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1.
Breast Dis ; 41(1): 1-3, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34219707

RESUMO

During the first hit of SARS-COVID pandemic, an important reorganization of Healthcare Services has been done, and new protocols and pathways to protect frail patients like oncological patients were designed. The second hit of pandemic had stressed these new pathways and suggests to health-workers some improvements for safer management of patents.We reported our experience in organizing the clinical pathway of neoadjuvant therapy candidate patients based on the execution of sentinel lympho-node biopsy and the placement of implantable venous access port in the same access to operating room before neoadjuvant chemotherapy suggesting a possible organizational model. In the period October-December 2020 we have included in this new type of path twelve patients and we have not registered any cases of COVID among the patients included. We think this new path, adopted amid the second hit, will be useful for all Breast Units that are facing the challenge of guaranteeing the highest standards of care in a historical moment where the health emergency occupies the efforts of health workers and the economic resources of health systems.


Assuntos
Antineoplásicos/administração & dosagem , Neoplasias da Mama/tratamento farmacológico , COVID-19/prevenção & controle , Cateterismo Venoso Central/métodos , Controle de Infecções/métodos , Segurança do Paciente , Biópsia de Linfonodo Sentinela/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Cateterismo Venoso Central/instrumentação , Cateterismo Venoso Central/normas , Cateteres Venosos Centrais , Quimioterapia Adjuvante , Procedimentos Clínicos , Feminino , Humanos , Controle de Infecções/normas , Mastectomia , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estadiamento de Neoplasias , Biópsia de Linfonodo Sentinela/normas
2.
Infect Dis Clin North Am ; 35(4): 841-856, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34752222

RESUMO

Despite a large volume of research in prevention, central line-associated bloodstream infections and catheter-related bloodstream infections continue to cause significant morbidity, mortality, and increased health care costs. Strategies in prevention, including decision about catheter placement, insertion bundles, adherence to standard of care guidelines, and technologic innovations, shown to decrease rates of catheter-related bloodstream infections and central line-associated bloodstream infections are described in this update. The coronavirus disease 2019 pandemic has resulted in increased health care-acquired infections, including central line-associated bloodstream infections.


Assuntos
Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Bacteriemia/epidemiologia , Bacteriemia/etiologia , COVID-19/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/etiologia , Cateterismo Venoso Central/normas , Tomada de Decisão Clínica , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/etiologia , Humanos , Pacotes de Assistência ao Paciente/normas , Guias de Prática Clínica como Assunto , SARS-CoV-2
3.
Hosp Pract (1995) ; 49(3): 141-150, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33781151

RESUMO

BACKGROUND: Vascular access by means of intravenous catheters is essential for the safe, effective and cost-efficient delivery of intravenous fluids, antibiotics, nutrition and chemotherapy, but the use of these devices is not without complications. PURPOSE: A faculty of multidisciplinary European vascular access team (VAT) Leads/Members and experts sought to reframe how the implementation of a VAT could have positive impacts on patients and hospitals. METHODS: Interview data from a Faculty of nine VAT Leads/Members and experts from six European countries on the impact of multidisciplinary VATs in modern healthcare were assessed. A literature search was conducted that included Medline®-cited peer-reviewed articles published in the past 10 years in order to identify impact data and post-implementation of a multidisciplinary VAT that support the benefits to patient safety and satisfaction and to hospital efficiencies reported in the interview program. RESULTS: While VATs vary in structure and function, clarity of purpose and supportive training and education are key. Barriers to the implementation of VATs show commonality across countries, such as lack of investment, insufficient training and lack of awareness. Proven markers of VAT success include rapid referrals, improved patient outcomes and improved organizational efficiency. Standardization of outcomes data capture, processing and reporting are key to monitoring performance against baseline. Awareness of the cost of complications arising from inappropriate choice and placement, and poor care and maintenance, of the vascular access device must be raised. CONCLUSIONS: The implementation of VATs can positively impact patient safety and satisfaction, improve organizational efficiencies and cost-effectiveness, and could create new opportunities for in- and outpatient services, beneficial to both patients and institutions.


