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1.
J Emerg Nurs ; 45(5): 512-516, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31445627

RESUMO

INTRODUCTION: Vascular access procedures are among the most commonly performed procedures in the emergency department. The objective of the current study was to compare the contrast extravasation rate for ultrasound-guided peripheral intravenous (USGPIV) catheter placement by emergency nurses with peripheral intravenous catheters placed by standard landmark techniques. METHODS: A retrospective chart review of all ED patients at our urban tertiary-care institution who underwent contrasted computed tomography examination and suffered contrast extravasation events was performed. A logbook of all ED patients who underwent USGPIV placement and an institution-wide electronic patient safety incident-reporting system was reviewed for all contrast extravasation events between May 2014, and February 2017. Data were analyzed using descriptive statistics, Student t-tests for continuous data, and χ2 or Fisher's exact test for categorical data. RESULTS: One thousand five hundred USGPIV catheters were placed by 27 emergency nurses. Contrast material was administered 29,508 times, and, of these, 291 were administered via USGPIV placement. There were 74 peripheral IV lines with documented contrast extravasations (0.25%) as reported in the safety-event database; 12 (4.1%) were from the USGPIV population, and 62 (0.21%) occurred in the standard landmark technique population. Relative risk of contrast extravasation events with USGPIV placement was 19.4 (95% confidence interval [CI], 10.6-35.6), and the absolute risk difference was 3.9% (95% CI 1.6%-6.2%). DISCUSSION: USGPIV placement by trained emergency nurses has higher rates of contrast extravasation than with standard landmark technique placement.


Assuntos
Cateterismo Periférico/métodos , Enfermagem em Emergência/métodos , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Ultrassonografia de Intervenção/métodos , Humanos , Recursos Humanos de Enfermagem no Hospital , Estudos Retrospectivos
2.
Sante Publique ; Vol. 31(1): 93-102, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31210522

RESUMO

INTRODUCTION: To prevent extravasations in medical imaging, analyses of organizational and professional circumstances of the occurrence of extravasations have been conducted in the Bordeaux University Hospital (BUH). METHOD: Two parallel studies were conducted: (i) clinical practice evaluation (CPE) including practice analysis groups and development of indicator of extravasation occurrence; (ii) Case-control study analyzing the factors associated with the occurrence of extravasations. Cases were constituted with consecutive series of patients with extravasation occurred in the BUH; controls were constituted of series of patients managed in medical imaging in the BUH without any extravasation. Statistical analysis included univariate and multivariate regression logistic models. RESULTS: CPE identified the following circumstances: patient' characteristics (female gender, low blood vessels) and professional situations (lack of check of: peripheral veinous access, contrast media temperature, injection process and lack of matching between injection amount and veinous access diameter). In the case-control analysis, patients' gender and catheter placement in medical imaging were significantly associated with the occurrence of extravasations. Guidelines have been drafted allowing the decrease of extravasation incidence. CONCLUSION: Adherence to guidelines of contrast media preparation and injection process is very important to prevent extravasation and improve patient safety.


Assuntos
Meios de Contraste/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Tomografia Computadorizada por Raios X/efeitos adversos , Estudos de Casos e Controles , Meios de Contraste/administração & dosagem , Hospitais Universitários , Humanos , Incidência , Injeções Intravenosas , Tomografia Computadorizada por Raios X/métodos
3.
J Surg Res ; 233: 256-261, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30502256

RESUMO

BACKGROUND: Lymphatic malformations (LMs) are congenital and arise from errors in vascular embryogenesis. LMs are categorized by cyst size as microcystic, macrocystic, or combined. Abdominal LMs are rare. Surgical resection of abdominal LMs has been the mainstay of therapy, but recurrence and morbidity are high. We sought to determine the effectiveness of sclerotherapy treatment for abdominal LM. METHODS: A single-center, retrospective review from 2014 to 2018 was conducted evaluating pediatric patients with abdominal LM. RESULTS: Ten patients were included, n = 9 had macrocystic LM and one patient had combined disease. The average age at first treatment was 6.8 y. The most common presenting symptoms were abdominal distention, pain, infection, and anemia. Preprocedural imaging was performed for all patients; median pretreatment volume was 1572.9 cm3 (range, 67.2-13,226.4). LMs were accessed using ultrasound guidance and injected with opacified doxycycline. Patients received a mean of 7.1 sclerotherapy injections. Complications included intraperitoneal doxycycline extravasation (n = 1), managed conservatively, and LM infection (n = 1), treated with intravenous antibiotics and drainage. One patient went on to surgical resection due to inability gain stable intracystic access; follow-up ultrasonography showed no recurrence. Postprocedural imaging was available in n = 8. Volume decreased by 96.7% after sclerotherapy. The median remaining volume was 0 cm3 (range, 0-599.7) (P = 0.016). Postsclerotherapy magnetic resonance imaging was obtained in n = 6, with complete resolution in 83.3%. All patients had resolution of presenting symptoms. Follow-up duration was 12.3 mo. CONCLUSIONS: Initial results demonstrate that sclerotherapy is an effective and durable treatment for symptom resolution and volume reduction of abdominal LM.


