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1.
J Trauma Nurs ; 28(5): 290-297, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34491944

RESUMO

BACKGROUND: Catheter-associated urinary tract infection (CAUTI) is a noted complication among geriatric hip fracture patients. This complication results in negative outcomes for both the patients and the institution providing care. Screening measures to identify predisposing factors, with early diagnosis and treatment of urinary tract infection (UTI) present on admission, may lead to reduced rates of CAUTI. OBJECTIVE: The goals of this study were to determine the prevalence of UTI on admission among geriatric hip fracture patients and whether routine screening for UTI or predisposing factors at presentation resulted in reduced rates of CAUTI. METHODS: A retrospective observational study of geriatric hip fracture patients from January 2017 to December 2018 at a Level I trauma center was performed. Rates of UTI on admission and CAUTI were calculated using routine admission urinalysis. RESULTS: Of the 183 patients in the sample, 36.1% had UTI on admission and 4.4% of patients developed CAUTI. There were no significant differences in patient demographics, comorbidities, and complications between those with UTI on admission and those without. CONCLUSIONS: Urinary tract infection on admission may be present among a large portion of geriatric hip fracture patients, leading to increased rates of CAUTI. Routine screening for UTI and its predisposing factors at admission can identify these patients earlier and lead to earlier treatments and prevention of CAUTI.


Assuntos
Infecções Relacionadas a Cateter , Infecção Hospitalar , Fraturas do Quadril , Infecções Urinárias , Idoso , Cateteres , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/epidemiologia , Humanos , Estudos Retrospectivos , Centros de Traumatologia , Infecções Urinárias/diagnóstico , Infecções Urinárias/epidemiologia , Infecções Urinárias/prevenção & controle
2.
BMC Res Notes ; 14(1): 355, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34507611

RESUMO

OBJECTIVES: Induction of labour (IOL), or starting labour artificially, can be a lifesaving intervention for pregnant women and their babies, and rates are rising significantly globally. As rates increase, it becomes increasingly important to fully evaluate all available data, especially that from low income settings where the potential benefits and harms are greater. The goal of this paper is to describe the datasets collected as part of the Induction with Foley OR Misoprostol (INFORM) Study, a randomised trial comparing two of the recommended methods of cervical ripening for labour induction, oral misoprostol and Foley catheter, in women being induced for hypertension in pregnancy, at two sites in India during 2013-15. DATA DESCRIPTION: This dataset includes comprehensive data on 602 women who underwent IOL for hypertensive disorders in pregnancy. Women were randomly assigned to cervical ripening with oral misoprostol or a transcervical Foley catheter in two government hospitals in India. The main dataset has 367 variables including monitoring during the induction of labour, medications administered, timing and mode of delivery, measures of neonatal morbidity and mortality, maternal mortality and morbidity, maternal satisfaction and health economic data. The dataset is anonymised and available on ReShare.


Assuntos
Hipertensão , Misoprostol , Ocitócicos , Cateteres , Maturidade Cervical , Feminino , Humanos , Índia , Recém-Nascido , Trabalho de Parto Induzido , Gravidez
3.
JNMA J Nepal Med Assoc ; 59(239): 688-691, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34508509

RESUMO

INTRODUCTION: Transurethral resection of the prostate requires a catheter in situ post-surgery. Early removal of catheter can reduce the length of hospital stay reducing the healthcare cost. It can also reduce the risk of infection due to prolonged catheterization. Our aim was to determine the median duration of hospital stay after early foley's removal after transurethral resection of prostate among patients in a tertiary care hospital. METHODS: A descriptive cross-sectional study was done in a tertiary care hospital from July 2019 to December 2020 and ethical clearance was obtained from the institutional review committee. Foley's catheter were removed on the first post-operative day, who met the criteria of catheter removal. Convenience sampling was done. After foley's removal patients were observed for spontaneous voiding. Patients with complications like hematuria, clot retention, urinary retention were recatherized. The data were expressed in mean with standard deviation, median with interquartile range and frequency and percentage as applicable using Statistical Package for the Social Sciences version 16. RESULTS: Out of the 150 participants included in the study, the median duration of hospital stay after the early removal of foley's catheter was 3 days (interquartile range 2-4 days). A total of 20 (13.3%) patients underwent recatherization. Nine (6%) patients had to be recatheterized due to clot retention, and 11 (7.3%) were due to urinary retention. CONCLUSIONS: This study showed that the median duration of hospital stay after early removal of foley's catheter among patients undergoing transurethral resection of the prostate was similar to studies done in national/international settings.


