Hemostasis control after femoral percutaneous approach: A systematic review and meta-analysis.

BACKGROUND: Hemostasis control after percutaneous endovascular procedures through the femoral approach remains challenging for catheterization laboratory nurses, given method variability. OBJECTIVE: To summarize the available evidence on vascular devices efficacy dedicated to hemostasis control compared to the extrinsic compression after percutaneous procedures in the femoral vein or artery. METHODS: A systematic review with meta-analysis of randomized clinical trials was conducted. We compared different hemostasis methods in adult patients who underwent diagnostic and/or therapeutic procedures through femoral access. The databases searched were PubMed, Embase, CINAHL and Cochrane CENTRAL, and updated on 03/2022. The outcomes included hematoma, pseudoaneurysm, bleeding, minor and major vascular complication, time to hemostasis, device failure, and manual compression repetition. The risk of bias was assessed using the Cochrane Risk of Bias Tool 1.0. Pooled effect sizes on continuous, categorical and proportion variables were estimated with the random effects model. The continuous variables were summarized as the difference between means weighted by the inverse of variance (WMD), and the categorical ones by the summary of relative risks (RR), estimated by the DerSimonian and Laird method. The Freeman-Tukey method was used to estimate the summary effect of proportions. RESULTS: Fifty articles were included in the systematic review. When compared to extrinsic compression, vascular closure devices resulted in a relative risk reduction (RRR) for hematoma: RR 0.82 [95%CI 0.72 to 0.94] and in shorter time to hemostasis WMD -15.06 min [95%CI -17.56 to -12.56]; no association was observed between interventions with vascular closure devices and extrinsic compression for pseudoaneurysm, bleeding, minor and major vascular complications. Compared to extrinsic compression, sealant or gel type devices were compatible with a RRR for hematoma: RR 0.73 [95%CI 0.59 to 0.90]; and metal clip or staple type devices for pseudoaneurysm: RR 0.48 [95%CI 0.25 to 0.90]; and major vascular complication: RR 0.33 [95%CI 0.17 to 0.64]. For each 100 observations, the device failure rate for metal clip or staple was 3.28% [95%CI 1.69 to 6.27]; for suture 6.84% [95%CI 4.93 to 9.41]; for collagen 3.15% [95%CI 2.24 to 4.41]; and for sealant or gel 7.22% [95% CI 5.49 to 9.45]. CONCLUSIONS: Vascular closure devices performed better in hemostasis control. The certainty of the evidence was rated as very low to moderate. REGISTRATION: PROSPERO CRD42019140794.

Development of a nursing outcome for a percutaneous procedure.

OBJECTIVES: To develop a nursing outcome, consistent with the standardized format of outcomes within the nursing Outcomes Classification (NOC). This outcome will include an outcome label, an outcome definition, and clinical indicators. The proposed use for this outcome is to evaluate the access site of a percutaneous procedure. METHODS: Concept analysis with a scoping review. Initially, content experts were recruited to validate the indicators of the proposed outcome in order to complete a consensus validation. After consensus validation, a review of the proposed outcome and its indicators was completed by two of the editors of the NOC team to confirm that the outcome label, definition, and indicators were consistent with the NOC taxonomy. During this review, edits were made on the label name and definition. FINDINGS: After a series of reviews, the initial outcome of Vascular Status: Percutaneous Procedure Access was changed to Tissue Injury Severity: Percutaneous Procedure. In addition, the original definition of the condition of an access site for percutaneous procedure by venous or arterial puncture and health of surrounding tissues was edited to: Severity of complications from a needle-puncture access through the skin and into deeper tissues. The outcome has 11 indicators to be used to formulate a target rating for use in the clinical setting. The indicators were not edited over the course of the reviews. CONCLUSION: The proposed outcome will assist nurses in evaluating the access site of percutaneous procedures and in identifying possible complications. IMPLICATIONS FOR THE NURSING PRACTICE: This research contributes to the refinement of the NOC taxonomy by having a new outcome that meets clinical practice needs.

OBJETIVOS: Desenvolver um resultado de enfermagem, consistente com o formato padronizado de resultados da Classificação dos Resultados de Enfermagem (NOC). Este resultado incluirá um título de resultado, uma definição de resultado e indicadores clínicos. O uso proposto para esse resultado é avaliar o local de acesso de um procedimento percutâneo. MÉTODOS: Análise de conceito com revisão de escopo. Inicialmente, especialistas de conteúdo foram utilizados para validar os indicadores do resultado proposto em uma validação por consenso. Após a validação por consenso, uma revisão do resultado proposto e de seus indicadores foi realizada por dois editores da equipe da Classificação dos Resultados de Enfermagem para confirmar o título do resultado, definição e indicadores para serem consistentes com a taxonomia NOC. Durante esta revisão, foram feitas edições no título e na definição. RESULTADOS: Após uma série de revisões, o resultado denominado inicialmente de Estado Vascular: Acesso Procedimento Percutâneo foi alterado para Gravidade da Lesão Tecidual: Procedimento Percutâneo. Além disso, a definição original de condição de um local de acesso de procedimento percutâneo por punção venosa ou arterial e saúde dos tecidos adjacentes foi editada para - Gravidade das complicações de um acesso por punção com agulha através da pele e em tecidos mais profundos. O resultado tem 11 indicadores a serem usados para formular uma classificação-alvo para uso no ambiente clínico. Os indicadores não foram editados ao longo das revisões. CONCLUSÃO: O resultado proposto auxiliará o enfermeiro a avaliar o local de acesso dos procedimentos percutâneos e identificar possíveis complicações. IMPLICAÇÕES PARA A PRÁTICA DE ENFERMAGEM: Esta pesquisa contribui para o refinamento da taxonomia NOC por ter um novo resultado que atende às necessidades da prática clínica.

