Este estudo teve como objetivo avaliar a conduta do enfermeiro frente ao traumatismo de uretra ocasionado pela inserção do cateter uretral. Este estudo teve aprovação do Comitê de Ética em pesquisa da Escola de Enfermagem de Ribeirão Preto - Parecer 466/12 e foi realizado em um Hospital Universitário em duas etapas: na primeira etapa, descritiva, foi efetuada consulta ao sistema eletrônico do hospital que trata de notificações sobre eventos adversos dos pacientes. Nessa etapa foi utilizado instrumento de perguntas objetivas elaborado pelo próprio pesquisador. Na segunda, quase-experimental pós teste, foram coletados os dados relacionados a autoconfiança de enfermeiros, que participaram de cenário simulado de baixa fidelidade. Nessa etapa para obtenção dos dados foi aplicado um questionário de caracterização dos sujeitos e instrumento já validado, de autoconfiança na Assistência de Enfermagem à Retenção Urinária (EAAERU), a qual encontra-se dividida em cinco fatores: 1) \"Intervenções realizadas durante o cateterismo urinário e/ou em situações iatrogênicas\", 2) \"Intervenções prévias ao cateterismo urinário\", 3) \"Intervenções realizadas após o cateterismo urinário\"; 4) \"Comunicação, consentimento e preparo dos materiais para realização do cateterismo urinário\", e 5) \"Avaliação objetiva da RU\" (retenção urinária). Os dados da primeira etapa foram analisados por estatística descritiva e os dados da segunda etapa foram codificados e digitados duplamente em planilhas do aplicativo Excel®, exportados e analisados no programa SPSS (Statistical Package for Social Science) ®, versão 22.0, como a escala original. Os resultados demonstram que na primeira fase do estudo entre as 5300 notificações do serviço, apenas 27 (1,96%) estavam relacionadas a problemas urinários. Entre essas, cinco diretamente ao cateterismo urinário. Na segunda fase do estudo, a amostra foi composta por 53 enfermeiros, entre os quais a maior parte era do sexo feminino, com idade média de 36 anos, menos de dez anos de formação. Entre eles a maioria cursava ou já haviam cursado pós-graduação. Segundo os entrevistados todos 53 (100,0%) já realizaram o cateterismo urinário e 46 (86,8%) já vivenciaram dificuldades no procedimento. A maioria já avaliou trauma uretral ocasionado pela passagem do cateter. A conduta tomada nessa circunstância foi comunicar o fato e solicitar avaliação de outro profissional (médico e/ou outro enfermeiro). Após atividade simulada de trauma uretral, na avaliação da autoconfiança, a EAAERU demonstrou boa confiabilidade na sua aplicação (? 0,966). Os menores escores encontrados na autoconfiança dos profissionais estiveram relacionados aos fatores 1) \"Intervenções realizadas durante o cateterismo urinário e/ou em situações iatrogênicas\" e 5) \"Avaliação objetiva da RU\". Observou-se ainda associação positiva entre a autoconfiança e a frequência de realização do cateterismo urinário. Conclui-se que os traumas de uretra são comuns na prática clínica, porém pouco notificados. Com relação à autoconfiança na introdução do cateterismo urinário em que ocorrem situações de trauma de uretra há dificuldade na tomada de decisão e na avaliação objetiva da RU. Uma vez que o cateterismo é de competência do enfermeiro, são necessários programas e instrumentos que capacitem os profissionais para tais situações / This study aimed to evaluate the conduct of the nurse to the urethral trauma caused by the insertion of urethral catheter. This study was approved by the Ethics Committee in research of the College of Nursing in Ribeirão Preto - Opinion 466/12 and was performed in University Hospital in two stages: in the first stage, descriptive, a question was made on the hospital\'s electronic system, which deals with notifications about adverse events of patients. In this stage, it was used an instrument of objective questions elaborated by the researcher herself. In the second stage, quasi-experimental posttest study, the data related to self-confidence of nurses who participated in simulated low-fidelity scenario was collected. In this stage, to obtain the data, it was applied a characterization questionnaire of subjects and already validated instrument of Self-Confidence Scale of Nursing Care in Urinary Retention (EAAERU), which is divided in five factors: 1) \"Interventions performed during urinary catheterization and/or in iatrogenic situations\", 2) \"Prior interventions to performing urinary catheterization\", 3) \"Interventions performed for urinary catheters\"; 4) \"Communication, consent and preparation of materials for performing urinary catheterization\", and 5) \"Objective evaluation of the urinary retention\". The first stage\'s data were analyzed by descriptive statistic and the