Assuntos
Doxiciclina/administração & dosagem , Anormalidades Linfáticas/terapia , Escleroterapia/métodos , Prevenção Secundária/métodos , Cavidade Abdominal/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Extravasamento de Materiais Terapêuticos e Diagnósticos/etnologia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Anormalidades Linfáticas/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Recidiva , Estudos Retrospectivos , Escleroterapia/efeitos adversos , Resultado do Tratamento , Ultrassonografia de Intervenção
4.
Rev Esc Enferm USP ; 52: e03360, 2018 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-30304200

RESUMO

OBJECTIVE: The objective of this study was to identify the incidence of infiltration and extravasation in newborns using peripheral venous catheter, and affecting factors. METHOD: This observational study examined catheters inserted into newborns who received inpatient care in the neonatal intensive care unit of a state hospital located in the west of Turkey. A total of 452 peripheral venous catheters inserted into 152 newborns were observed. The forms were completed by the researchers based on their observations at each shift. RESULTS: The infiltration/extravasation occurred in 45.6% of peripheral venous catheters inserted into newborns; 19.7% were stage I and 11.7% were stage IV. A statistically significant relationship was found between the gestation week as well as the birth weight of newborns and the occurrence of infiltration/extravasation complication. In addition, there were statistically significant relationships between the administration of single or multiple antibiotics, total parenteral nutrition and the incidence of infiltration/extravasation complication. CONCLUSION: It is recommended to use an appropriate scale for the assessment of infiltration/extravasation as well as to implement measures for preventing the occurrence of infiltration/extravasation.


Assuntos
Cateterismo Periférico/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Unidades de Terapia Intensiva Neonatal , Antibacterianos/administração & dosagem , Peso ao Nascer , Cateterismo Periférico/métodos , Feminino , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Masculino , Nutrição Parenteral Total/métodos , Estudos Prospectivos , Fatores de Risco , Turquia
5.
Eur Radiol ; 28(12): 5368-5375, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29876706

RESUMO

OBJECTIVE: To evaluate the frequency, outcome, and risk factors of intravenous contrast media (CM) extravasation during contrast-enhanced CT scans in a large population. METHODS: After institutional review board approval, 142,651 patients (72,976 males and 69,675 females; mean age, 59.9 ± 13.0 years) who underwent contrast-enhanced CT scans with intravenous CM between January 2015 and April 2017 were retrospectively included. The frequency of CM extravasations and their clinical outcomes were investigated. Risk factors of CM extravasation were evaluated using logistic regression with generalized estimating equation analyses. In addition, the frequency and risk factors of large-volume (≥100 ml) CM extravasation were also investigated. RESULTS: CM extravasation occurred in 0.23% (321/142,651) of patients, all of which were of mild degree and resolved without any sequelae through conservative management. Multivariate analysis revealed that female gender [odds ratio (OR) = 1.61; p < 0.001], 60 < age ≤ 70 years (OR = 1.71; p = 0.004) or age > 70 years (OR = 2.49; p < 0.001), patients in general wards (OR = 2.71; p < 0.001) or ICUs (OR = 4.76; p < 0.001), 9.4 < CM viscosity ≤ 10.0 (OR = 1.65; p = 0.015), 10.0 < CM viscosity ≤ 10.6 (OR = 1.60; p = 0.002), and CM viscosity > 16.0 (OR = 2.55, p < 0.001) were independent risk factors for CM extravasation. CONCLUSION: CM extravasation during contrast-enhanced CT scans was uncommon with no substantial clinical consequences. Several risk factors that may have the potential to reduce the occurrence of CM extravasation were identified. KEY POINTS: • The observed frequency of contrast media extravasation during contrast-enhanced CT scans was 0.23% (321/142,651). • Significant risk factors for contrast media extravasation were female gender, age older than 60 years, patients in general wards or ICUs, and the viscosity of contrast media greater than 9.4 mPa∙s. • The main preventive action for contrast media extravasation would be to lower the viscosity of contrast media.


Assuntos
Meios de Contraste/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Injeções Intravenosas , Masculino , Pessoa de Meia-Idade , Razão de Chances , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
6.
Eur Radiol ; 28(12): 5376-5383, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29948071

RESUMO

OBJECTIVES: Our aim was to retrospectively investigate the frequency and outcome of large-volume iodinated contrast medium (CM) extravasation in our institution and to compare our management protocol to current practice. METHODS: Institutional review board approval was obtained, and informed consent was waived because the study was retrospective. From January 2008 to September 2016, radiological examinations with intravenous non-ionic iodinated CM administration were performed in 67,129 patients. Contrast medium extravasation events on CT scans and intravenous pyelograms but not on angiograms were included. All data were collected prospectively and stratified according to age, injection method (manual vs auto-injection), prevention of extravasation by various means (including intercom alarm), management of extravasation (routine application of silver sulfadiazine ointment, clobetasol propionate cream, and damp gauze at room temperature), etc. RESULTS: The incidence of large-volume CM extravasation was very low (0.04% [27/67,129] overall; 0.03% related to manual injection [age range, 59-92 years; mean, 75.4 years], and 0.045% related to auto-injection [age range, 36-86 years; mean, 65.8 years]). The CM extravasation volume in majority of patients was 20-40 ml in 5 of 9 patients (55.6%) in the manual injection group and 14 of 18 (77.8%) in the auto-injection group. Swelling and pain were the most common symptoms. No patient developed severe signs or needed surgical intervention. CONCLUSIONS: Results show a very low incidence of large-volume CM extravasation without severe complications or sequelae. The casual effect between our protocols and good outcome cannot be scrutinised thoroughly because the study lacks a control group and is retrospective. KEY POINTS: • The incidence of large-volume contrast medium extravasation (≥20 ml) was 0.04%. • No patient needed surgical intervention, and most recovered within 7 days. • Each element of our management protocol contributed to good outcome.