Assuntos
Cateterismo Venoso Central/normas , Cateterismo Periférico/normas , Implementação de Plano de Saúde/organização & administração , Comunicação Interdisciplinar , Equipe de Assistência ao Paciente/organização & administração , Radiologia Intervencionista/normas , Infecções Relacionadas a Cateter/prevenção & controle , Humanos , Garantia da Qualidade dos Cuidados de Saúde
4.
Best Pract Res Clin Anaesthesiol ; 35(1): 135-140, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33742573

RESUMO

Guidelines for prevention of catheter-related bloodstream infection (CR-BSI) describe a series of recommendations for correct insertion and handling of central venous catheters (CVCs). Since their implementation, quality programs such as "Zero bacteremia" have achieved a reduction in CR-BSI rates, but there is still room for further improvement. New evidence is emerging regarding, e.g., antiseptic-antimicrobial impregnated catheters or the use of passive disinfection of closed connectors. These examples of new tools among others might help to further decrease infection rates. This article aims to review new evidence-based strategies to reduce catheter insertion-related infection.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/métodos , Cateteres Venosos Centrais , Medicina Baseada em Evidências/métodos , Ultrassonografia de Intervenção/métodos , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos Locais/administração & dosagem , Bacteriemia/diagnóstico por imagem , Bacteriemia/etiologia , Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/diagnóstico por imagem , Infecções Relacionadas a Cateter/etiologia , Cateterismo Venoso Central/normas , Cateteres Venosos Centrais/microbiologia , Cateteres Venosos Centrais/normas , Medicina Baseada em Evidências/normas , Humanos , Ultrassonografia de Intervenção/normas
5.
Medicine (Baltimore) ; 100(2): e24156, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466189

RESUMO

ABSTRACT: Patients with colorectal cancer (CRC) treated with curative intent surgery undergo continuous fluorouracil (5-FU) infusion-based chemotherapy using totally implantable central venous port system (TICVPS) in cases with high risk of recurrence. Approximately 30% of patients relapse after therapy completion, especially within 2 years. Hence, many patients with high risk CRC keep the TICVPS for 6 to 24 months after treatment with regular intervals of TICVPS flushing. However, little is known about the proper interval duration of the port. The aim of this study is to investigate whether a 3 months extended interval is safe and if port maintenance is feasible.A retrospective cohort was compiled of patients with CRC who underwent curative intent surgery and perioperative chemotherapy using TICVPS between 2010 and 2017. The primary end point was TICVPS maintenance rate, including maintenance of TICVPS for at least 6 months, planned TICVPS removal after 6 months, and regaining the use of TICVPS at the time of recurrence.A total of 214 patients with CRC underwent curative intent treatments during the study period. Among them, 60 patients were excluded, including 6 patients for early recurrence within 3 months and 54 patients with violation of flushing interval. Finally, 154 patients were analyzed. Mean flushing interval was 98.4 days (95% confidence interval [CI], 96.2-100.6; range, 60-120). In December 2018, 35 patients kept the TICVPS, 92 patients had planned removal, 25 patients reused the TICVPS, and 2 patients had to unexpectedly remove the TICVPS due to site infection and pain. Thus, the functional TICVPS maintenance rate was 98.8% (152/154). Thirty-eight patients relapsed, and 30 patients were treated with intravenous chemotherapy. Among them, 25 patients (83.3%) reused the maintained TICVPS without a reinsertion procedures.Our study demonstrated that 3-month interval access and flushing is safe and feasible for maintaining TICVPS during surveillance of patients with CRC. An extended interval up to 3 months can be considered because it is compatible with CRC surveillance visit schedules.


Assuntos
Cateterismo Venoso Central/normas , Cateteres Venosos Centrais/tendências , Tratamento Farmacológico/instrumentação , Adulto , Idoso , Antineoplásicos/uso terapêutico , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/instrumentação , Cateterismo Venoso Central/enfermagem , Neoplasias Colorretais/tratamento farmacológico , Neoplasias Colorretais/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo
6.
Pediatrics ; 147(2)2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33414235

