patient's clinical and demographic characteristics. Adverse events up to the third postoperative day occurred similarly in both groups. However, the intermittent infusion system usage in underweight children should be considered, due to the lower volume of infused heparin solution [ClinicalTrials.gov Identifier: NCT01097031].
Subject(s)
Anticoagulants/administration & dosage , Catheterization, Peripheral , Heparin/administration & dosage , Catheters, Indwelling , Female , Humans , Infant , Infant, Newborn , Infusions, Intra-Arterial , Male , Postoperative PeriodABSTRACT
INTRODUÇÃO: O diagnóstico precoce e o tratamento dos defeitos cardíacos congênitos têm reconhecido impacto na qualidade de vida dos pacientes. Nosso objetivo foi descrever a população de pacientes com cardiopatias congênitas submetidos a procedimentos diagnósticos ou terapêuticos percutâneos em um centro terciário. MÉTODOS: Análise retrospectiva de 1.002 pacientes submetidos a cateterismo cardíaco no período de 2003 a 2009 no Instituto de Cardiologia do Rio Grande do Sul. Variáveis demográficas, clínicas e do procedimento foram obtidas a partir de um banco de dados institucional e dos prontuários dos pacientes. RESULTADOS: A mediana de idade dos pacientes foi de 33 (0-73) anos e a de peso, de 23 (9,6-52,6) kg. Houve predominância do sexo feminino (52%), de doença acianótica (63,2%) e de diagnóstico realizado no período pós-natal (94,8%). Estenose pulmonar (22,9%), comunicação interatrial (22,5%) e persistência do canal arterial (21,6%) foram os defeitos acianóticos mais comuns, e tetralogia de Fallot foi a doença cianótica mais frequente (15,2%). A maioria dos procedimentos (58,6%) foi terapêutica, incluindo valvuloplastias pulmonares (32,9%), fechamento de comunicações interatriais (20,9%) e fechamento de persistências do canal arterial (15%). Em 19,2% dos pacientes foram observadas complicações, sendo os hematomas inguinais (7,8%) ou a febre (7,6%) as mais frequentes. Ocorreram 3 óbitos (0,3%) relacionados aos procedimentos. CONCLUSÕES: Os resultados deste estudo evidenciaram a predominância de procedimentos terapêuticos em pacientes com cardiopatias congênitas acianóticas, realizados com baixo índice de complicações, em centro terciário de referência.
BACKGROUND: Early diagnosis and treatment of congenital heart defects have a well-known impact on patient´s quality of life. This study aimed to describe the population of patients with congenital heart disease submitted to percutaneous diagnostic or therapeutic procedures at a tertiary referral center. METHODS: Retrospective analysis of 1,002 patients submitted to cardiac catheterization between 2003 and 2009 at Instituto de Cardiologia do Rio Grande do Sul. Clinical, demographic and procedure variables were obtained from an institutional database and patient charts. RESULTS: Median age was 33 (0-73) years and median weight was 23 (9.6-52.6) kg. Patients were predominantly females (52%), with acyanotic heart disease (63.2%) and postnatal diagnosis (94.8%). Pulmonary stenosis (22.9%), atrial septal defect (22.5%) and patent ductus ateriosus (21.6%) were the most common acyanotic heart defects, whereas tetralogy of Fallot was the most frequent cyanotic heart disease (15,2%). Most of the procedures (58,6%) were therapeutic, including pulmonary balloon valvuloplasty (32.9%), atrial septal defect closure (20.9%) and ductus arteriosus closure (15%). Complications were observed in 19.2% of patients, and inguinal hematomas (7.8%) and fever (7.6%) were the most frequent findings. There were 3 procedure-related deaths (0.3%). CONCLUSIONS: The study results demonstrated the prevalence of therapeutic procedures in patients with acyanotic heart disease, performed with a low complication rate at a tertiary referral center.
Subject(s)
Humans , Male , Female , Adult , Heart Defects, Congenital/complications , Heart Defects, Congenital/diagnosis , Catheterization/methods , Catheterization , Health ProfileABSTRACT
Objetivo: Verificar a evolução da ferida operatória por esternotomia realizada com curativo de cianocrilato, em crianças submetidas à cirurgia cardíaca. Métodos: estudo transversal prospectivo, realizado com crianças no pós-operatório imediato, de ambos os sexos, com idade ≤ 12 anos. A coleta de dados foi realizada através de um instrumento. As variáveis foram: sangramento, hiperemia, hematoma, equimose, secreção na ferida operatória e tempo de circulação extracorpórea. Resultados: Foram incluídos 86 pacientes, com mediana de idade de 17 (7 - 65) meses, 43 (50%) do sexo masculino. A cirurgia mais prevalente foi comunicação interventricular 31 (36%). O tempo de internação na unidade de terapia intensiva foi 8,7 ± 9,7 dias. Os resultados demonstraram que 67 (77%) dos pacientes apresentaram boa evolução da ferida operatória. Conclusão: O curativo com cianocrilato no pós-operatório imediato de cirurgia cardíaca pediátrica contribuiu para uma adequada cicatrização cirúrgica, com redução de riscos de infecções devido a uma menor manipulação da ferida operatória.
Objective: to follow the healing of a sternotomy surgical wound in which cyanoacrylate bandaging was used, in children who underwent heart surgery. Methods: prospective cross-sectional study performed with children during the immediate postoperative period of heart surgery, with the average of 12 and both genders. The data collected were performed using an instrument. The variables were: bleeding, hyperemia, hematoma, ecchymosis, secretion from surgical wound and extracorporeal circulation time. Results: eighty-six patients were included, with median of 17 (7 - 65) months, 43 (50%) male. The most prevalent surgery was interventricular communication 31(36%). The length of stay in the intensive care unit was 8.7 ± 9.7 days. The showed that in 67 (77%) of the patients the surgical wound healed well. Conclusion: the cyanoacrylate bandage during the post-surgery period immediately after pediatric heart surgery achieved adequate surgical healing, with lower risk of infection due to less handling of the surgical wound.
Objetivo: percibir la evolución de la herida operatoria por estereotomía concurativo de cianocrilato, en niños sometidos a cirugía cardiaca. Métodos: estudio transversal prospectivo, con niños en postoperatorio inmediato, de ambos sexos, con edad < 12 años. La recolecta de datos se realizó mediante un instrumento. Las variables fueron:sangramiento, hiperemia, hematoma, equimosis, secreción y tiempo de circulación extracorpórea. Resultados: fueron incluidos 86 pacientes, con edad mediana de 17 (7-65) meses, 43 el (50%) del sexo masculino. La cirugía más prevalente fue comunicación interventricular 31 el (36%). El tiempo de internación en la unidad de terapia intensiva fue 8,7 + 9,7 días. Los resultados comprueban que 67 el (77%) de los pacientes presentaronbuena evolución de la herida operatoria. Conclusión: el curativo con cianocrilato en el postoperatorio inmediato de cirugía cardiaca pediátrica contribuye para una adecuada cicatrización quirúrgica, con reducción de riesgos de infecciones, pues hay unadisminución en la manipulación de la herida operatoria.