Assuntos
Tratamento Conservador/métodos , Meios de Contraste/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Tomografia Computadorizada por Raios X/métodos , Idoso , Idoso de 80 Anos ou mais , China , Extravasamento de Materiais Terapêuticos e Diagnósticos/terapia , Feminino , Humanos , Incidência , Injeções Intravenosas/efeitos adversos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
7.
J Trauma Acute Care Surg ; 85(3): 527-535, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29901544

RESUMO

BACKGROUND: The objective was to assess the predictive performance of different intravascular contrast extravasation (ICE) characteristics for need for pelvic transarterial embolization (TAE) to determine the risk factors of false positives. METHODS: A retrospective study was performed in our trauma center between 2010 and 2015. All severe trauma patients with pelvic fracture were included. Pelvic ICE characteristics on computed tomography (CT) scan were studied: arterial (aSICE), portal surface (pSICE), and extension (exSICE) anatomic relationships. The overall predictive performance of ICE surfaces for pelvic TAE was analyzed using receiver operating characteristic curves. The analysis focused on risk factors for false positives. RESULTS: Among 311 severe trauma patients with pelvic ring fracture (mean age, 42 ± 19 years; mean Injury Severity Score, 27 ± 19), 94 (30%) had at least one pelvic ICE on the initial CT scan. Patients requiring pelvic TAE had significantly larger aSICE and pSICE than others (p = 0.001 and p = 0.035, respectively). The overall ability of ICE surfaces to predict pelvic TAE was modest (aSICE area under the receiver operating characteristic curve, 0.76 [95% confidence interval, 0.64-0.90]; p = 0.011) or nonsignificant (pSICE and exSICE). The high-sensitivity threshold was defined as aSICE 20 mm or more. Using this threshold, 76% of patients were false positives. Risk factors for false positives were admission systolic blood pressure of 90 mm Hg or greater (63% vs 20%; p = 0.03) and low transfusion needs (63% vs 10%; p = 0.009), extravasation in contact with complex bone fracture (78% vs 30%; p = 0.008), or the absence of a direct relationship between extravasation and a large retroperitoneal hematoma (100% vs 38%; p < 0.001). CONCLUSION: A significant pelvic ICE during the arterial phase does not guarantee the need for pelvic TAE. Three quarters of patients with aSICE of 20 mm or more did not need pelvic TAE. Several complementary CT scan criteria will help to identify this risk of false positives to determine adequate hemostatic pelvic procedures. LEVEL OF EVIDENCE: Therapeutic study, level IV.


Assuntos
Embolização Terapêutica/métodos , Pelve/diagnóstico por imagem , Tomografia Computadorizada por Raios X/efeitos adversos , Ferimentos não Penetrantes/diagnóstico por imagem , Adulto , Angiografia/métodos , Embolização Terapêutica/estatística & dados numéricos , Extravasamento de Materiais Terapêuticos e Diagnósticos/complicações , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Reações Falso-Positivas , Feminino , Fraturas Ósseas/diagnóstico por imagem , Hematoma , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Ossos Pélvicos/lesões , Ossos Pélvicos/patologia , Pelve/irrigação sanguínea , Pelve/lesões , Valor Preditivo dos Testes , Espaço Retroperitoneal/irrigação sanguínea , Espaço Retroperitoneal/patologia , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X/métodos , Centros de Traumatologia , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/terapia
8.
Rev Lat Am Enfermagem ; 26: e3002, 2018.
Artigo em Português, Espanhol, Inglês | MEDLINE | ID: mdl-29791668

RESUMO

OBJECTIVE: to determine the incidence rate and risk factors for the nursing-sensitive indicators phlebitis and infiltration in patients with peripheral venous catheters (PVCs). METHOD: cohort study with 110 patients. Scales were used to assess and document phlebitis and infiltration. Socio-demographic variables, clinical variables related to the PVC, medication and hospitalization variables were collected. Descriptive and inferential analysis and multivariate logistic models were used. RESULTS: the incidence rate of phlebitis and infiltration was respectively 43.2 and 59.7 per 1000 catheter-days. Most PVCs with these vascular traumas were removed in the first 24 hours. Risk factors for phlebitis were: length of hospital stay (p=0.042) and number of catheters inserted (p<0.001); risk factors for infiltration were: piperacillin/tazobactan (p=0.024) and the number of catheters inserted (p<0.001). CONCLUSION: the investigation documented the incidence of nursing-sensitive indicators (phlebitis and infiltration) and revealed new risk factors related to infiltration. It also allowed a reflection on the nursing care necessary to prevent these vascular traumas and on the indications and contraindications of the PVC, supporting the implementation of the PICC as an alternative to PVC.