Assuntos
Ressecção Transuretral da Próstata , Cateterismo , Cateteres , Estudos Transversais , Humanos , Tempo de Internação , Masculino
4.
Arch Esp Urol ; 74(7): 676-680, 2021 Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-34472436

RESUMO

INTRODUCTION AND OBJECTIVES:  The ureteral catheter is used to provide adequate drainage of the upper urinary tract. They have been used to prevent or relieve ureteral obstruction due to multiple causes. The literature mentions the standard placement of double J catheter guided by fluoroscopy, reporting the use of ultrasound exclusively in cases of pregnant patients in order to avoid ionizing radiation. Based on the aforementioned, the primary objective was to evaluate the placement of double J catheter guided by ultrasound, as an alter native technique to the use of the fluoroscope in ureteral obstructions, as secondary objectives the intensity of the pain and the complications of the procedure. MATERIALS AND METHODS: An observational, descriptive and prospective study was carried out with 41patients who attended the lithiasis consultation. RESULTS: A total of 41 patients who under went double J catheter guided by ultrasound were evaluated, achieving it successfully in 35 of the cases, resulting in bad position in 2 patients and being impossible to insert it in 4. Averageage was 41 years, size of the lithium 10.41mm. The complications presented were 17% with the use of the scale of Clavien modified these complications were represented as follows: 4.9% grade I back pain, 7.2% grade II lower urinary tract symptoms, lower tract infections, and 4.9% grade IIIa malposition. CONCLUSIONS: The placement of ureteral catheters guided by ultrasound, represent a useful tool, safe, with manageable complications, taking place in times adjusted to the procedure.


Assuntos
Ureter , Obstrução Ureteral , Cateteres , Humanos , Estudos Prospectivos , Stents , Ultrassonografia , Ultrassonografia de Intervenção , Obstrução Ureteral/diagnóstico por imagem
5.
BMC Med Educ ; 21(1): 434, 2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404414

RESUMO

BACKGROUND: The American Association of Medical Colleges has defined peripheral intravenous cannulation as one of the eight practical skills that a medical student should possess upon graduation. Since following a standard hygiene protocol can reduce the rate of complications such as bloodstream infections, the medical student's compliance to hygienic standards is highly relevant. METHODS: This unicentric longitudinal cohort study included 177 medical students undergoing OSCE 1 in the winter semesters 2016/2017 and 2017/2018 as well as OSCE 2 during the winter semesters 2018/2019 and 2019/2020 at the University of Cologne. Their performance in peripheral intravenous cannulation was rated by trained student supervisors using a scaled 13-item questionnaire and compared between OSCE 1 and OSCE 2. RESULTS: Overall, a decline in the correct placement of peripheral intravenous catheters was observed among advanced medical students during OSCE 2 (mean total score: 6.27 ± 1.84) in comparison to their results in OSCE 1 (mean total score: 7.67 ± 1.7). During OSCE 2, the students were more negligent in regard to hygienic behavior, such as disinfection of the puncture site as well as hand disinfection before and after venipuncture. Their patients were also less likely to be informed about the procedure as compared to OSCE 1. CONCLUSIONS: An unsatisfying performance in regard to peripheral intravenous cannulation was observed in medical students with hygiene compliance deteriorating between the third and fifth year of their study. Thus, we promote an extension of practical hygiene and stress management training in medical school to reduce complications associated with intravenous catheters, such as bloodstream infections.