Revisão sistemática e metanálise de ensaios clínicos randomizados de métodos de controle da hemostasia em procedimentos percutâneos por abordagem femoral / Systematic review and meta-analysis of randomized clinical trials of methods to control hemostasis in percutaneous procedures using the femoral approach

Introdução: Procedimentos percutâneos estão em ascensão e de forma expressiva o acesso femoral ainda é utilizado por muitas especialidades de laboratórios de cateterismo. A despeito do aprimoramento da técnica de punção e dos diferentes métodos de hemostasia, seu controle ainda é um desafio para as equipes dos laboratórios, principalmente pelos diferentes mecanismos de ação. Neste contexto, sumarizar as evidências para identificar as diferenças na eficácia e segurança seriam muito importantes para estas equipes. Objetivo: Conduzir uma revisão sistemática com metanálise comparando métodos de controle da hemostasia para o acesso femoral em pacientes submetidos a procedimento percutâneo. Métodos: Realizou-se uma revisão sistemática com metanálise de ensaios clínicos randomizados que compararam dispositivos de fechamento vascular e compressão extrínseca. A busca foi realizada no PubMed/MEDLINE, Embase, CINAHL e CENTRAL, sem delimitar início e com atualização em março de 2021. O risco de viés foi avaliado utilizando a ferramenta Cochrane Risk of Bias Tool (RoB) 1.0. Os parâmetros para dados contínuos, categóricos e de proporção de eventos foram estimados a partir do modelo de efeitos aleatórios. O nível de significância adotado foi de 0,05 e intervalo de confiança (IC) de 95%. Os dados contínuos foram apresentados como diferença entre médias ponderadas pelo inverso da variância (WMD), e parâmetros para riscos relativos (RR) foram estimados pelo método de DerSimonian and Laird. Para estimar a proporção de eventos de falha foi utilizado o método de Freeman-Tukey. Resultados: Foram incluídos 46 artigos para síntese qualitativa e 44 para quantitativa. Dispositivos de fechamento vascular comparados à compressão extrínseca resultaram em risco reduzido de hematoma: RR 0,82 [95% IC 0,72 a 0,94; P=0,005] e menor tempo de hemostasia: WMD -15,06 min [95% IC -17,56 a -12,56; P<0,00001]. Não houve diferença para pseudoaneurisma RR 0,84 [95% IC 0,54 a 1,30; P=0,44], sangramento RR 0,96 [95% IC 0,55 a 1,67; P=0,88], complicação vascular menor RR 0,80 [95% IC 0,60 a 1,06; P=0,12] e complicação vascular maior [0,69 (0,39 a 1,22); P=0,20]. Os dispositivos do tipo selante ou gel foram compatíveis com risco reduzido de hematoma RR 0,73 [95% IC 0,59 a 0,90; P=0,004] e dispositivos do tipo clip de metal/grampo com risco reduzido de pseudoaneurisma RR 0,48 [95% IC 0,25 a 0,90; P=0,02] e complicação vascular maior RR 0,33 [95% IC 0,17 a 0,64; P=0,001], quando comparados à compressão extrínseca. A taxa de falha do dispositivo foi de 3,28% (95% IC 1,69 a 6,27) para clip de metal/grampo, 7,09% (95% IC 4,91 a 10,15) para sutura, 3,04% (95% IC 2,10 a 4,37) para colágeno e 7,21% (95% IC 5,21% a 8,89%) para selante ou gel. Conclusões: Os dispositivos de fechamento vascular reduzem o risco de formação de hematoma e do tempo de hemostasia em comparação à compressão extrínseca. Os dispositivos do tipo selante ou gel e do tipo clip de metal ou grampo apresentaram melhor desempenho no controle da hemostasia em relação à compressão extrínseca, e os dispositivos do tipo colágeno tendem a menor proporção de eventos de falha entre os dispositivos. Um viés médio e um baixo grau de confiança foram observados nas estimativas de evidências.

Introduction: Percutaneous procedures are on the rise and femoral access is still significantly used by many specialties in catheterization laboratories. Despite the improvement of the puncture technique and the different hemostasis methods, its control is still a challenge for the laboratory teams, mainly due to the different mechanisms of action. In this context, summarizing the evidence to identify differences in efficacy and safety would be very important for these workers. Objective: To conduct a systematic review with meta-analysis comparing hemostasis control methods for femoral access in patients undergoing percutaneous procedure. Methods: A systematic review was carried out with a meta-analysis of randomized clinical trials that compared vascular closure devices and extrinsic compression. The search was carried out in PubMed/MEDLINE, Embase, CINAHL and CENTRAL, without delimiting the beginning and updated in March 2021. The risk of bias was assessed using the Cochrane Risk of Bias Tool (RoB) 1.0. The parameters for continuous, categorical and event proportion data were estimated from the random effects model. The level of significance adopted was 0.05 and the confidence interval (CI) was 95%. Continuous data were presented as a difference between averages weighted by the inverse of variance (WMD), and parameters for relative risks (RR) were estimated using the DerSimonian and Laird method. To estimate the proportion of failure events, the Freeman-Tukey method was used. Results: 46 articles were included for qualitative synthesis and 44 for quantitative. Vascular closure devices compared to extrinsic compression resulted in reduced risk of hematoma: RR 0.82 [95% CI 0.72 to 0.94; P = 0.005] and shorter hemostasis time: WMD -15.06 min [95% CI -17.56 to -12.56; P <0.00001]. There was no difference for RR pseudoaneurysm 0.84 [95% CI 0.54 to 1.30; P = 0.44], bleeding RR 0.96 [95% CI 0.55 to 1.67; P = 0.88], minor vascular complication RR 0.80 [95% CI 0.60 to 1.06; P = 0.12] and major vascular complication [0.69 (0.39 to 1.22); P = 0.20]. Sealant or gel type devices were compatible with reduced risk of hematoma RR 0.73 [95% CI 0.59 to 0.90; P = 0.004] and metal clip/staple type devices with reduced risk of pseudoaneurysm RR 0.48 [95% CI 0.25 to 0.90; P = 0.02] and major vascular complication RR 0.33 [95% CI 0.17 to 0.64; P = 0.001], when compared to extrinsic compression. The failure rate of the device was 3.28% (95% CI 1.69 to 6.27) for metal clip/staple, 7.09% (95% CI 4.91 to 10.15) for suture, 3.04% (95% CI 2.10 to 4.37) for collagen and 7.21% (95% IC 5.21% a 8.89%) for sealant or gel. Conclusions: Vascular closure devices reduce the risk of hematoma formation and hemostasis time compared to extrinsic compression. Sealant or gel and metal clip or staple devices performed better in controlling hemostasis in relation to extrinsic compression, and collagen type devices tend to have a lower proportion of failure events among devices. A medium bias and a low degree of confidence were observed in the evidence estimates.