Assuntos
Cateterismo Periférico/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Flebite/epidemiologia , Flebite/etiologia , Veias/lesões , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
9.
J Vasc Access ; 19(3): 266-271, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29772983

RESUMO

PURPOSE: The aim of this study is to determine the prevalence of infiltration and extravasation among children staying in a children's hospital and the interventions carried out when infiltration or extravasation occurred. METHODS: A prospective and descriptive research design was used in the study, conducted between September 2015 and February 2016, and determined the prevalence of infiltration and extravasation and their characteristics. The study sample consisted of 297 peripheral catheters in 173 pediatric patients. RESULTS: Of 297 peripheral catheters, 50.8% were located on the right and 30.6% were inserted in the dorsal metacarpal vein. Infiltration and extravasation occurred in 2.9% and 2.3% of the patients, respectively. The prevalence of infiltration and extravasation was 5.5 and 4.4 per 1000 patient-days, respectively. The applied interventions after infiltration or extravasation included covering with a gauze dressing or alcohol-soaked cotton, cold application, irrigation with physiological saline, and elevation. CONCLUSION: The infiltration and extravasation prevalence were found to be high, but the interventions to address them were inadequate. Training and implementation strategies should be planned for pediatric nurses to prevent infiltration and extravasation.


Assuntos
Cateterismo Periférico/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Hospitais Pediátricos , Adolescente , Fatores Etários , Criança , Pré-Escolar , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico , Extravasamento de Materiais Terapêuticos e Diagnósticos/terapia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Prevalência , Prognóstico , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Turquia
10.
J Ultrasound Med ; 37(10): 2379-2385, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29637586

RESUMO

OBJECTIVES: To explore the risk factors on contrast agent venous intravasation during transvaginal 4-dimensional hysterosalpingo-contrast sonography (TVS 4D-HyCoSy). METHODS: The TVS 4D-HyCoSy imaging data were collected from 276 female infertile patients. The correlation between endometrial thickness, days after menstruation, intrauterine intervention history, fallopian tubal patency degree, and contrast agent venous intravasation, respectively, was analyzed. RESULTS: In our study, the incidence of contrast agent venous intravasation was 13.04%. Endometrial thickness and days after menstruation were significantly associated with venous intravasation (P < .05). However, there was no significance for intrauterine intervention history and fallopian tube patency degree. CONCLUSIONS: Contrast agent intravasation during TVS 4D-HyCoSy is not infrequent. Performing TVS 4D-HyCoSy according to endometrial thickness and menstrual period could reduce intravasation incidence to some extent.


Assuntos
Meios de Contraste/administração & dosagem , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Histerossalpingografia/métodos , Aumento da Imagem/métodos , Imagem Tridimensional/métodos , Ultrassonografia/métodos , Adulto , Tubas Uterinas/diagnóstico por imagem , Feminino , Humanos , Masculino , Estudos Prospectivos , Fatores de Risco , Útero/diagnóstico por imagem , Adulto Jovem
11.
Digestion ; 98(1): 41-47, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29672291

RESUMO

BACKGROUND/AIMS: Although colonic diverticular bleeding (CDB) often ceases spontaneously, re-bleeding occurs in about 30%. Bleeding diverticulum can be treated directly by endoscopic hemostasis; however, it is difficult to perform colonoscopy in all cases with limited medical resource and certain risks. The aim of this study was to clarify who should undergo colonoscopy as well as appropriate methods of initial management in CDB patients. METHODS: A total of 285 patients who were diagnosed as CDB and underwent colonoscopy from March 2004 to October 2015 were retrospectively analyzed. First, the association between re-bleeding and various factors including patients' background and initial management were analyzed. Second, the examination conditions that influenced bleeding point identification were analyzed. RESULTS: Of 285 patients, 187 were men and 98 were women. Median age was 75 years, and the median observation period was 17.5 months. Re-bleeding was observed in 79 patients (28%). A history of CDB (OR 2.1, p = 0.0090) and chronic kidney disease (CKD; OR 2.3, p = 0.035) were risk factors, and bleeding point identification (OR 0.20, p = 0.0037) was a preventive factor for re-bleeding. Bleeding point identification significantly reduced approximately 80% of re-bleeding. Furthermore, extravasation on CT (OR 3.7, p = 0.031) and urgent colonoscopy (OR 5.3, p < 0.001) were predictors for identification of bleeding point. Compared to bleeding point identification of 11% in all patients who underwent colonoscopy, identification rate in those who had extravasation on CT and underwent urgent colonoscopy was as high as 70%. CONCLUSIONS: Contrast-enhanced CT upon arrival is suggested, and patients with extravasation on CT would be good candidates for urgent colonoscopy, as well as patients who have a history of CDB and CKD.


