Valoración de la seguridad del paciente en la práctica clínica de terapia renal sustitutiva en las unidades de vigilancia intensiva / Patient safety assessment in the clinical practice of renal replacement therapy in intensive care unit

Introducción: La seguridad del paciente en unidades de vigilancia intensiva, con terapia renal sustitutiva intermitente, está influenciada por diversos factores: los inherentes al paciente, humanos y técnicos.Objetivo: Identificar los factores de riesgo y principales incidencias presentes en la práctica clínica, que interfieren en la seguridad del paciente al que se le realiza terapia sustantiva renal intermitente.Material y Método: Estudio descriptivo y retrospectivo de 413 sesiones de terapia sustitutiva renal intermitente. Se obtuvieron datos demográficos, clínicos, complicaciones clínicas, técnicas, controles de monitores, medidas correctivas y factores de riesgo relacionados con las enfermeras mediante un cuestionario de experteza en diálisis. Resultados: 413 sesiones; (52,1%) hemodiálisis intermitente. Edad media 65 años; 78,7% sexo masculino; motivo de ingreso shock séptico (35,1%).Incidencias: error en la asignación de la modalidad (33,2%), pautas sin actualizar (30,5%), disfunción del acceso vascular (15,7%). Complicaciones clínicas: 47,6 en hemodiálisis intermitente, destacando hipotensión en 41,2%.Complicaciones técnicas en el 37,7% de las sesiones, coagulación total o parcial del circuito extracorpóreo (16,7%). Relacionados con el personal: falta de un programa estandarizado de formación (57,1%), variabilidad de personal (81%) y no asistencia a la capacitación programada (52,4%). Conclusión: La seguridad del paciente con terapia sustitución renal en unidades de vigilancia intensiva, es un proceso multifactorial: relacionados con aspectos no modificables (asociados al paciente), incidencias durante el procedimiento y complicaciones. Aunque no se produjeron efectos adversos mayores en la evolución clínica del paciente, éstos son considerados potenciales y algunos previsibles, controlables y evitables.(AU)

Introduction: Patient safety in intensive care units with intermittent renal replacement therapy is influenced by different factors; including patient-related, human, and technical factors.Objective: Identify risk factors and major incidences present in clinical practice affecting the patient safety on intermittent renal replacement therapy.Material and Method: Descriptive and retrospective study of 413 sessions of intermittent renal replacement therapy. Demographic and clinical data, clinical and technical complications, monitor controls, corrective measures, and nurse-related risk factors were obtained using a dialysis expert questionnaire. Results: Out of the 413 sessions, 52.1% were intermittent hemodialysis. Patients had a mean age of 65 years and 78.7% were male. 35.1% were admitted by septic shock. Incidences include error in modality assignment (33.2%), outdated protocols (30.5%) and vascular access dysfunction (15.7%). As clinical complications found 47.6% in intermittent hemodialysis and 41.2% had hypotension. Technical complications in 37.7% of sessions, with total or partial extracorporeal circuit coagulation (16.7%). As personnel related factors highlighted the lack of standardized training program (57.1%), personnel variability (81%), and not attending scheduled training (52.4%).Conclusions: Patient safety with renal replacement therapy in intensive care units is a multifactorial process involving non-modifiable patient-related aspects, incidences during the procedure, and complications. Although no major adverse effects were produced in the patient’s clinical evolution, risk factors are considered potential and some of them predictable, controllable, and avoidable.(AU)

Caracterização da sedação e analgesia em unidade de terapia intensiva: estudo observacional / Characterization of the sedation and analgesia in intensive care unit: an observational study / Caracterización de la sedación y analgesia en unidad de terapia intensiva: estudio observacional

OBJETIVO: avaliar o processo de sedação e analgesia em pacientes sob ventilação mecânica invasiva (VMI). MÉTODO: estudo transversal, observacional, realizado de setembro de 2014 a fevereiro de 2015 na UTI de uma instituição de ensino de Goiânia/GO. A amostra foi constituída de 30 pacientes maiores de 18 anos, intubados e sedados há mais de 24 horas (protocolo no. 763.827/2014). RESULTADOS: foram utilizadas analgesia e sedação contínua e intermitente, sendo o fentanil e o dormonid as drogas mais usadas. DISCUSSÃO: o tratamento padrão entre pacientes críticos e submetidos à VMI foi a sedação contínua, administrada devido à ansiedade, para facilitar o cuidado da equipe de enfermagem. A principal indicação para sedação foi a manutenção de VMI. CONCLUSÃO: falta padronização das condutas no manejo da sedação. Recomenda-se a elaboração de protocolos com atuação da equipe multiprofissional.

AIM: to evaluate the process of sedation and analgesia in patients undergoing invasive mechanical ventilation (IMV). METHOD: cross-sectional, observational study conducted from September 2014 to February 2015 in the ICU of a teaching institution in Goiânia/GO. The sample consisted of 30 patients over 18 years old, intubated and sedated for more than 24 hours (protocol no. 763.827/2014). RESULTS: continuous and intermittent sedation, and analgesia were used, with fentanyl and midazolam hydrochloride commonly used drugs. DISCUSSION: the standard treatment for critically ill patients and submitted to IMV was continuous sedation administered due to anxiety in order to facilitate the nursing staff care. The main indication for sedation was the maintenance of IMV. CONCLUSION: lack standardization of approaches in the management of sedation. It is recommended to develop protocols with multidisciplinary effort.

OBJETIVO: evaluar el proceso de sedación y analgesia en pacientes bajo ventilación mecánica invasiva (VMI). MÉTODO: estudio transversal, observacional, realizado de septiembre de 2014 a febrero de 2015 en la UTI de una institución de educación de Goiânia/GO. La muestra fue constituida de 30 pacientes mayores de 18 años, intubados y sedados hace más de 24 horas (protocolo no. 763.827/2014). RESULTADOS: fueron utilizadas analgesia y sedación continua e intermitente, siendo el fentanil y el dormonid las drogas más usadas. DISCUSIÓN: el tratamiento estándar entre pacientes críticos y sometidos a la VMI fue la sedación continua, administrada debido a la ansiedad, para facilitar el cuidado del equipo de enfermería. La principal indicación para sedación fue el mantenimiento de VMI. CONCLUSIÓN: falta estandarización de las conductas en el manejo de la sedación. Se recomienda la elaboración de protocolos con actuación del equipo multidisciplinar.

Nursing care management of clients in intensive care: content analysis

Aims: To identify the management process of the nurse in directly caring for the hospitalized client in an intensive care unit; to characterize how the work process of the intensive care nurse guides the caring provided to the client and; to discuss the management process of direct care of the work performed by the intensive care nurse. Method: This is a descriptive study based on a qualitative approach, undertaken with 16 nurses. To collect the information, we used a semi-structured interview, non-participative observation and a journal. The results were later categorized and submitted to content analysis based on Bardin's principles. Results: The nurse has two guiding axes to his actions: the mind map and the real map. The designs done on the mind map start from a single point, with the information radiating from this central point. However, when implementing management processes that were planned mentally, nurses generate a real map based on which they know how to perform. Conclusion: In caring management, the nurse sees himself connected with the client, even though the professional does not get involved with direct care tasks...