RESUMO

BACKGROUND: Pediatric musculoskeletal infection (MSKI) is a common cause of hospitalization with associated morbidity. To improve the care of pediatric MSKI, our objectives were to achieve 3 specific aims within 24 months of our quality improvement (QI) interventions: (1) 50% reduction in peripherally inserted central catheter (PICC) use, (2) 25% reduction in sedations per patient, and (3) 50% reduction in empirical vancomycin administration. METHODS: We implemented 4 prospective QI interventions at our tertiary children's hospital: (1) provider education, (2) centralization of admission location, (3) coordination of radiology-orthopedic communication, and (4) implementation of an MSKI infection algorithm and order set. We included patients 6 months to 18 years of age with acute osteomyelitis, septic arthritis, or pyomyositis and excluded patients with complex chronic conditions or ICU admission. We used statistical process control charts to analyze outcomes over 2 general periods: baseline (January 2015-October 17, 2016) and implementation (October 18, 2016-April 2019). RESULTS: In total, 224 patients were included. The mean age was 6.1 years, and there were no substantive demographic or clinical differences between baseline and implementation groups. There was an 81% relative reduction in PICC use (centerline shift 54%-11%; 95% confidence interval 70-92) and 33% relative reduction in sedations per patient (centerline shift 1.8-1.2; 95% confidence interval 21-46). Empirical vancomycin use did not change (centerline 20%). CONCLUSIONS: Our multidisciplinary MSKI QI interventions were associated with a significant decrease in the use of PICCs and sedations per patient but not empirical vancomycin administration.


Assuntos
Artrite Infecciosa/terapia , Hospitais Pediátricos/normas , Osteomielite/terapia , Piomiosite/terapia , Melhoria de Qualidade/organização & administração , Centros de Atenção Terciária/normas , Adolescente , Antibacterianos/uso terapêutico , Gestão de Antimicrobianos/normas , Gestão de Antimicrobianos/tendências , Cateterismo Venoso Central/normas , Cateterismo Venoso Central/tendências , Criança , Pré-Escolar , Sedação Consciente/normas , Sedação Consciente/tendências , Feminino , Hospitais Pediátricos/organização & administração , Humanos , Lactente , Masculino , Estudos Prospectivos , Melhoria de Qualidade/estatística & dados numéricos , Centros de Atenção Terciária/organização & administração , Resultado do Tratamento , Vancomicina/uso terapêutico
8.
Angiol. (Barcelona) ; 72(6): 298-307, nov.-dic. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-199690

RESUMO

El acceso vascular en los pacientes en programa de hemodiálisis condiciona de forma significativa la calidad de las sesiones de diálisis, su morbimortalidad, complicaciones y necesidad de nuevos procedimientos a lo largo del tiempo, además de importantes implicaciones técnicas y económicas. Se trata de pacientes frágiles, muchas veces reintervenidos, que van a requerir un acceso vascular durante largos periodos de tiempo o para el resto de su vida, por lo que estamos ante una piedra angular que debemos tratar de la mejor forma posible. Y en este campo, los ultrasonidos ofrecen, más que en ninguna otra localización, una inestimable ayuda en todas las etapas del acceso vascular: desde su planificación, creación, seguimiento, o como herramienta intraoperatoria


Vascular access in patients on hemodialysis significantly affects the quality of life, morbidity, mortality, complications and the need for new procedures over time. In addition, they have important technical and economic implications. These are fragile patients, often with many reinterventions, who will require vascular access for long periods of time or for the rest of their lives, so we are facing a big health problem that we must treat in the best possible way. In this framework, ultrasounds offer, more than in any other location, an invaluable help in all stages of vascular disease: from planning the arteriovenous access, creation, follow-up or as intraoperative tool. This document tries to provide an update and help to clinical practice


Assuntos
Humanos , Derivação Arteriovenosa Cirúrgica/normas , Cateterismo Venoso Central/normas , Ultrassonografia de Intervenção/normas , Cateterismo Venoso Central/métodos , Derivação Arteriovenosa Cirúrgica/métodos , Ultrassonografia de Intervenção/métodos , Sociedades Médicas , Espanha , Diálise Renal/métodos , Diálise Renal/normas
9.
Comput Inform Nurs ; 39(4): 208-214, 2020 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-33136611