Assuntos
Doenças do Colo/terapia , Colonoscopia/métodos , Divertículo do Colo/complicações , Hemorragia Gastrointestinal/terapia , Hemostase Endoscópica/métodos , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue/estatística & dados numéricos , Colo/irrigação sanguínea , Colo/diagnóstico por imagem , Doenças do Colo/diagnóstico por imagem , Doenças do Colo/etiologia , Meios de Contraste/administração & dosagem , Divertículo do Colo/diagnóstico por imagem , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Feminino , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
12.
Medicine (Baltimore) ; 97(9): e0055, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29489663

RESUMO

BACKGROUND: This systematic review combines data from multiple papers on contrast media extravasation to identify factors contributing to increased extravasation risk. METHODS: Data were extracted from 17 papers reporting 2191 extravasations in 1,104,872 patients (0.2%) undergoing computed tomography (CT) or magnetic resonance imaging (MRI). RESULTS: Extravasation rates were 0.045% for gadolinium-based contrast agents (GBCA) and nearly 6-fold higher, 0.26% for iodinated contrast agents. Factors associated with increased contrast media extravasations included: older age, female gender, using an existing intravenous (IV) instead of placing a new IV in radiology, in-patient status, use of automated power injection, high injection rates, catheter location, and failing to warm up the more viscous contrast media to body temperature. CONCLUSION: Contrast media extravasation is infrequent but nearly 6 times less frequent with GBCA for MRI compared with iodinated contrast used in CT.


Assuntos
Meios de Contraste/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Imagem por Ressonância Magnética/efeitos adversos , Tomografia Computadorizada por Raios X/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
13.
Acta Paediatr ; 107(7): 1240-1246, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29461646

RESUMO

AIM: Epidemiological data on the incidence and risk factors of extravasation of peripheral intravenous catheters (PIVC) in neonates and children are scarce and that is what this study explored. METHODS: This was a one-year retrospective study of all neonates and paediatric intensive care patients with at least one recorded PIVC at the Geneva University Hospitals, Switzerland, in 2013. The extravasation rate was determined for all patients, including neonates below 28 days, and for all PIVCs. Multivariate analysis of the associated risk factors was performed. RESULTS: We analysed 1300 PIVC in 695 paediatric patients with a median age of 1.5 years. The overall extravasation incidence was 17.6% for all patients and 11.7% for PIVC. The overall incidence rate of PIVC extravasation was 4.5 per 100 catheters days, and the risk was highest in the 201 neonates, at 28.4%. The incidence rate four days after insertion of the PIVC was around three times higher than on day one. Neonates and the in situ duration of PIVCs were associated risk factors (p < 0.001). CONCLUSION: Extravasation was frequent and neonates were particularly at risk. Younger age and longer in situ PIVC duration were independent risk factors for extravasation.


Assuntos
Cateterismo Periférico/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Dispositivos de Acesso Vascular/efeitos adversos , Criança , Pré-Escolar , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores de Risco , Suíça/epidemiologia
14.
Am J Emerg Med ; 36(2): 294-296, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29137904

RESUMO

PURPOSE: To characterize the management, outcomes, and emergency department (ED) length of stay (LOS) following iodinated contrast media extravasation events in the ED. METHODS: All ED patients who developed iodinated contrast media extravasation following contrast-enhanced CT (CECT) from October 2007-December 2016 were retrospectively identified. Medical records were reviewed and management, complications, frequency of surgical consultation, and ED LOS were quantified using descriptive statistics. The Wilcoxon rank sum test was used to compare ED LOS in patients who did and did not receive surgical consultation. RESULTS: A total of 199 contrast extravasation episodes occurred in ED patients during the 9-year study period. Of these, 42 patients underwent surgical consultation to evaluate the contrast extravasation event. No patient developed progressive symptoms, compartment syndrome, or tissue necrosis, and none received treatment beyond supportive care (warm/cold packs, elevation, compression). Median ED LOS for patients who did and did not receive surgical consultation was 11.3h versus 9.0h, respectively (p<0.01). CONCLUSION: Close observation and supportive care are sufficient for contrast extravasation events in the ED without concerning symptoms (progressive pain/swelling, altered tissue perfusion, sensory changes, or blistering/ulceration). Routine surgical consultation is likely unnecessary in the absence of these symptoms - concordant with the current American College of Radiology guidelines - and may be associated with longer ED LOS without impacting management.


Assuntos
Meios de Contraste/efeitos adversos , Gerenciamento Clínico , Serviço Hospitalar de Emergência , Extravasamento de Materiais Terapêuticos e Diagnósticos/terapia , Tomografia Computadorizada por Raios X/efeitos adversos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
15.
Rev. latinoam. enferm. (Online) ; 26: e3002, 2018. tab
Artigo em Inglês | LILACS | ID: biblio-901933

RESUMO

ABSTRACT Objective: to determine the incidence rate and risk factors for the nursing-sensitive indicators phlebitis and infiltration in patients with peripheral venous catheters (PVCs). Method: cohort study with 110 patients. Scales were used to assess and document phlebitis and infiltration. Socio-demographic variables, clinical variables related to the PVC, medication and hospitalization variables were collected. Descriptive and inferential analysis and multivariate logistic models were used. Results: the incidence rate of phlebitis and infiltration was respectively 43.2 and 59.7 per 1000 catheter-days. Most PVCs with these vascular traumas were removed in the first 24 hours. Risk factors for phlebitis were: length of hospital stay (p=0.042) and number of catheters inserted (p<0.001); risk factors for infiltration were: piperacillin/tazobactan (p=0.024) and the number of catheters inserted (p<0.001). Conclusion: the investigation documented the incidence of nursing-sensitive indicators (phlebitis and infiltration) and revealed new risk factors related to infiltration. It also allowed a reflection on the nursing care necessary to prevent these vascular traumas and on the indications and contraindications of the PVC, supporting the implementation of the PICC as an alternative to PVC.