Hemostasis after percutaneous transfemoral access: A protocol for systematic review.

BACKGROUND: Access site hemostasis after percutaneous procedures done in the catheterization laboratory still needs to be better studied in relation to such aspects as the different results achieved with different hemostasis strategies, the impact of different introducer sheath sizes, and arterial versus venous access. The objective of this review is to synthesize the available scientific evidence regarding different techniques for hemostasis of femoral access sites after percutaneous diagnostic and therapeutic procedures. METHODS: This review is being reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). The primary outcomes will include the following vascular complications: hematoma, pseudoaneurysm, bleeding, minor, and major vascular complications. The secondary outcomes will include the following: time to hemostasis, repetition of manual compression, and device failure. A structured strategy will be used to search the PubMed/ MEDLINE, Embase, CINAHL, and CENTRAL databases. In addition, a handsearch of the reference lists of selected studies will be conducted. The ERIC research database will be queried for the gray literature and ClinicalTrials.gov, for potential results not yet published in indexed journals. Two reviewers will independently screen citations and abstracts, identify full-text articles for inclusion, extract data, and appraise the quality and risk of bias of included studies. If possible, a meta-analysis will be carried out. All estimations will be made using Review Manager 5.3. Statistical heterogeneity will be assessed by considering the I2 proxy, accompanied with qualitative indicators such as differences in procedures, interventions, and outcomes among the studies. If synthesis proves inappropriate, a narrative review will be undertaken. RESULTS: This protocol adheres to the PRISMA-P guideline to ensure clarity and completeness of reporting at all phases of the systematic review. CONCLUSION: This study will provide synthesized information on different methods used to achieve hemostasis after femoral access. ETHICS AND DISSEMINATION: Ethical approval number CAAE 19713219700005327. The results of the systematic review will be disseminated via publication in a peer-reviewed journal and through conference presentations. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019140794.

Nursing diagnosis risk for bleeding as an indicator of quality of care for patient safety. / Diagnóstico de enfermagem risco de sangramento como indicador de qualidade assistencial à segurança de pacientes.

OBJECTIVE: To describe the implantation of a care quality indicator associated to the nursing diagnosis of patients at high risk of bleeding, based on the alarming results of prothrombin time (PT), partially activated thromboplastin time (aPTT) and platelets. METHODS: Retrospective experience report of multidisciplinary actions developed in a university hospital. The stages of the study involved team meetings, search for effective communication strategies and creation of a new indicator of quality of care. RESULTS: The indicator was called "Compliance of Nursing Diagnosis Risk for bleeding", monitored monthly since June 2016. The technical file includes the characteristics and attributes of the indicator. Based on the analyzes of the indicator, action plans are established for its qualification. CONCLUSION: The implementation of the quality of care indicator associated to the nursing diagnosis improved the communication process, the monitoring and the nursing care to patients at risk of bleeding.

Surgical safety in catheterization laboratory. / Segurança cirúrgica em laboratório de cateterismo.

OBJECTIVE: To describe the process of implanting the surgical safety checklist in a catheterization laboratory (CL). METHOD: Descriptive case report study about the safety strategies developed in the last six years in a university hospital in the southern region of Brazil. RESULTS: The six international patient safety goals (IPSG) were incorporated into the care practice in accordance with the hospital's Joint Comission International (JCI) accreditation program, through a continuous process of educational nature. The checklist was adapted considering the characteristics of the unit and the procedures performed. CONCLUSION: The implementation of the checklist provided the promotion of patient safety, greater staff integration, advances in communication among professionals and the recording of in-room care information.

Diagnóstico de enfermagem risco de sangramento como indicador de qualidade assistencial à segurança de pacientes / Diagnóstico de enfermería riesgo de sangrado como indicador de calidad asistencial de la seguridad de pacientes / Nursing diagnosis risk for bleeding as an indicator of quality of care for patient safety

Resumo OBJETIVO Descrever a implantação de um indicador de qualidade assistencial associado ao diagnóstico de enfermagem de pacientes com alto risco de sangramento, com base nos resultados alarmantes de tempo de protombina (TP), tempo de tromboplastina parcialmente ativada (TTPa) e plaquetas. MÉTODOS Relato de experiência retrospectivo de ações multidisciplinares desenvolvidas em um hospital universitário. As etapas do estudo envolveram reuniões de equipes, busca de estratégias de comunicação efetiva e criação de um novo indicador de qualidade assistencial. RESULTADOS O indicador foi denominado "Conformidade do Diagnóstico de Enfermagem Risco de Sangramento", monitorado mensalmente desde junho de 2016. A ficha técnica contempla as características e atributos do indicador. Com base nas suas análises são estabelecidos planos de ações para sua qualificação. CONCLUSÃO A implantação do indicador de qualidade assistencial associado ao diagnóstico de enfermagem aprimorou o processo de comunicação, monitoramento e cuidado de enfermagem a pacientes com risco de sangramento.