RESUMO

It is clear that interdisciplinary communication and collaboration have the potential to mitigate healthcare-associated harm, yet there is limited research on how communication through documentation in the patient record can support collaborative decision making. Understanding what information is needed to support collaborative decision making is necessary to design electronic health information systems that facilitate effective communication and, ultimately, safe care. To explore this issue, we focused on information needs related to central venous catheter management and the prevention of central line-associated blood stream infections. Semistructured interviews were conducted with nurses working in an intensive care unit. Interview transcripts were analyzed using inductive thematic analysis. Three themes were identified: (1) challenges managing documentation in multiple places in the absence of formal documentation processes for central venous catheter management; (2) lack of standardized decision-making processes for managing central venous catheters; and (3) oral communication holds it together. Our findings provide a foundation for the development of EHR functional requirements that enhance communication regarding the management of central venous catheters and facilitate the prompt removal of unnecessary lines.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/normas , Comportamento Cooperativo , Tomada de Decisões , Documentação/normas , Comunicação Interdisciplinar , Enfermagem de Cuidados Críticos , Registros Eletrônicos de Saúde/organização & administração , Humanos , Unidades de Terapia Intensiva , Entrevistas como Assunto , Pesquisa Qualitativa
10.
Rev Esc Enferm USP ; 54: e03629, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-33084798

RESUMO

OBJECTIVE: To evaluate knowledge and behavior of professionals in Intensive Care Units regarding the actions recommended in the bundle on preventing central venous catheter-related bloodstream infection. METHOD: Cross-sectional descriptive quantitative study, conducted in three Intensive Care Units. The data were collected through a face-to-face questionnaire applied to health professionals. The software R 3.3.1 was used for data analysis. RESULTS: Two-hundred and ninety-two professionals participated. Regarding knowledge, the hand hygiene item presented a higher level both for the insertion (92.46%) and maintenance (97.27%) moments. Usage of chlorhexidine as an antiseptic, followed by alcohol (47.94%) and providing a date for hub or connectors (19.87%) were the least known items. As for behavior, the professionals reported: using always the correct attire for catheter insertion (84.25%), never waiting for the antiseptic to dry before catheter insertion (25.34%) and never cleaning hub or connectors with 70% alcohol (23.86%). CONCLUSION: Results show that the professionals' knowledge and behavior regarding the central venous catheter bundle present deficiencies, revealing the importance of promoting training programs for this knowledge domain.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central , Cateteres Venosos Centrais , Competência Profissional , Adulto , Cateterismo Venoso Central/normas , Clorexidina , Estudos Transversais , Etanol , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Unidades de Terapia Intensiva
11.
J Pediatr Oncol Nurs ; 37(5): 305-312, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32639196

RESUMO

Central venous access devices (CVADs) are the standard of care in pediatric oncology. Occlusion is a common complication that can lead to delays in therapy, readmission, and CVAD removal and reinsertion. Early treatment of partial occlusions using a standardized protocol may restore patency and increase life span of CVADs. The objective of this study was to develop and evaluate a nurse-led protocol to manage partial CVAD occlusions in pediatric oncology and autologous bone marrow transplant patients. The protocol enabled nurses to manage partially occluded CVADs by administering thrombolytic therapy following an algorithm and patient-specific standing order. The primary outcome was time from recognition of the partial occlusion to instillation of a thrombolytic. Secondary outcomes were thrombolytic dwell time, number of complete occlusions, and CVAD life span. We used a quasi-experimental, after-only, nonequivalent control group design to compare patients not exposed (retrospective cohort, n = 137) and patients exposed (prospective cohort, n = 101) to the nurse-led protocol. Mann-Whitney U tests were used to compare time to treatment, dwell time, and CVAD life span between cohorts, and χ2 was used to compare the proportion of occlusions classified as complete. Time to treatment was significantly lower in the prospective cohort (M = 99.9 minutes) versus the retrospective cohort (M = 483.7 minutes), U = 1366.50, p < .01, as was thrombolytic dwell time, U = 282.50, p < .01. Proportion of complete occlusions and CVAD life span did not differ between cohorts. The nurse-led protocol was effective to manage partial CVAD occlusions in pediatric oncology patients.


Assuntos
Infecções Relacionadas a Cateter/enfermagem , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/normas , Neoplasias/terapia , Enfermagem Oncológica/normas , Pediatria/normas , Guias de Prática Clínica como Assunto , Tempo para o Tratamento/normas , Adulto , Cateterismo Venoso Central/instrumentação , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Papel do Profissional de Enfermagem , Estudos Prospectivos , Estudos Retrospectivos
12.
Crit Care ; 24(1): 458, 2020 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-32703235