RESUMO Objetivo: determinar a taxa de incidência e os fatores de risco para os indicadores sensíveis aos cuidados de Enfermagem, flebite e infiltração, em pacientes portadores de cateteres venosos periféricos (CVPs). Método: estudo de coorte com 110 pacientes. Utilizou-se escalas para avaliar e documentar flebite e infiltração. Recolheram-se variáveis sociodemográficas, clínicas, relativas ao CVP, à medicação e à internação, bem como efetuou-se análise descritiva e inferencial, e modelação logística multivariada. Resultados: a taxa de incidência de flebite e infiltração foi de 43,2 e 59,7 por mil cateteres-dia, respectivamente. A maioria dos CVPs foi removida nas primeiras 24h devido a esses traumas vasculares. Foram fatores de risco para flebite o tempo de internação (p=0,042) e o número de cateteres inseridos (p<0,001), sendo para infiltração a piperacilina/tazobactan (p=0,024) e o número de cateteres inseridos (p<0,001). Conclusão: a investigação documentou a incidência de indicadores sensíveis aos cuidados de Enfermagem (flebite e infiltração) e evidenciou novos fatores de risco relacionados à infiltração. Possibilitou, também, uma reflexão sobre os cuidados de Enfermagem para prevenir esses traumas vasculares, as indicações e as contraindicações do CVP, tendo subsidiada a implementação do PICC nas práticas de Enfermagem como alternativa ao CVP.


RESUMEN Objetivos: determinar la tasa de incidencia y los factores de riesgo para los indicadores sensibles a los cuidados de Enfermería, flebitis e infiltración, en pacientes portadores de catéteres venosos periféricos (CVPs). Método: se trata de un estudio de cohorte entre 110 pacientes. Se utilizaron escalas para evaluar y documentar la flebitis y la infiltración. Se recogieron variables sociodemográficas y clínicas, relativas al CVP, a la medicación y a la internación. Se realizó un análisis descriptivo e inferencial, y modelación logística multivariada. Resultados: la tasa de incidencia de flebitis e infiltración fue de 43,2 y 59,7 por mil catéteres-día, respectivamente. Se removió la mayoría de los CVPs en las primeras 24 horas debido a dichos traumas vasculares. Los factores de riesgo para la flebitis fueron: el tiempo de internación (p=0,042) y el número de catéteres insertados (p<0,001); para la infiltración: la piperacilina/tazobactan (p=0,024) y el número de catéteres insertados (p<0,001). Conclusión: la investigación documentó la incidencia de indicadores sensibles a los cuidados de Enfermería (flebitis e infiltración) y evidenció nuevos factores de riesgo relacionados con la infiltración. Posibilitó, también, una reflexión sobre los cuidados de Enfermería para prevenir los traumas vasculares y sobre las indicaciones y contraindicaciones del CVP, con la implantación del PICC auxiliando en las prácticas de Enfermería como alternativa del CVP.


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Flebite/etiologia , Flebite/epidemiologia , Cateterismo Periférico/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Fatores de Risco , Estudos de Coortes
16.
Rev. latinoam. enferm. (Online) ; 26: e3002, 2018. tab
Artigo em Inglês | BDENF - Enfermagem, LILACS | ID: biblio-901954

RESUMO

ABSTRACT Objective: to determine the incidence rate and risk factors for the nursing-sensitive indicators phlebitis and infiltration in patients with peripheral venous catheters (PVCs). Method: cohort study with 110 patients. Scales were used to assess and document phlebitis and infiltration. Socio-demographic variables, clinical variables related to the PVC, medication and hospitalization variables were collected. Descriptive and inferential analysis and multivariate logistic models were used. Results: the incidence rate of phlebitis and infiltration was respectively 43.2 and 59.7 per 1000 catheter-days. Most PVCs with these vascular traumas were removed in the first 24 hours. Risk factors for phlebitis were: length of hospital stay (p=0.042) and number of catheters inserted (p<0.001); risk factors for infiltration were: piperacillin/tazobactan (p=0.024) and the number of catheters inserted (p<0.001). Conclusion: the investigation documented the incidence of nursing-sensitive indicators (phlebitis and infiltration) and revealed new risk factors related to infiltration. It also allowed a reflection on the nursing care necessary to prevent these vascular traumas and on the indications and contraindications of the PVC, supporting the implementation of the PICC as an alternative to PVC.