Resumen OBJETIVO Describir la implementación de un indicador de calidad asistencial asociado al diagnóstico de enfermería de pacientes con alto riesgo de sangrado, con base en los resultados alarmantes de tiempo de protombina (Tp), tiempo de tromboplastina parcialmente activada (TTPa) y plaquetas. MÉTODO Relato de experiencia retrospectiva de acciones multidisciplinares desarrolladas en un hospital universitario. Las etapas del estudio involucraron reuniones de equipos, búsqueda de estrategias de comunicación efectiva y creación de un nuevo indicador de calidad asistencial. RESULTADOS El indicador se denominó "Conformidad del Diagnóstico de Enfermería Riesgo de Sangrado", y se monitoreó mensualmente desde junio de 2016. La ficha técnica contempla las características y atributos del indicador. Con base en los análisis del indicador se establecen planes de acción para su cualificación. CONCLUSIÓN La implementación del indicador de calidad asistencial asociado al diagnóstico de enfermería mejoró el proceso de comunicación, el monitoreo y el cuidado de enfermería a pacientes con riesgo de sangrado.

Abstract OBJECTIVE To describe the implantation of a care quality indicator associated to the nursing diagnosis of patients at high risk of bleeding, based on the alarming results of prothrombin time (PT), partially activated thromboplastin time (aPTT) and platelets. METHODS Retrospective experience report of multidisciplinary actions developed in a university hospital. The stages of the study involved team meetings, search for effective communication strategies and creation of a new indicator of quality of care. RESULTS The indicator was called "Compliance of Nursing Diagnosis Risk for bleeding", monitored monthly since June 2016. The technical file includes the characteristics and attributes of the indicator. Based on the analyzes of the indicator, action plans are established for its qualification. CONCLUSION The implementation of the quality of care indicator associated to the nursing diagnosis improved the communication process, the monitoring and the nursing care to patients at risk of bleeding.

Segurança cirúrgica em laboratório de cateterismo / Seguridad quirúrgica en laboratorio de cateterismo / Surgical safety in catheterization laboratory

Resumo OBJETIVO Descrever o processo de implantação da lista de verificação de segurança cirúrgica em laboratório de cateterismo (LC). MÉTODO Estudo descritivo do tipo relato de experiência das estratégias de segurança desenvolvidas nos últimos seis anos em hospital universitário da região Sul do Brasil. RESULTADOS Foram incorporadas na prática assistencial as seis metas internacionais de segurança do paciente (MISP) em consonância com o programa de acreditação hospitalar pela Joint Comission International (JCI), por meio de um processo contínuo com caráter educativo. A lista de verificação foi adaptada considerando as características da unidade e os procedimentos realizados. CONCLUSÕES A implantação da lista de verificação proporcionou a promoção da segurança do paciente, maior integração da equipe, avanços na comunicação entre os profissionais e no registro das informações da assistência em sala.

Resumen OBJETIVO Describir el proceso de implantación de la lista de verificación de seguridad quirúrgica en un laboratorio de cateterismo (LC). MÉTODO Estudio descriptivo del tipo relato de experiencia sobre las estrategias de seguridad desarrolladas en los últimos seis años en un hospital universitario de la región Sur de Brasil. RESULTADOS Se incorporaron en la práctica asistencial las seis metas internacionales de seguridad del paciente (MISP) en consonancia con el programa de acreditación hospitalaria por la Joint Comission International (JCI), a través de un proceso continuo con carácter educativo. La lista de verificación fue adaptada considerando las características de la unidad y los procedimientos realizados. Conclusión: La implantación de la lista de verificación proporcionó la promoción de la seguridad del paciente, una mayor integración del equipo, avances en la comunicación entre los profesionales y en el registro de las informaciones de la asistencia en sala.

Abstract OBJECTIVE To describe the process of implanting the surgical safety checklist in a catheterization laboratory (CL). METHOD Descriptive case report study about the safety strategies developed in the last six years in a university hospital in the southern region of Brazil. RESULTS The six international patient safety goals (IPSG) were incorporated into the care practice in accordance with the hospital's Joint Comission International (JCI) accreditation program, through a continuous process of educational nature. The checklist was adapted considering the characteristics of the unit and the procedures performed. CONCLUSION The implementation of the checklist provided the promotion of patient safety, greater staff integration, advances in communication among professionals and the recording of in-room care information.

Vascular access complications in patients undergoing percutaneous procedures in hemodynamics: a scoping review. / Complicações do acesso vascular em pacientes submetidos a procedimentos percutâneos em hemodinâmica: revisão de escopo.

OBJECTIVE: To map the production of knowledge on vascular access complications in patients undergoing percutaneous procedures in hemodynamic laboratories. METHODS: Scoping review study. The search strategy was developed in three stages, considering the period from July 2005 to July 2015 in the PubMed, CINAHL, Scopus, and LILACS databases. The collected data were analyzed and summarized in a narrative form. RESULTS: One-hundred twenty-eight publications that made it possible to map the contexts of study of complications, occurrence according to access routes, as well as an understanding of diagnosis and clinical management, were included. Three theme categories were identified: complications; predictive factors; and diagnosis/treatment. CONCLUSION: Vascular access site complications range according to the access route used. Knowledge of factors that permeate the occurrence of these events may contribute to early detection, planning, and monitoring of the care implemented.

Elevated serum interleukin-6 is predictive of coronary artery disease in intermediate risk overweight patients referred for coronary angiography.

BACKGROUND: Interleukin-6 (IL-6) plays a central role in atherosclerosis and inflammation. It may improve risk prediction in patients at intermediate cardiovascular risk. OBJECTIVE: To analyze the impact of serum IL-6 in predicting early angiographic coronary artery disease in patients at intermediate cardiovascular risk with chest pain. METHODS: In a cross-sectional study, patients referred for coronary angiography due to suspected coronary artery disease (CAD) were included. Coronary artery disease was defined as the presence of at least 30% stenosis in one or more coronary artery. Severity of CAD was classified by the anatomic burden score. Performance of serum IL-6 assay was compared with ACC/AHA atherosclerotic cardiovascular disease (ASCVD) risk score and hs-CRP through receiver operating characteristic (ROC) curves. RESULTS: We have included 48 patients with a mean 10-year ASCVD risk of 10.0 ± 6.8%. The prevalence of CAD was 72.9%. The presence of CAD was associated with higher mean levels of IL-6 (p = 0.025). Patients with CAD had significantly more overweight than subjects without CAD. In 27% of patients, IL-6 was >1.0 pg/mL and 100% of these patients had CAD, while only 64% in those with IL-6 <1.0 pg/mL, corresponding to a positive predictive value of 100% (p = 0.015). The area under the receiver operating characteristic (ROC) curve of IL-6, hs-CRP and ASCVD were respectively 0.72, 0.60 and 0.54. Intermediate risk patients with IL-6 >1.0 pg/mL were further reclassified into ASCVD high risk due to the presence of coronary lesions. CONCLUSION: In intermediate risk patients referred for coronary angiography, a serum IL-6 level above 1 pg/mL is predictive of significant CAD. IL-6 determination may be useful to reclassify ASCVD intermediate risk patients into higher risk categories.