Assuntos
Estudantes de Medicina , Cateterismo , Cateteres , Competência Clínica , Avaliação Educacional , Humanos , Higiene , Estudos Longitudinais , Estudos Prospectivos
7.
Wiad Lek ; 74(7): 1622-1627, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34459762

RESUMO

OBJECTIVE: The aim: We aimed to assess the feasibility and safety of performing balloon aortic valvuloplasty (BAV) with Valver balloon catheter (Balton, Poland) in adults with severe aortic stenosis as a bridge or palliative treatment. PATIENTS AND METHODS: Materials and methods: We identified consecutive patients who underwent BAV procedures between May 2019 and March 2020 using Valver balloon catheters. Demographic data, medical history, and clinical characteristics were retrospectively collected in all study patients together with periprocedural data as well as 12-month follow-up data. RESULTS: Results: We included 18 patients. The mean population age was 78.1±8.9 years, and women were 61.1%. The most common co-morbidities were arterial hypertension (88.9%), dyslipidemia (83.3%), and coronary artery disease (72.2%). The baseline mean aortic valve pressure gradient was 49.94±27.02 mmHg and the mean aortic valve area (AVA) was 0.65±0.20 cm2. In all cases, the procedure was performed from the femoral access via the 8F sheath. Two Valver balloon catheter sizes were used 18x40mm (33.3%) and 20x40mm (66.7%). Three periprocedural complications were observed, and none was associated with the Valver balloon catheter per se. The transthoracic echocardiography after the procedure revealed a decrease in the mean pressure gradient of 11.1±8.85 mmHg, and an increase in AVA of 0.21±0.19 cm2. At 12-month follow-up, the mortality rate was 38.9%. CONCLUSION: Conclusions: BAV is a procedure increasingly performed in catheterization laboratories worldwide. This paper confirmed the relative safety of BAV with Valver balloon catheters in the modern era, showing a low incidence of valve and vascular complications.


Assuntos
Estenose da Valva Aórtica , Cuidados Paliativos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/cirurgia , Cateteres , Feminino , Humanos , Estudos Retrospectivos , Resultado do Tratamento
8.
Mo Med ; 118(4): 374-380, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34373674

RESUMO

Background: Peripherally inserted central catheter (PICC) placement is necessary for delivery of intravenous (IV) antibiotics to treat bone and soft tissue infections. Upper extremity deep venous thrombosis (DVT) after PICC placement is a complication with unknown incidence in the orthopaedic literature. The major objectives of this study are Identifying the rate of upper extremity PICC-associated DVTs after orthopaedic procedures;Which orthopaedic subspecialties are most likely to encounter an upper extremity PICC-associated DVT?What surgeries or medical comorbidities are risk factors for upper extremity PICC-associated DVTs?Does type of DVT chemoprophylaxis decrease the risk of an upper extremity PICC-associated DVT? Methods: A retrospective review of electronic medical records (EMR) was performed to include all patients undergoing irrigation and debridement (I&D) for treatment of orthopaedic surgery-related infections over a 10-year period. All patients with PICC placement were included for analyses. Age, sex, and medical comorbidities were extracted from the EMR. Mann-Whitney non-parametric tests, Fisher's exact tests, Chi-square tests, and Cochran-Mantel-Haenszel (CMH) tests were used to determine associations with DVT events for those with PICCs based on medical comorbidities, PICC lumen size, team placing the PICC, impact of implant removal, and protective effect of DVT chemoprophylaxis. Significance was set at p<0.05. Results: Twenty-one of 660 patients (3.18% rate) were found to have an upper extremity PICC-associated DVT. A history of DVT (OR=8.99 [95% CI: 3.39, 49.42]) was significantly associated with an upper extremity PICC-associated DVT. The greatest risk for an upper extremity PICC-associated DVT was intramedullary implant removal (OR=12.43 [95% CI: 3.13, 49.52]). The type of DVT chemoprophylaxis did not significantly affect the likelihood of an upper extremity PICC-associated DVT. Conclusion: Intramedullary implant removal and a history of DVT are risk factors for an upper extremity PICC-associated DVT. The results of this study should be of particular interest to surgeons who do not typically give DVT prophylaxis and plan to perform surgery on patients with CHF, a history of a DVT, or plan to manipulate the intramedullary canal.


