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BACKGROUND: Peripheral intravenous catheter (PIVC) insertion is the most common invasive procedure in the hospital setting. Ultrasound guided PIVC insertion in specific populations and settings has shown patient care benefits. OBJECTIVE: To compare the success rate of first attempts of ultrasound guided PIVC insertion performed by nurse specialists with conventional PIVC insertion performed by nurse assistants. METHOD: Randomized, controlled, single-center clinical trial registered on the ClinicalTrials.gov platform under registration NTC04853264, conducted at a public university hospital from June to September 2021. Adult patients hospitalized in clinical inpatient units with an indication for intravenous therapy compatible with a peripheral venous network were included. Participants in the intervention group (IG) received ultrasound guided PIVC performed by nurse specialists from the vascular access team, while those in the control group (CG) received conventional PIVC by nurse assistants. RESULTS: The study included a total of 166 patients: IG (n = 82) and CG (n = 84), mean age 59.5 ± 16.5 years, mostly women (n = 104, 62.7%) and white (n = 136, 81.9%). Success rate on the first attempt of PIVC insertion in IG was 90.2% and in CG was 35.7% (p < 0.001), with a relative risk of 2.5 (95% CI 1.88-3.40) for success in IG versus CG. Overall assertiveness rate was 100% in IG and 71.4% in CG. Regarding procedure performance time, the medians in IG and CG were 5 (4-7) and 10 (6-27.5) min respectively (p < 0.001). As for the incidence of negative composite outcomes, IG had lower rates compared to CG, 39% versus 66.7% (p < 0.001), generating a 42% lower probability of negative outcomes in IG, 0.58 (95% CI: 0.43-0.80). CONCLUSION(S): Successful first-try insertion was higher in the group receiving ultrasound-guided PIVC. Moreover, there were no insertion failures and IG presented lower insertion time rates and incidence of unfavorable outcomes.
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Introdução: o uso de ultrassonografia para orientação da punção venosa periférica em pacientes adultos pode impactar na sua experiência durante a internação hospitalar. Estudos com metodologias robustas que possam agregar conhecimento sobre essa temática são úteis para a prática clínica. Objetivo: este estudo se propôs a comparar a experiência do paciente na punção venosa periférica orientada por ultrassonografia com a punção venosa periférica convencional (palpação/visualização). Método: trata-se de um ensaio clínico randomizado (ECR) tipo PROBE (Prospective Randomized Open Blinded End Point), paralelo, controlado e de centro único. Este estudo foi intitulado: Patient experience with ultrasound-guided versus conventional peripheral venipuncture: PERCEPT Clinical Trial, registrado na plataforma ClinicalTrials.gov sob o registro: NCT04853290. O estudo foi conduzido em um hospital público universitário, de junho a agosto de 2021. Foram incluídos pacientes adultos internados por qualquer condição clínica não cirúrgica, com indicação de terapia intravenosa compatível com acesso venoso periférico. Os participantes foram divididos em: grupo intervenção (GI) - punção venosa periférica com ultrassom executada por enfermeiros especialistas de um programa de acesso vascular; e grupo controle (GC) - punção venosa periférica convencional executada por enfermeiros da prática clínica. A randomização foi realizada em blocos de diferentes tamanhos e estratificados por idade, através de uma ferramenta própria do software Research Electronic Data Capture (REDCap). O desfecho primário incluiu a experiência do paciente com relação a dor durante o procedimento e sua relação com o método utilizado para a obtenção do acesso venoso, avaliado por meio da Escala Numérica Verbal (ENV), Net Promoter Score (NPS) e Escala Likert (EL). Desfechos secundários incluíram o tempo de permanência do cateter venoso periférico e as complicações ocorridas durante a permanência do dispositivo venoso. Todas as variáveis foram monitoradas diariamente por oito dias, término do tratamento, alta ou óbito, o que ocorresse primeiro. Resultados: foram incluídos 64 pacientes: GI (n= 32) e GC (n=32), sexo feminino (51,5%), predomínio de raça branca (87,5%) e média de idade 56 ±16 anos. A dor experenciada pelo paciente imediatamente após o procedimento de punção venosa periférica, foi "nenhuma a leve" no GI, para 25 (78,1%) pacientes, e moderada a intensa no GC para 21 (65,7%) pacientes, P <0,001. Na análise não categorizada da dor observou-se GI: 2 (1 3) vs. GC: 4 (3 6), P < 0,001. A experiência do paciente quanto ao método utilizado para a obtenção do acesso venoso foi positiva em ambos os grupos. A recomendação do procedimento no GI (NPS +90,6%) vs. GC (NPS +18,8%) foi considerada excelente e boa, respectivamente (P <0,001). Pacientes do GI apresentaram menor desconforto (P= 0,011) e maior segurança (P <0,001); relataram impressão mais positiva quanto ao local escolhido para o acesso venoso periférico (P <0,001) e ao número de tentativas para a punção (P <0,001). Não se observou diferença significativa entre os grupos quanto ao tempo de permanência do acesso venoso periférico (P= 0,704) e às complicações ocorridas (flebite, lesão e infiltração) durante a permanência do dispositivo venoso (P= 0,257). Conclusões: os resultados deste ECR permitem concluir que a experiência dos pacientes puncionados com acesso venoso periférico orientado por ultrassonografia, executados por enfermeiro especialista, foi superior à dos pacientes que receberam o acesso pelo método convencional. Os pacientes apresentaram menos dor e recomendaram de maneira significativa o procedimento orientado por ultrassom.