Complicações do acesso vascular em pacientes submetidos a procedimentos percutâneos em hemodinâmica: revisão de escopo / Las complicaciones del acceso vascular en pacientes sometidos a procedimientos percutáneos en hemodinamia: revisión de escopo / Vascular access complications in patients undergoing percutaneous procedures in hemodynamics: a scoping review

Resumo OBJETIVO Mapear a produção de conhecimento acerca das complicações do acesso vascular em pacientes submetidos a procedimentos percutâneos em Laboratório de Hemodinâmica. MÉTODOS Estudo do tipo revisão de escopo. Elaborou-se estratégia de busca em três etapas, considerando o período entre julho de 2005 e 2015, nas bases de dados PubMed, CINAHL, Scopus e LILACS. Os dados extraídos foram analisados e sintetizados de forma narrativa. RESULTADOS Foram incluídas 128 publicações que permitiram mapear os contextos de estudo das complicações, a ocorrência de acordo com as vias, bem como a compreensão do diagnóstico e manejo clínico. Como síntese da análise identificou-se três categorias temáticas: Complicações; Fatores preditores; e Diagnóstico/tratamento. CONCLUSÃO As complicações no local do acesso vascular são de ocorrência variável conforme a via de acesso utilizada. O conhecimento dos fatores que permeiam a ocorrência destes eventos podem auxiliar no reconhecimento precoce, planejamento e monitorização dos cuidados implementados.

Resumen OBJETIVO Mapear la producción de conocimiento acerca de las complicaciones del acceso vascular en pacientes sometidos a procedimientos percutâneos en el Laboratorio de Hemodinamia. MÉTODOS Estudio de tipo revisión de escopo. Se elaboró la estrategia de búsqueda en tres etapas, considerando el período comprendido entre julio 2005 y 2015, en las bases PubMed, CINAHL, Scopus y LILACS. Los datos extraídos fueron analizados y sintetizados de forma narrativa. RESULTADOS Fueron incluidas 128 publicaciones que permitieron mapear los contextos de estudio de las complicaciones, la ocurrencia de acuerdo con las vías, así como la comprensión del diagnóstico y manejo clínico. Como síntesis del análisis se identificó tres categorías temáticas: Complicaciones, Factores predictores y Diagnóstico/tratamiento. CONCLUSIÓN Las complicaciones en el sitio del acceso vascular son de ocurrencia variable de acuerdo con la vía de acceso utilizada. El conocimiento de los factores que están presentes en la ocurrencia de estos eventos puede auxiliar en el reconocimiento temprano, planeamiento y control de la atención implementados.

Abstract OBJECTIVE To map the production of knowledge on vascular access complications in patients undergoing percutaneous procedures in hemodynamic laboratories. METHODS Scoping review study. The search strategy was developed in three stages, considering the period from July 2005 to July 2015 in the PubMed, CINAHL, Scopus, and LILACS databases. The collected data were analyzed and summarized in a narrative form. RESULTS One-hundred twenty-eight publications that made it possible to map the contexts of study of complications, occurrence according to access routes, as well as an understanding of diagnosis and clinical management, were included. Three theme categories were identified: complications; predictive factors; and diagnosis/treatment. CONCLUSION Vascular access site complications range according to the access route used. Knowledge of factors that permeate the occurrence of these events may contribute to early detection, planning, and monitoring of the care implemented.

Reducing bed rest time from five to three hours does not increase complications after cardiac catheterization: the THREE CATH Trial.

OBJECTIVE: to compare the incidence of vascular complications in patients undergoing transfemoral cardiac catheterization with a 6F introducer sheath followed by 3-hour versus 5-hour rest. METHODS: randomized clinical trial. Subjects in the intervention group (IG) ambulated 3 hours after sheath removal, versus 5 hours in the control group (CG). All patients remained in the catheterization laboratory for 5 hours and were assessed hourly, and were contacted 24, 48, and 72 h after hospital discharge. RESULTS: the sample comprised 367 patients in the IG and 363 in the GC. During cath lab stay, hematoma was the most common complication in both groups, occurring in 12 (3%) IG and 13 (4%) CG subjects (P=0.87). Bleeding occurred in 4 (1%) IG and 6 (2%) CG subjects (P=0.51), and vasovagal reaction in 5 (1.4%) IG and 4 (1.1%) CG subjects (P=0.75). At 24-h, 48-h, and 72-h bruising was the most commonly reported complication in both groups. None of the comparisons revealed any significant between-group differences. CONCLUSION: the results of this trial show that reducing bed rest time to 3 hours after elective cardiac catheterization is safe and does not increase complications as compared with a 5-hour rest. ClinicalTrials.gov Identifier: NCT-01740856.

Nursing outcome "Severity of infection": conceptual definitions for indicators related to respiratory problems / Resultado de enfermería ''severidad de la infección: definiciones conceptuales para indicadores relacionados a problemas respiratorios / Resultado de Enfermagem ''Gravidade de Infecção: definições conceituais para os indicadores relacionados a problemas respiratórios

Objective.Build conceptual definitions for some indicators of the nursing outcome Infection Severity in the Nursing Outcomes Classification (NOC) related to respiratory problems, based on scientific evidence of signs and symptoms of infection in adults. Methods. Integrative literature review with search in the databases PubMed, CINAHL, LILACS and SCOPUS. Studies whose full texts were available, published in Spanish, Portuguese or English, using the descriptors infection severity, nursing outcomes classification NOC, respiratory infections and respiratory signs and symptoms. Results. Nine publications were analyzed that supported the elaboration of the conceptual definitions for eight indicators of the Nursing Outcome Infection Severity: purulent drainage, fever, chilling, unstable temperature, pain, colonization of drainage cultivation, white blood cell count elevation and white blood cell count drop. Conclusion. This study contributed to understand the terms used in the nursing outcome Infection Severity, in order to improve and facilitate the use of the NOC, as it enhances the conceptual clarity of the selected indicators with a view to producing better scientific evidence.