Assuntos
Cateterismo Venoso Central , Cateterismo Periférico , Ortopedia , Trombose Venosa , Cateterismo Venoso Central/efeitos adversos , Cateterismo Periférico/efeitos adversos , Cateteres , Desbridamento , Humanos , Estudos Retrospectivos , Fatores de Risco , Extremidade Superior , Trombose Venosa/epidemiologia , Trombose Venosa/etiologia , Trombose Venosa/prevenção & controle
9.
Nat Commun ; 12(1): 5072, 2021 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-34417473

RESUMO

In vivo bioprinting has recently emerged as a direct fabrication technique to create artificial tissues and medical devices on target sites within the body, enabling advanced clinical strategies. However, existing in vivo bioprinting methods are often limited to applications near the skin or require open surgery for printing on internal organs. Here, we report a ferromagnetic soft catheter robot (FSCR) system capable of in situ computer-controlled bioprinting in a minimally invasive manner based on magnetic actuation. The FSCR is designed by dispersing ferromagnetic particles in a fiber-reinforced polymer matrix. This design results in stable ink extrusion and allows for printing various materials with different rheological properties and functionalities. A superimposed magnetic field drives the FSCR to achieve digitally controlled printing with high accuracy. We demonstrate printing multiple patterns on planar surfaces, and considering the non-planar surface of natural organs, we then develop an in situ printing strategy for curved surfaces and demonstrate minimally invasive in vivo bioprinting of hydrogels in a rat model. Our catheter robot will permit intelligent and minimally invasive bio-fabrication.


Assuntos
Bioimpressão , Cateteres , Imãs/química , Robótica , Animais , Linhagem Celular , Elasticidade , Condutividade Elétrica , Humanos , Hidrogéis/química , Fígado/diagnóstico por imagem , Ratos Sprague-Dawley , Suínos , Tomografia Computadorizada por Raios X , Viscosidade
10.
BMJ Open ; 11(8): e046366, 2021 08 18.
Artigo em Inglês | MEDLINE | ID: mdl-34408033

RESUMO

OBJECTIVES: Catheter-related bloodstream infections (CRBSI) are a common healthcare-associated infection and therefore targeted by surveillance programmes in many countries. Concerns, however, have been voiced regarding the reliability and construct validity of CRBSI surveillance and the connection with the current diagnostic procedures. The aim of this study was to explore the experiences of infection control practitioners (ICPs) and medical professionals with the current CRBSI surveillance in the Netherlands and their suggestions for improvement. DESIGN: Qualitative study using focus group discussions (FGDs) with ICPs and medical professionals separately, followed by semistructured interviews to investigate whether the points raised in the FGDs were recognised and confirmed by the interviewees. Analyses were performed using thematic analyses. SETTING: Basic, teaching and academic hospitals in the Netherlands. PARTICIPANTS: 24 ICPs and 9 medical professionals. RESULTS: Main themes derived from experiences with current surveillance were (1) ICPs' doubt regarding the yield of surveillance given the low incidence of CRBSI, the high workload and IT problems; (2) the experienced lack of leadership and responsibility for recording information needed for surveillance and (3) difficulties with applying and interpreting the CRBSI definition. Suggestions were made to simplify the surveillance protocol, expand the follow-up and surveillance to homecare settings, simplify the definition and customise it for specific patient groups. Participants reported hoping for and counting on automatisation solutions to support future surveillance. CONCLUSIONS: This study reveals several problems with the feasibility and acceptance of the current CRBSI surveillance and proposes several suggestions for improvement. This provides valuable input for future surveillance activities, thereby taking into account automation possibilities.


