RESUMO
PURPOSE: To investigate of predictor's factors of difficult venous access device in the operating room in elective surgery. METHODS: In a prospective study in central operating room, were included all patients scheduled for a surgical or diagnostic intervention. Were excluded all patients admitted with functional venous access. For each, were recorded patient's demographic characteristics (age, gender, ASA class, BMI), history (chemotherapy, prolonged ICU stay, hospitalization for more than five days), data from the clinical examination (presence of skin lesions, arteriovenous fistulas, burns, neurological deficits) and the type of operator (trainee, nurse, resident, senior). The difficulty was judged on the number of attempts required for successful venous access. Puncture was considered easier for a number of attempts to one to two and difficult if the number of attempts was greater than two. Predictor's factors were identified after univariate and multivariate analysis. RESULTS: During one year (March 2008 to February 2009), form returns in 1500 were met, 1325 were usable. Venous catheterization was successful in 50.9% at the first attempt in 24.2% of patients at the second attempt and after three attempts in 18% of patients. Only 6.8% of patients required more than three attempts. A central venous catheter was required in seven patients. In multivariate analysis, chemotherapy (OR=4.54, 95% CI [2.92 to 7.03]; P<0.001), a nurse in training (OR=2.27, 95% CI [1.40 to 3.63]; P=0.001), a resident in training (OR=2.14, 95% CI [1.29 to 3.58]; P=0.003) and the presence of burns (OR=3.59, 95% CI [2.44 to 5.27]; P<0.001) were identified as independent predictors of difficulty of peripheral venous access. DISCUSSION: The optimization of venous access devices in the operating room through the search for predictors of difficulty.
Assuntos
Cateterismo Periférico/estatística & dados numéricos , Cuidados Intraoperatórios/estatística & dados numéricos , Salas Cirúrgicas , Cuidados Pré-Operatórios/estatística & dados numéricos , Derivação Arteriovenosa Cirúrgica/estatística & dados numéricos , Queimaduras/epidemiologia , Cateterismo Periférico/instrumentação , Cateterismo Periférico/enfermagem , Grupos Diagnósticos Relacionados , Tratamento Farmacológico/estatística & dados numéricos , Desenho de Equipamento , Hospitais Militares/estatística & dados numéricos , Humanos , Internato e Residência , Marrocos , Enfermagem de Centro Cirúrgico , Auxiliares de Cirurgia , Médicos , Estudos Prospectivos , Fatores de Risco , Fatores SocioeconômicosAssuntos
Angioedema/induzido quimicamente , Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Anti-Hipertensivos/efeitos adversos , Enalapril/efeitos adversos , Angioedema/patologia , Pré-Escolar , Diuréticos/farmacologia , Quimioterapia Combinada , Furosemida/farmacologia , Humanos , Nicardipino/farmacologia , Língua/efeitos dos fármacos , Língua/patologia , Resultado do Tratamento , Suspensão de TratamentoAssuntos
Raquianestesia , Anestésicos Locais/efeitos adversos , Bupivacaína/efeitos adversos , Hipersensibilidade a Drogas/etiologia , Morfina/efeitos adversos , Paraplegia/etiologia , Complicações Pós-Operatórias/etiologia , Adulto , Anestésicos Locais/administração & dosagem , Anestésicos Locais/imunologia , Anti-Inflamatórios/uso terapêutico , Toxinas Botulínicas Tipo A/administração & dosagem , Toxinas Botulínicas Tipo A/uso terapêutico , Bupivacaína/administração & dosagem , Bupivacaína/imunologia , Cistite Intersticial/tratamento farmacológico , Hipersensibilidade a Drogas/tratamento farmacológico , Feminino , Humanos , Metilprednisolona/uso terapêutico , Morfina/administração & dosagem , Morfina/imunologia , Paraplegia/imunologia , Complicações Pós-Operatórias/imunologia , Prurido/induzido quimicamente , Indução de Remissão , Transtornos de Sensação/induzido quimicamenteAssuntos
Bacteriemia/microbiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Leuconostoc , Adulto , Bacteriemia/diagnóstico , Bacteriemia/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Humanos , MasculinoRESUMO
Elderly people are more likely to be affected by hyponatremia related to the use of specific inhibitors of serotonin recaptation. Doctors who treat old patients should be aware of this adverse effect which can be serious but is reversible. The observation of a new case of SIADH induced by fluoxetine in a 65 years-old patient is the opportunity to point out the main aspects of this pathological entity which must be suspected in case with hyponatraemia, blood hypoosmolality and high urinary osmolarity.