RESUMO Objetivo: determinar a taxa de incidência e os fatores de risco para os indicadores sensíveis aos cuidados de Enfermagem, flebite e infiltração, em pacientes portadores de cateteres venosos periféricos (CVPs). Método: estudo de coorte com 110 pacientes. Utilizou-se escalas para avaliar e documentar flebite e infiltração. Recolheram-se variáveis sociodemográficas, clínicas, relativas ao CVP, à medicação e à internação, bem como efetuou-se análise descritiva e inferencial, e modelação logística multivariada. Resultados: a taxa de incidência de flebite e infiltração foi de 43,2 e 59,7 por mil cateteres-dia, respectivamente. A maioria dos CVPs foi removida nas primeiras 24h devido a esses traumas vasculares. Foram fatores de risco para flebite o tempo de internação (p=0,042) e o número de cateteres inseridos (p<0,001), sendo para infiltração a piperacilina/tazobactan (p=0,024) e o número de cateteres inseridos (p<0,001). Conclusão: a investigação documentou a incidência de indicadores sensíveis aos cuidados de Enfermagem (flebite e infiltração) e evidenciou novos fatores de risco relacionados à infiltração. Possibilitou, também, uma reflexão sobre os cuidados de Enfermagem para prevenir esses traumas vasculares, as indicações e as contraindicações do CVP, tendo subsidiada a implementação do PICC nas práticas de Enfermagem como alternativa ao CVP.


RESUMEN Objetivos: determinar la tasa de incidencia y los factores de riesgo para los indicadores sensibles a los cuidados de Enfermería, flebitis e infiltración, en pacientes portadores de catéteres venosos periféricos (CVPs). Método: se trata de un estudio de cohorte entre 110 pacientes. Se utilizaron escalas para evaluar y documentar la flebitis y la infiltración. Se recogieron variables sociodemográficas y clínicas, relativas al CVP, a la medicación y a la internación. Se realizó un análisis descriptivo e inferencial, y modelación logística multivariada. Resultados: la tasa de incidencia de flebitis e infiltración fue de 43,2 y 59,7 por mil catéteres-día, respectivamente. Se removió la mayoría de los CVPs en las primeras 24 horas debido a dichos traumas vasculares. Los factores de riesgo para la flebitis fueron: el tiempo de internación (p=0,042) y el número de catéteres insertados (p<0,001); para la infiltración: la piperacilina/tazobactan (p=0,024) y el número de catéteres insertados (p<0,001). Conclusión: la investigación documentó la incidencia de indicadores sensibles a los cuidados de Enfermería (flebitis e infiltración) y evidenció nuevos factores de riesgo relacionados con la infiltración. Posibilitó, también, una reflexión sobre los cuidados de Enfermería para prevenir los traumas vasculares y sobre las indicaciones y contraindicaciones del CVP, con la implantación del PICC auxiliando en las prácticas de Enfermería como alternativa del CVP.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Flebite/etiologia , Flebite/epidemiologia , Veias/lesões , Cateterismo Periférico/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Incidência , Fatores de Risco , Estudos de Coortes
17.
Turk J Pediatr ; 59(2): 1621-168, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29276869

RESUMO

Yan YM, Gong M, Chen JL, Li D, Xu TT, Zou H, Li AQ, Fan QL, Lu QF. Incidence, risk factors and treatment outcomes of drug extravasation in pediatric patients in China. Turk J Pediatr 2017; 59: 162-168. Extravasation injury is a common phenomenon in hospitals. Failure to detect and treat extravasation injury can lead to irreversible local injuries, tissue necrosis and malfunction of the affected tissue. Until now, it is largely unknown about incidence, risk factors and treatment outcomes of extravasation in Chinese pediatric patients. The aim of this study is to explore the incidence, risk factors and summarize the characteristics and treatment outcomes of extravasation injuries resulting in drug extravasation among Chinese children in our hospital. The children undergoing infusion therapy (0-18 years) were enrolled in this study between December 2014 and June 2015 in Shanghai Children`s Hospital. The patients` information including age, gender, injection site, estimated volume of solution extravasated, patient symptoms, severity of extravasation injury, treatment methods, and outcomes was collected. Multivariate logistic regression was used to identify the independent risk factors for the development of extravasation. The incidence of extravasations in pediatric patients was 1.79% (18/1,004). The severity of extravasation was labeled with grade range from Grade 1 through Grade 4: 4 cases with Grade 1, 8 cases with Grade 2, 5 cases with Grade 3, and 1 case with Grade 4. The risk factors of extravasation include infused high volume/day (≥1000 ml), received operation, infused agents with high osmolarity and poor vein condition. The severity of extravasation was related to the large volumes of drug or special drugs (high-osmolarity, high-risk, low pH, etc). All extravasations were treated with physical, pharmacological and surgical intervention according to our standard operation protocols. Systematic implementation of intervention can alleviate the extravasation injuries and improve the patients` outcome.