Assuntos
Infecções Relacionadas a Cateter , Sepse , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/prevenção & controle , Cateteres , Humanos , Países Baixos/epidemiologia , Reprodutibilidade dos Testes
11.
Front Public Health ; 9: 631865, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34458217

RESUMO

Catheter-related bloodstream infection (CRBSI) is an important healthcare-associated infection caused by various nosocomial pathogens. Candida parapsilosis has emerged as a crucial causative agent for the CRBSI in the last two decades. Many factors have been associated with the development of CRBSI including, demography, pre-maturity, comorbidities (diabetes mellitus, hypertension, heart diseases, neuropathy, respiratory diseases, renal dysfunction, hematological and solid organ malignancies, and intestinal dysfunction), intensive care unit (ICU) admission, mechanical ventilation (MV), total parenteral nutrition (TPN), prior antibiotic and/or antifungal therapy, neutropenia, prior surgery, immunosuppressant, and type, site, number, and duration of catheters. This study aims to determine C. parapsilosis CRBSI risk factors. A retrospective study has been performed in an 853-bedded tertiary-care hospital in north-eastern Malaysia. All inpatients with C. parapsilosis positive blood cultures from January 2006 to December 2018 were included, and their medical records were reviewed using a standardized checklist. Out of 208 candidemia episodes, 177 had at least one catheter during admission, and 31 cases had not been catheterized and were excluded. Among the 177 cases, 30 CRBSI cases were compared to 147 non-CRBSI cases [81 bloodstream infections (BSIs), 66 catheter colonizers]. The significance of different risk factors was calculated using multivariate analysis. Multivariate analysis of potential risk factors shows that ICU admission was significantly associated with non-CRBSI as compared to CRBSI [OR, 0.242; 95% CI (0.080-0.734); p = 0.012], and TPN was significantly positively associated with CRBSI than non-CRBSI [OR, 3.079; 95%CI (1.125-8.429); p = 0.029], while other risk factors were not associated significantly. Patients admitted in ICU were less likely to develop C. parapsilosis CRBSI while patients receiving TPN were more likely to have C. parapsilosis CRBSI when compared to the non-CRBSI group.


Assuntos
Candida parapsilosis , Candidemia , Candidemia/epidemiologia , Cateteres , Humanos , Estudos Retrospectivos , Fatores de Risco
12.
J Infect Chemother ; 27(10): 1400-1406, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34362659

RESUMO

This guideline contains updated recommendations on the management and prevention of CAUTIs by the Urological Association of Asia and the Asian Association of Urinary Tract Infection and Sexually Transmitted Infection.


Assuntos
Infecções Relacionadas a Cateter , Infecção Hospitalar , Infecções Urinárias , Ásia , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/prevenção & controle , Cateteres , Humanos , Cateterismo Urinário/efeitos adversos , Infecções Urinárias/tratamento farmacológico
14.
Int J Hyperthermia ; 38(1): 1149-1163, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34376106

RESUMO

PURPOSE: To develop and validate a three-dimensional (3-D) computer model based on accurate geometry of an irrigated cardiac radiofrequency (RF) ablation catheter with microwave radiometry capability, and to test catheter performance. METHODS: A computer model was developed based on CAD geometry of a RF cardiac ablation catheter prototype to simulate electromagnetic heating, heat transfer, and computational fluid dynamics (blood flow, open irrigation, and natural convection). Parametric studies were performed; blood flow velocity (0-25 cm/s) and irrigation flow (0-40 ml/min) varied, both with perpendicular (PE) and parallel (PA) catheter orientations relative to tissue. Tissue Agar phantom studies were performed under similar conditions, and temperature maps were recorded via infrared camera. Computer model simulations were performed with constant voltage and with voltage adjusted to achieve maximum tissue temperatures of 95-105 °C. RESULTS: Model predicted thermal lesion width at 5 W power was 5.8-6.4 mm (PE)/6.5-6.6 mm (PA), and lesion depth was 4.0-4.3 mm (PE)/4.0-4.1 mm (PA). Compared to phantom studies, the mean errors of the computer model were as follows: 6.2 °C(PE)/4.3 °C (PA) for maximum gel temperature, 0.7 mm (10.9%) (PE)/0.1 mm (0.8%) (PA) for lesion width, and 0.3 mm (7.7%)(PE)/0.7 mm (19.1%) (PA) for lesion depth. For temperature-controlled ablation, model predicted thermal lesion width was 7-9.2 mm (PE)/8.6-9.2 mm (PA), and lesion depth was 4.3-5.5 mm (PE)/3.4-5.4 mm (PA). CONCLUSIONS: Computer models were able to reproduce device performance and to enable device evaluation under varying conditions. Temperature controlled ablation of irrigated catheters enables optimal tissue temperatures independent of patient-specific conditions such as blood flow.