Objetivo.Construir definições conceituais para alguns indicadores do resultado de enfermagem Gravidade de Infecção da Nursing Outcomes Classification (NOC) relacionados aos problemas respiratórios, a partir de evidências científicas sobre sinais e sintomas de infecção em pessoas adultas. Métodos. Revisão integrativa da literatura com busca nas bases de dados PubMed, CINAHL, LILACS e SCOPUS. Foram incluídos estudos com textos na integra, publicados em espanhol, português ou inglês, usando os descritores gravidade da infecção, classificação dos resultados de enfermagem da NOC, infecções respiratórias, e sinais e sintomas respiratórios. Resultados. Analisaram-se nove publicações que embasaram a elaboração das definições conceituais de oitos indicadores do Resultado de Enfermagem Gravidade de Infecção: expectoração purulenta, febre, hipotermia, instabilidade da temperatura, dor, colonização em cultura de expectoração, elevação na contagem das células brancas e depressão na contagem das células brancas. Conclusão. O estudo contribuiu para a compreensão dos termos utilizados no resultado enfermagem Gravidade de Infecção, de modo a aperfeiçoar e facilitar o uso da NOC, à medida que apresenta refinamento do ponto de vista conceitual dos indicadores selecionados, de modo a produzir melhores evidências científicas.

Objetivo.Construir definiciones conceptuales para algunos indicadores del resultado de enfermería severidad de la infección de Nursing Outcomes Classification (NOC) relacionados con problemas respiratorios, a partir de evidencias científicas sobre señales y síntomas para infección en personas adultas. Métodos. Revisión integrativa de la literatura en las bases de datos PubMed, CINAHL, LILACS y SCOPUS. Se incluyeron los estudios en texto completo publicados en español, portugués e inglés que incluyeran los descriptores severidad de la infección, clasificación de los resultados de enfermería NOC, infecciones respiratorias, y señales y síntomas respiratorios. Resultados. Se analizaron nueve publicaciones que fundamentaron la elaboración de las definiciones conceptuales de ocho indicadores del resultado de enfermería severidad de la infección: esputo purulento, fiebre, hipotermia, inestabilidad de la temperatura, dolor, colonización en el cultivo de esputo, aumento de leucocitos, disminución de leucocitos. Conclusión. El estudio contribuyó para la comprensión de los términos utilizados en el resultado de enfermería severidad de la infección, para perfeccionar y facilitar el uso de NOC, en la medida que presenta mayor claridad desde el punto de vista conceptual de los indicadores seleccionados, de modo que se pueda producir mejores evidencias científicas.

Nursing outcome "Severity of infection": conceptual definitions for indicators related to respiratory problems.

OBJECTIVE: Build conceptual definitions for some indicators of the nursing outcome Infection Severity in the Nursing Outcomes Classification (NOC) related to respiratory problems, based on scientific evidence of signs and symptoms of infection in adults. METHODS: Integrative literature review with search in the databases PubMed, CINAHL, LILACS and SCOPUS. Studies whose full texts were available, published in Spanish, Portuguese or English, using the descriptors infection severity, nursing outcomes classification NOC, respiratory infections and respiratory signs and symptoms. RESULTS: Nine publications were analyzed that supported the elaboration of the conceptual definitions for eight indicators of the Nursing Outcome Infection Severity: purulent drainage, fever, chilling, unstable temperature, pain, colonization of drainage cultivation, white blood cell count elevation and white blood cell count drop. CONCLUSION: This study contributed to understand the terms used in the nursing outcome Infection Severity, in order to improve and facilitate the use of the NOC, as it enhances the conceptual clarity of the selected indicators with a view to producing better scientific evidence.Objetivo.Construir definições conceituais para alguns indicadores do resultado de enfermagem Gravidade de Infecção da Nursing Outcomes Classification (NOC) relacionados aos problemas respiratórios, a partir de evidências científicas sobre sinais e sintomas de infecção em pessoas adultas. Métodos. Revisão integrativa da literatura com busca nas bases de dados PubMed, CINAHL, LILACS e SCOPUS. Foram incluídos estudos com textos na integra, publicados em espanhol, português ou inglês, usando os descritores gravidade da infecção, classificação dos resultados de enfermagem da NOC, infecções respiratórias, e sinais e sintomas respiratórios. Resultados. Analisaram-se nove publicações que embasaram a elaboração das definições conceituais de oitos indicadores do Resultado de Enfermagem Gravidade de Infecção: expectoração purulenta, febre, hipotermia, instabilidade da temperatura, dor, colonização em cultura de expectoração, elevação na contagem das células brancas e depressão na contagem das células brancas. Conclusão. O estudo contribuiu para a compreensão dos termos utilizados no resultado enfermagem Gravidade de Infecção, de modo a aperfeiçoar e facilitar o uso da NOC, à medida que apresenta refinamento do ponto de vista conceitual dos indicadores selecionados, de modo a produzir melhores evidências científicas.

Nível de complicação: acesso vascular - um novo resultado de enfermagem para avaliação de pacientes pós-procedimentos percutâneos

Dados de grandes estudos sobre a ocorrência de complicações vasculares pós-procedimentos percutâneos realizados em laboratórios de hemodinâmica são vastos na literatura. Contudo, a avaliação dos resultados clínicos dos pacientes após intervenções de enfermagem visando minimizá-las ou evitá-las ainda são incipientes na prática, com registros pouco objetivos e sistemáticos. Nesta perspectiva, a Nursing Outcomes Classification (NOC), que é uma classificação de resultados sensíveis às intervenções de enfermagem, possibilita o desenvolvimento de instrumentos com indicadores clínicos passíveis de serem medidos durante a avaliação clínica do enfermeiro...