Background: the usage of ultrasound equipment to guide peripheral venipuncture in adult patients may influence their experience during hospitalization. Studies with robust methodologies which can improve the knowledge on this subject are useful for clinical practice. Aim: this study aimed to compare the patient experience of ultrasound-guided peripheral venipuncture with conventional peripheral venipuncture (palpation/visualization). Method: it is a PROBE (Prospective Randomized Open Blinded End Point), parallel, controlled, and single center randomized clinical trial (RCT). It was entitled: Patient experience with ultrasound- guided versus conventional peripheral venipuncture: PERCEPT Clinical Trial, registered on the ClinicalTrials.gov platform under registration: NCT04853290. The study was conducted at a public university hospital from June to August 2021. Adult patients hospitalized for any non- surgical clinical condition, with indication for intravenous therapy compatible with peripheral intravenous access were included. Participants were divided into intervention group (IG) - ultrasound peripheral venipuncture executed by specialized nurses (vascular access program); and control group (CG) - conventional peripheral venipuncture executed by clinical practice nurses. Randomization was performed in blocks of varied sizes and stratified by age, using a tool from the Research Electronic Data Capture (REDCap) software. The primary outcome included the patient's experience of pain during the procedure and its relationship to the method used to obtain venous access, assessed using the verbal Numerical Rating Scale (vNRS), Net Promoter Score (NPS) and Likert Scale (EL). Secondary outcomes included peripheral venous catheter dwell time and complications that occurred during venous device permanence. All variables were monitored daily for eight days, end of treatment, discharge, or death, whichever came first. Results: 64 patients were included: IG (n=32) and CG (n=32), female (51.5%), predominantly white (87.5%) and mean age 56 ±16 years. The pain experienced by the patient immediately after the peripheral venipuncture procedure was "none to mild" in the IG regarding 25 (78.1%) patients, and moderate to severe in the CG regarding 21 (65.7%) patients, P <0.001. In the non-categorized pain analysis, IG: 2 (1 3) vs. CG: 4 (3 6), P < 0.001, was detected. The patient's experience regarding the method used to obtain venous access was positive in both groups. The recommendation of the procedure in IG (NPS +90.6%) vs. CG (NPS +18.8%) was considered excellent and good, respectively (P <0.001). IG patients had less discomfort (P= 0.011) and greater safety (P < 0.001); had a more positive impression regarding the site chosen for peripheral venous access (P < 0.001) and the number of puncture attempts (P <0.001). There was no significant difference between the groups in terms of peripheral intravenous catheter dwell time (P= 0.704) and complications that occurred (phlebitis, injury, and infiltration) during venous device permanence (P = 0.257). Conclusions: the results of this RCT allow us to conclude that the experience of patients punctured with peripheral intravenous access guided by ultrasound, executed by a specialist nurse, was superior to that of patients who received access by the conventional method. Patients had less pain and significantly recommended the ultrasound-guided procedure.
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EnfermagemRESUMO
Objetiva-se descrever a elaboração de um protocolo para o atendimento de pacientes portadores de Germes Multirresistentes (GMR) em uma unidade de internação. Estudo de consenso entre especialistas, concebido em um hospital universitário. A amostra foi composta por enfermeiros do setor, pelos profi ssionais da Comissão de Controle de Infecção da instituição e por professores de uma universidade federal. As informações foram coletadas por meio de registro de reuniões sistemáticas. Elaborou-se um protocolo para o atendimento dos pacientes portadores através da defi nição de parâmetros para a área física, assistência em equipe multiprofi ssional, organização do trabalho da enfermagem, indicadores à serem acompanhados, entre outros. Concluí-se que no Brasil, poucas são as instituições que possuem características semelhantes para cuidados de pacientes portadores de GMR. A utilização de um protocolo fornece elementos norteadores para a organização do atendimento, padronizando o cuidado e qualifi cando a assistência
The aim is to describe the protocol elaboration for the care of patients with Multidrug-Resistant Germs (MDR) in an care unit. Consensus study among specialists, conceived in a university hospital. The sample consisted of the sector nurses, the Infection Control Commission of the institution and professors from a federal university. The information was collected through systematic meeting records. A protocol was developed for the care of the patients with parameters about physical area, assistance in multiprofessional team, nursing work organization, indicators to be followed, among others. It concludes that in Brazil, there are few institutions that have similar characteristics for the patients care with MDR. The protocol use provides guiding elements for the care organization, standardizing care and qualifying care