Assuntos
Gerenciamento Clínico , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Adolescente , Criança , Pré-Escolar , China/epidemiologia , Extravasamento de Materiais Terapêuticos e Diagnósticos/terapia , Feminino , Hidratação , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
18.
Nefrologia ; 37(6): 608-621, 2017.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29122210

RESUMO

BACKGROUND: Haemodialysis (HD) patients are a high-risk population group. For these patients, an error could have catastrophic consequences. Therefore, systems that ensure the safety of these patients in an environment with high technology and great interaction of the human factor is a requirement. OBJECTIVES: To show a systematic working approach, reproducible in any HD unit, which consists of recording the complications and errors that occurred during the HD session; defining which of those complications could be considered adverse event (AE), and therefore preventable; and carrying out a systematic analysis of them, as well as of underlying real or potential errors, evaluating their severity, frequency and detection; as well as establishing priorities for action (Failure Mode and Effects Analysis system [FMEA systems]). METHODS: Retrospective analysis of the graphs of all HD sessions performed during one month (October 2015) on 97 patients, analysing all recorded complications. The consideration of these complications as AEs was based on a consensus among 13 health professionals and 2 patients. The severity, frequency and detection of each AE was evaluated by the FMEA system. RESULTS: We analysed 1303 HD treatments in 97 patients. A total of 383 complications (1 every 3.4 HD treatments) were recorded. Approximately 87.9% of them was deemed AEs and 23.7% complications related with patients' underlying pathology. There was one AE every 3.8 HD treatments. Hypertension and hypotension were the most frequent AEs (42.7 and 27.5% of all AEs recorded, respectively). Vascular-access related AEs were one every 68.5 HD treatments. A total of 21 errors (1 every 62 HD treatments), mainly related to the HD technique and to the administration of prescribed medication, were registered. The highest risk priority number, according to the FMEA, corresponded to errors related to patient body weight; dysfunction/rupture of the catheter; and needle extravasation. CONCLUSIONS: HD complications are frequent. Consideration of some of them as AEs could improve safety by facilitating the implementation of preventive measures. The application of the FMEA system allows stratifying real and potential errors in dialysis units and acting with the appropriate degree of urgency, developing and implementing the necessary preventive and improvement measures.


Assuntos
Análise do Modo e do Efeito de Falhas na Assistência à Saúde/métodos , Segurança do Paciente , Diálise Renal/efeitos adversos , Medição de Risco/métodos , Idoso , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/etiologia , Comorbidade , Falha de Equipamento , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Feminino , Unidades Hospitalares de Hemodiálise/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Gestão de Riscos/métodos , Dispositivos de Acesso Vascular/efeitos adversos
19.
Radiography (Lond) ; 23(4): e87-e92, 2017 11.
Artigo em Inglês | MEDLINE | ID: mdl-28965909

RESUMO

BACKGROUND: Iodinated contrast extravasation is a serious complication associated with intravenous administration in radiology. Departmental protocols and the radiographer's approach on both prevention techniques and treatment will affect the prevalence of extravasation, and the eventual outcome for the patient when it does occur. AIMS: To examine contrast extravasation protocols in place in Irish CT departments for alignment with European Society of Urogenital Radiology (ESUR) Guidelines (2014); to establish radiographer's opinions on contrast extravasation; and to examine radiographer adherence to protocols. METHODS: Contrast extravasation protocols from a purposively selected sample of CT departments across Ireland (n = 6) were compared to ESUR guidelines, followed by an online survey of CT radiographers practicing in the participating centres. RESULTS: All participating CT departments (n = 5) had written protocols in place. High risk patients, such as elderly or unconscious, were identified in most protocols, however, children were mentioned in just one protocol and obese patients were not specified in any. The response rate of CT radiographers was 23% (n = 24). 58% (n = 14) of respondents indicated that contrast extravasation was more likely during CTA examinations. While high levels of confidence in managing extravasation were reported, suggested treatment approaches, and confidence in same, was more variable. Clinical workload in CT departments was also identified as a factor impacting on patient care and management. CONCLUSION: While contrast extravasation protocols were generally in line with ESUR Guidelines, high risk patients may not be getting sufficient attention. More radiographer awareness of patient monitoring needs, particularly in busy departments with a heavy workload may also reduce extravasation risk, and improve management of same.


Assuntos
Meios de Contraste/administração & dosagem , Extravasamento de Materiais Terapêuticos e Diagnósticos , Tomografia Computadorizada por Raios X , Protocolos Clínicos , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Extravasamento de Materiais Terapêuticos e Diagnósticos/prevenção & controle , Humanos , Irlanda , Guias de Prática Clínica como Assunto , Fatores de Risco , Inquéritos e Questionários
20.
Clin J Oncol Nurs ; 21(4): 438-445, 2017 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-28738039

RESUMO

BACKGROUND: Given the high-risk nature and nurse sensitivity of chemotherapy infusion and extravasation prevention, as well as the absence of an industry benchmark, a group of nurses studied oncology-specific nursing-sensitive indicators. 
. OBJECTIVES: The purpose was to establish a benchmark for the incidence of chemotherapy extravasation with vesicants, irritants, and irritants with vesicant potential.
. METHODS: Infusions with actual or suspected extravasations of vesicant and irritant chemotherapies were evaluated. Extravasation events were reviewed by type of agent, occurrence by drug category, route of administration, level of harm, follow-up, and patient referrals to surgical consultation.
. FINDINGS: A total of 739,812 infusions were evaluated, with 673 extravasation events identified. Incidence for all extravasation events was 0.09%.


Assuntos
Antineoplásicos/efeitos adversos , Institutos de Câncer/organização & administração , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Neoplasias/tratamento farmacológico , Antineoplásicos/administração & dosagem , Humanos , Incidência , Neoplasias/enfermagem
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