Assuntos
Ablação por Cateter , Cateteres , Simulação por Computador , Coração , Humanos , Temperatura
15.
Curr Cardiol Rep ; 23(8): 95, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34196796

RESUMO

PURPOSE OF REVIEW: Transcatheter mitral valve replacement (TMVR) has been developed to address the need for an alternative therapeutic option to surgery in patients suffering from severe mitral regurgitation who are at high surgical risk. The present review illustrated the state-of-the-art of catheter-based mitral valve replacement evaluating technical characteristics and early clinical experience of different devices to outline prospects and challenges of TMVR. RECENT FINDINGS: Several devices are currently under clinical assessment. Early experience has demonstrated high procedural success of TMVR. However, TMVR faces several possible hurdles such as left ventricular outflow tract obstruction (LVOTO) after prosthesis deployment, access site complications, and thrombotic risk requiring anticoagulatory therapy. Future studies should assess long-term prosthesis stability, optimal anticoagulation regime, and occurrence of paravalvular leakage. The development of smaller TMVR prostheses suitable for transseptal implantation could overcome bleeding complications. In perspective, TMVR may emerge to a clinically relevant therapeutic approach for patients with severe MR at high surgical risk.


Assuntos
Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Insuficiência da Valva Mitral , Cateterismo Cardíaco , Cateteres , Humanos , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/cirurgia , Resultado do Tratamento
17.
BMJ Open ; 11(7): e045895, 2021 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-34226216

RESUMO

OBJECTIVES: Determine the effect of the catheter to vein ratio (CVR) on rates of symptomatic thrombosis in individuals with a peripherally inserted central catheter (PICC) and identify the optimal CVR cut-off point according to diagnostic group. DESIGN: Retrospective cohort study. SETTING: 4 tertiary hospitals in Australia and New Zealand. PARTICIPANTS: Adults who had undergone PICC insertion. PRIMARY OUTCOME MEASURE: Symptomatic thrombus of the limb in which the PICC was inserted. RESULTS: 2438 PICC insertions were included with 39 cases of thrombosis (1.6%; 95% CI 1.14% to 2.19%). Receiver operator characteristic analysis was unable to be performed to determine the optimal CVR overall or according to diagnosis. The association between risk of thrombosis and CVR cut-offs commonly used in clinical practice were analysed. A 45% cut-off (≤45% versus ≥46%) was predictive of thrombosis, with those with a higher ratio having more than twice the risk (relative risk 2.30; 95% CI 1.202 to 4.383; p=0.01). This pattern continued when only those with malignancy were included in the analysis, those with cancer had twice the risk of thrombosis with a CVR greater than 45%. Whereas the 33% CVR cut-off was not associated with statistically significant results overall or in those with malignancy. Neither the 33% or 45% CVR cut-off produced statistically significant results in those with infection or other non-malignant conditions. CONCLUSIONS: Adherence to CVR cut-offs are an important component of PICC insertion clinical decision making to reduce the risk of thrombosis. These results suggest that in individuals with cancer, the use of a CVR ≤45% should be considered to minimise risk of thrombosis. Further research is needed to determine the risk of thrombosis according to malignancy type and the optimal CVR for those with a non-malignant diagnosis.


Assuntos
Cateterismo Venoso Central , Cateterismo Periférico , Trombose Venosa Profunda de Membros Superiores , Adulto , Austrália , Cateterismo Venoso Central/efeitos adversos , Cateterismo Periférico/efeitos adversos , Cateteres , Humanos , Nova Zelândia , Estudos Retrospectivos , Fatores de Risco
18.
BMJ Open ; 11(7): e048370, 2021 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-34272222