There is extensive data from studies on the occurrence of vascular complications following percutaneous procedures conducted in hemodynamics laboratories. However, assessment of clinical outcomes in patients submitted to nursing interventions, aimed to minimize or prevent such complications, is incipient, without objective and systematic records. Therefore, the Nursing Outcomes Classification (NOC), a classification of outcomes sensitive to nursing interventions, allows developing tools with clinical indicators that can be measured during clinical examination conducted by nurses...

Datos de grandes estudios sobre la ocurrencia de complicaciones vasculares postprocedimientos percutáneos realizados en laboratorios de hemodinamia son amplios en la literatura. Sin embargo, la evaluación de los resultados clínicos de los pacientes después de intervenciones de enfermería visualizando minimizarlas o evitarlas aún son incipientes en la práctica, con registros poco objetivos y sistemáticos. En esta perspectiva, la Nursing Outcomes Classification (NOC), que es una clasificación de resultados sensibles a las intervenciones de enfermería, posibilita el desarrollo de instrumentos con indicadores clínicos plausibles de ser medidos durante la evaluación clínica del enfermero...

Reducing bed rest time from five to three hours does not increase complications after cardiac catheterization: the THREE CATH Trial / Redução do repouso de cinco para três horas não aumenta complicações após cateterismo cardíaco: THREE CATH Clinical Trial / La reducción del reposo de cinco para tres horas no aumenta las complicaciones después del Clinical Trial Three Cath

Abstract Objective: to compare the incidence of vascular complications in patients undergoing transfemoral cardiac catheterization with a 6F introducer sheath followed by 3-hour versus 5-hour rest. Methods: randomized clinical trial. Subjects in the intervention group (IG) ambulated 3 hours after sheath removal, versus 5 hours in the control group (CG). All patients remained in the catheterization laboratory for 5 hours and were assessed hourly, and were contacted 24, 48, and 72 h after hospital discharge. Results: the sample comprised 367 patients in the IG and 363 in the GC. During cath lab stay, hematoma was the most common complication in both groups, occurring in 12 (3%) IG and 13 (4%) CG subjects (P=0.87). Bleeding occurred in 4 (1%) IG and 6 (2%) CG subjects (P=0.51), and vasovagal reaction in 5 (1.4%) IG and 4 (1.1%) CG subjects (P=0.75). At 24-h, 48-h, and 72-h bruising was the most commonly reported complication in both groups. None of the comparisons revealed any significant between-group differences. Conclusion: the results of this trial show that reducing bed rest time to 3 hours after elective cardiac catheterization is safe and does not increase complications as compared with a 5-hour rest. ClinicalTrials.gov Identifier: NCT-01740856

Resumo Objetivo: comparar a incidência de complicações vasculares em pacientes submetidos a cateterismo cardíaco com introdutor 6 French sob abordagem transfemoral com repouso de 3 horas e de 5 horas Método: ensaio clínico randomizado. Os sujeitos incluídos no grupo intervenção (GI) deambularam 3 horas após a retirada do introdutor versus 5 horas para os do grupo controle (GC). Todos os pacientes permaneceram 5 horas no laboratório de hemodinâmica (LH), onde foram avaliados a cada hora, e foram contatados em 24, 48 e 72 h após a alta hospitalar. Resultados: a amostra foi composta por 367 pacientes no GI e 363 no GC. Durante a permanência no LH, hematoma foi a complicação mais observada em ambos os grupos, ocorrendo em 12 (3%) pacientes do GI e 13 (4%) do GC (P=0,87). Sangramento ocorreu em 4 (1%) pacientes do GI e 6 (2%) do GC (P=0,51), e reação vasovagal em 5 (1,4%) pacientes do GI e 4 (1,1%) do GC (P=0,75). Em 24, 48 e 72 h, equimose foi a complicação mais relatada por ambos os grupos, seguida por dor no local da punção. Nenhuma das comparações revelou significância estatística entre os grupos. Conclusão: as resultados deste estudo demonstram que a redução do tempo de repouso para 3 horas após cateterismo cardíaco eletivo mostrou-se segura, não ocasionando um aumento de complicações quando comparada ao repouso de 5 horas. Registro Clinical Trials: NCT-01740856.

Resumen Objetivo: comparar la incidencia de complicaciones vasculares en pacientes sometidos a cateterismo cardíaco con introductor 6 French bajo abordaje transfemoral con reposo de 3 horas y de 5 horas Método: ensayo clínico aleatorio. Los sujetos incluidos en el grupo intervención (GI) deambularon 3 horas después de la retirada del introductor versus 5 horas para los del grupo control (GC). Todos los pacientes permanecieron 5 horas en el laboratorio de hemodinámica (LH), en donde fueron evaluados a cada hora, y fueron contactados en 24, 48 y 72 h después del alta hospitalaria. Resultados: la muestra estuvo compuesta por 367 pacientes en el GI y 363 en el GC. Durante la permanencia en el LH, el hematoma fue la complicación más observada en los dos grupos, ocurriendo en 12 (3%) pacientes del GI y 13 (4%) del GC (P=0,87). La hemorragia ocurrió en 4 (1%) pacientes del GI y 6 (2%) del GC (P=0,51), y la reacción vasovagal en 5 (1,4%) pacientes del GI y 4 (1,1%) del GC (P=0,75). En 24, 48 y 72 h, la equimosis fue la complicación más relatada por los dos grupos, seguida por dolor en el local de la punción. Ninguna de las comparaciones reveló tener significación estadística entre los grupos. Conclusión: los resultados de este estudio demuestran que la reducción del tiempo de reposo para 3 horas después del cardíaco electivo se mostró segura, no ocasionando un aumento de complicaciones cuando comparada al reposo de 5 horas. Registro Clinical Trials: NCT-01740856

[Nursing workload in a coronary unit according to the Nursing Activities Score]. / Carga de trabalho em unidade coronariana Segundo o Nursing Activities Score.