RESUMO

BACKGROUND: Chlorhexidine-gluconate (CHG) impregnated dressings may prevent catheter-related bloodstream infections (CRBSI). Chlorhexidine-impregnated sponge dressings (sponge-dress) and gel dressings (gel-dress) have never been directly compared. We used the data collected for two randomized-controlled trials to perform a comparison between sponge-dress and gel-dress. METHODS: Adult critically ill patients who required short-term central venous or arterial catheter insertion were recruited. Our main analysis included only patients with CHG-impregnated dressings. The effect of gel-dress (versus sponge-dress) on major catheter-related infections (MCRI) and CRBSI was estimated using multivariate marginal Cox models. The comparative risks of dressing disruption and contact dermatitis were evaluated using logistic mix models for clustered data. An explanatory analysis compared gel-dress with standard dressings using either CHG skin disinfection or povidone iodine skin disinfection. RESULTS: A total of 3483 patients and 7941 catheters were observed in 16 intensive care units. Sponge-dress and gel-dress were utilized for 1953 and 2108 catheters, respectively. After adjustment for confounders, gel-dress showed similar risk for MCRI compared to sponge-dress (HR 0.80, 95% CI 0.28-2.31, p = 0.68) and CRBSI (HR 1.13, 95% CI 0.34-3.70, p = 0.85), less dressing disruptions (OR 0.72, 95% CI 0.60-0.86, p < 0.001), and more contact dermatitis (OR 3.60, 95% CI 2.51-5.15, p < 0.01). However, gel-dress increased the risk of contact dermatitis only if CHG was used for skin antisepsis (OR 1.94, 95% CI 1.38-2.71, p < 0.01). CONCLUSIONS: We described a similar infection risk for gel-dress and sponge-dress. Gel-dress showed fewer dressing disruptions. Concomitant use of CHG for skin disinfection and CHG-impregnated dressing may significantly increase contact dermatitis. TRIALS REGISTRATION: These studies were registered within ClinicalTrials.gov (numbers NCT01189682 and NCT00417235 ).


Assuntos
Bandagens/normas , Clorexidina/farmacologia , Tampões de Gaze Cirúrgicos/normas , Fatores de Tempo , Adulto , Animais , Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/instrumentação , Cateterismo Venoso Central/métodos , Cateterismo Venoso Central/normas , Cateterismo Periférico/instrumentação , Cateterismo Periférico/métodos , Cateterismo Periférico/normas , Clorexidina/administração & dosagem , Clorexidina/uso terapêutico , Estado Terminal/enfermagem , Desinfecção/instrumentação , Desinfecção/normas , Desinfecção/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
13.
Pediatrics ; 145(Suppl 3): S269-S284, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32482739

RESUMO

OBJECTIVES: Vascular access device decision-making for pediatric patients remains a complex, highly variable process. To date, evidence-based criteria to inform these choices do not exist. The objective of the Michigan Appropriateness Guide for Intravenous Catheters in pediatrics (miniMAGIC) was to provide guidance on device selection, device characteristics, and insertion technique for clinicians, balancing and contextualizing evidence with current practice through a multidisciplinary panel of experts. METHODS: The RAND Corporation and University of California, Los Angeles Appropriateness Method was used to develop miniMAGIC, which included the following sequential phases: definition of scope and key terms, information synthesis and literature review, expert multidisciplinary panel selection and engagement, case scenario development, and appropriateness ratings by an expert panel via 2 rounds. RESULTS: The appropriateness of the selection, characteristics, and insertion technique of intravenous catheters commonly used in pediatric health care across age populations (neonates, infants, children, and adolescents), settings, diagnoses, clinical indications, insertion locations, and vessel visualization devices and techniques was defined. Core concepts including vessel preservation, insertion and postinsertion harm minimization (eg, infection, thrombosis), undisrupted treatment provision, and inclusion of patient preferences were emphasized. CONCLUSIONS: In this study, we provide evidence-based criteria for intravenous catheter selection (from umbilical catheters to totally implanted venous devices) in pediatric patients across a range of clinical indications. miniMAGIC also highlights core vascular access practices in need of collaborative research and innovation.


Assuntos
Cateterismo Venoso Central/normas , Prova Pericial/normas , Pediatria/normas , Guias de Prática Clínica como Assunto/normas , Dispositivos de Acesso Vascular/normas , Adolescente , Cateterismo Venoso Central/métodos , Criança , Pré-Escolar , Prova Pericial/métodos , Humanos , Lactente , Recém-Nascido , Michigan , Pediatria/métodos
19.
J Vasc Surg ; 72(2): 403-404, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32417305
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