RESUMO

OBJECTIVES: There is a lack of data regarding the quality of peripheral intravenous catheter (PIVC)-related care from low-income and middle-income countries, even though the use of PIVCs may lead to local or severe systemic infections. Our main objective was to assess the feasibility and inter-rater agreement on the PIVC-mini Questionnaire (PIVC-miniQ) in a tertiary care hospital in Nepal. DESIGN: We performed an observational cross-sectional quantitative study using the PIVC-miniQ to collect information on PIVC quality. SETTING: Secondary care in a Nepalese hospital. All patients with PIVCs in selected wards were included in the study and PIVCs were assessed independently by two raters. Eight Nepalese nurses, one Nepalese student and three Norwegian students participated as raters. PRIMARY AND SECONDARY OUTCOME MEASURES: The intraclass correlation coefficient (ICC), positive, negative, absolute agreement, Scott's pi and sum score were calculated using PIVC-miniQ. We also aimed to describe PIVC quality of care, as it is important to prevent PIVC-associated complications such as phlebitis or catheter-associated bloodstream infections. RESULTS: A total of 390 patients (409 PIVCs) were included in the study. The ICC between raters was 0.716 for Nepalese raters, 0.644 for Norwegian raters and 0.481 for the pooled data. The most frequently observed problems associated with PIVCs were blood in the intravenous line (51.5%), pain and tenderness on palpation (43.4%), and fixation with opaque tape (38.5%). The average sum score was 3.32 deviations from best practice for PIVCs fixed with non-sterile opaque tape and 2.37 for those fixed with transparent dressing (p<0.001). CONCLUSION: The PIVC-miniQ is a feasible and reliable tool for nurses assessing PIVC quality in hospitalised patients in Nepal. The study revealed gaps in PIVC quality and care that could be improved by providing transparent PIVC dressings for all patients and requiring all PIVC insertions to be documented in patient charts.


Assuntos
Cateterismo Periférico , Cateteres , Estudos Transversais , Estudos de Viabilidade , Humanos , Nepal , Noruega , Inquéritos e Questionários , Centros de Atenção Terciária
19.
Artigo em Inglês | MEDLINE | ID: mdl-34300069

RESUMO

Intravenous therapy administration through peripheral venous catheters is one of the most common nursing procedures performed in clinical contexts. However, peripherally inserted central catheters (PICC) remain insufficiently used by nurses and can be considered a potential alternative for patients who need aggressive intravenous therapy and/or therapy for extended periods. The purpose of this study was to understand nurses' perspectives about PICC implementation in their clinical practice. As part of an action-research project, three focus groups were developed in June 2019 with nineteen nurses of a cardiology ward from a Portuguese tertiary hospital. From the content analysis, two main categories emerged: 'nursing practices' and 'patients'. Nurses considered PICC beneficial for their clinical practice because it facilitates maintenance care and catheter replacement rates. Moreover, nurses suggested that, since there is a need for specific skills, the constitution of vascular access teams, as recommended by international guidelines, could be an advantage. Regarding patient benefits, nurses highlighted a decrease in the number of venipunctures and also of patient discomfort, which was associated with the number of peripheral venous catheters. Infection prevention was also indicated. As an emerging medical device used among clinicians, peripherally inserted central catheters seem to be essential to clinical practice.


Assuntos
Cardiologia , Cateterismo Venoso Central , Enfermeiras e Enfermeiros , Cateterismo Venoso Central/efeitos adversos , Cateteres , Grupos Focais , Humanos
20.
BMJ Case Rep ; 14(7)2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34285033

RESUMO

A 48-year-old man presented to the surgery casualty with 1-day history of broken foreign body during the insertion of dialysis catheter and a failed surgical retrieval. A Doppler ultrasonography of the right groin and lower limb and a noncontrast CT of abdomen and pelvis were performed. Eventhough no intravascular foreign body could be identified on imaging, a decision to re-explore the wound was taken in view of definitive clinical history. A 9.5 cm-long, broken piece of tissue dilator was found inside the right external iliac vein, which was removed through venotomy of the femoral vein. Postoperative recovery was uneventful.


Assuntos
Veia Femoral , Diálise Renal , Cateteres , Veia Femoral/diagnóstico por imagem , Veia Femoral/cirurgia , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/cirurgia , Masculino , Pessoa de Meia-Idade
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