OBJECTIVE: this study aimed to using the Nursing Activities Score to assess nursing workload in a coronary care unit, to assess the distribution of workload between shifts, and to compare the current staff of the care unit with that recommended by the instrument. METHOD: this was a longitudinal study, conducted in a teaching hospital in Southern Brazil, between April to June 2012. RESULTS: A total of 604 NAS measures were obtained from the 61 patients included. The mean workload per shift was 47% (±12), with the greatest workload being reported in the afternoon shifts. CONCLUSION: according to the NAS, a mean of two and a maximum of 2.4 nursing professionals would be required per shift to meet all patient demands, suggesting that the current staff size in the CCU is adequate. The NAS was successful in assessing nursing workload and changes in patient demands over time.

Nursing workload in a coronary unit according to the Nursing Activities Score / Carga de trabajo en unidad coronaria según la Nursing Activities Score / Carga de trabalho em unidade coronariana segundo o Nursing Activities Score

Objective: this study aimed to using the Nursing Activities Score to assess nursing workload in a coronary care unit, to assess the distribution of workload between shifts, and to compare the current staff of the care unit with that recommended by the instrument.Method: this was a longitudinal study, conducted in a teaching hospital in Southern Brazil, between April to June 2012.Results: A total of 604 NAS measures were obtained from the 61 patients included. The mean workload per shift was 47% (±12), with the greatest workload being reported in the afternoon shifts.Conclusion: according to the NAS, a mean of two and a maximum of 2.4 nursing professionals would be required per shift to meet all patient demands, suggesting that the current staff size in the CCU is adequate. The NAS was successful in assessing nursing workload and changes in patient demands over time.

Objetivo: verificar la carga de trabajo de enfermería medida por la Nursing Activities Score en una unidad coronaria, su relación con los turnos de trabajo y comparar el cuadro de enfermería existente en la unidad con lo proyectado según los dados del instrumento.Método: estudio longitudinal realizado en un hospital universitario de la región sur de Brasil en el periodo de abril a junio de 2012. Resultados: se realizaron 604 medidas por turnos, en una muestra de 61 pacientes. La carga de trabajo fue del 47% (±12) en el análisis por turnos, con promedios más elevados en el turno de la tarde.Conclusión: se observó la necesidad de en promedio dos y hasta 2,4 profesionales de enfermería, estando consistente con el cuantitativo real de la unidad. El instrumento posibilito medir la carga de trabajo de enfermería e delinear la variabilidad de las demandas en los diferentes turnos de trabajo.

Objetivo: verificar a carga de trabalho de enfermagem aferida pelo Nursing Activities Score em uma unidade coronariana, analisar sua relação com os turnos de trabalho e comparar o quadro de enfermagem existente na unidade com o projetado segundo os dados do instrumento.Método: estudo longitudinal conduzido em um hospital universitário da região sul do Brasil no período de abril a junho de 2012. Foram realizadas 604 medidas por turnos, em uma amostra de 61 pacientes. A carga de trabalho foi de 47% (±12) na análise por turnos, com média mais elevada no turno da tarde.Resultados: observou-se a necessidade de em média dois e até 2,4 profissionais de enfermagem, estando condizente com o quantitativo real da unidade.Conclusão: o instrumento possibilitou mensurar a carga de trabalho de enfermagem e delinear a variabilidade das demandas nos diferentes turnos de trabalho.

HOMA-IR is associated with significant angiographic coronary artery disease in non-diabetic, non-obese individuals: a cross-sectional study.

UNLABELLED: Insulin resistance is a major component of metabolic syndrome, type 2 Diabetes Mellitus (T2DM) and coronary artery disease (CAD). Although important in T2DM, its role as a predictor of CAD in non-diabetic patients is less studied. In the present study, we aimed to evaluate the association of HOMA-IR with significant CAD, determined by coronary angiography in non-obese, non-T2DM patients. We also evaluate the association between 3 oral glucose tolerance test (OGTT) based insulin sensitivity indexes (Matsuda, STUMVOLL-ISI and OGIS) and CAD. We conducted a cross-sectional study with 54 non-obese, non-diabetic individuals referred for coronary angiography due to suspected CAD. CAD was classified as the "anatomic burden score" corresponding to any stenosis equal or larger than 50 % in diameter on the coronary distribution. Patients without lesions were included in No-CAD group. Patients with at least 1 lesion were included in the CAD group. A 75 g oral glucose tolerance test (OGTT) with measurements of plasma glucose and serum insulin at 0, 30, 60, 90 and 120 min was obtained to calculate insulin sensitivity parameters. HOMA-IR results were ranked and patients were also categorized into insulin resistant (IR) or non-insulin resistant (NIR) if they were respectively above or below the 75th percentile (HOMA-IR > 4.21). The insulin sensitivity tests results were also divided into IR and NIR, respectively below and above each 25th percentile. Chi square was used to study association. Poisson Regression Model was used to compare prevalence ratios between categorized CAD and IR groups. RESULTS: Fifty-four patients were included in the study. There were 26 patients (48 %) with significant CAD. The presence of clinically significant CAD was significant associated with HOMA-IR above p75 (Chi square 4.103, p = 0.0428) and 71 % of patients with HOMA-IR above p75 had significant CAD. Subjects with CAD had increased prevalence ratio of HOMA-IR above p75 compared to subjects without CAD (PR 1.78; 95 % CI 1.079-2.95; p = 0.024). Matsuda index, Stumvoll-ISI and OGIS index were not associated with significant CAD. We concluded that, in patients without diabetes or obesity, in whom a coronary angiography study is indicated, a single determination of HOMA-IR above 4.21 indicates increased risk for clinical significant coronary disease. The same association was not seen with insulin sensitivity indexes such as Matsuda, Stunvoll-ISI or OGIS. These findings support the need for further longitudinal research using HOMA-IR as a predictor of cardiovascular disease.