second stage\'s data were codified and double typed in spreadsheets in the Excel® app, exported and analyzed in the SPSS program (Statistical Package for Social Science)®, version 22.0, like the original scale. The results demonstrate that in the first stage of the study, among the 5300 notifications of service, only 27 (1,96%) were related to urinary problems. Among these, five directly related to urinary catheterization. In the second stage of the study, the sample was made by 53 nurses, among which most were women, with an average age of 36 years, less than ten years of formation. Among them, most were attending or had already attended postgraduate. According to the interviewers, all 53 (100,0%) had performed urinary catheterization and 46 (86,8%) had gone through trouble during the process. Most of them had evaluated urethral trauma caused by the introduction of the catheter. The conduct taken in this circumstance was to communicate the fact and request the evaluation of another professional (Doctor and/or another nurse). After simulated activity of the urethral trauma, in the self-confidence evaluation, EAAERU showed good reliability on its application (?=0,966). The lowest scores found in the professionals\' self-confidence were related to the factors 1) \"Interventions performed during urinary catheterization and/or in iatrogenic situations\" and 5) \"Objective evaluation of the urinary retention\". It was also observed positive association between the self-confidence and the performance of urethral catheterization. It is concluded that urethral traumas are common on clinical practice, however little notified. With regard to self-confidence to the introduction of urethral catheterization in which occur urethral trauma situations, there is difficulty in decision making and objective evaluation of the urinary retention. Once the catheterization is the nurse\'s responsibility, programs and tools are necessary to enable professionals in such situations

Esta revisão integrativa da literatura teve como objetivo identificar na literatura nacional e internacional, no período de 1992 a 2002, as publicações referentes à utilização de curativos para manutenção de cateter intravenoso periférico. Identificamos sete artigos científicos no banco de dados Medline por meio da utilização dos descritores “peripheral catheterization” e “dressing”. Para o alcance dos objetivos utilizado-se um roteiro sistematizado de coleta de dados. A análise constituiu da categorização, ordenação e síntese dos dados. Os resultados demonstraram que quatro publicações foram obtidas no site de periódicos on line disponibilizado pela Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, seis foram realizadas por enfermeiros, cinco utilizaram como metodologia o desenho descritivo comparativo. As complicações locais foram as variáveis investigadas na maioria das publicações, dois estudos demonstraram redução na ocorrência de complicações locais durante a utilização do curativo transparente com dispositivo de segurança acoplado. As considerações acerca dos problemas metodológicos identificados nas publicações fizeram concluir que falta base suficiente para subsidiar a seleção do curativo para manutenção de cateter intravenoso periférico. / This whole review of literature has the main goal to identify national and international literature within 1992 and 2002, the used reports were the aids to keep on the venous peripheral catheterization. It was identified 7 scientific reports in Medline data basis using the description “peripheral catheterization” and “dressing”. Reaching the goals it was used a standarded data collection. The outcomes showed that four reports were obtained from internet sites of Journals from Graduation and Personal Studies Coordination, six of them were from nurses, five of them used as methodology a comparative descriptive design . The local complications were the researched varieties in the most reports, two studies showed decreased local complications during the use of transparent aid as a close secure gadget. The considerations about the methodological problem identified in the reports leaded us to conclude that misses enough basis to help a selection from aid to maintenance peripheral intravenous peripheral catheterization.

Magnetic sensors are deployed in many applications such as automotive, consumer electronics, navigation and data storage devices. Their market’s growth is driven by demands of higher performance; primarily to assist in the advancement of the Internet of Things (IoT) and smart systems. Challenging obstacles of miniaturization and power consumptions must be overcome. A leading sensor that has the potential to accelerate the development is the magnetic tunnel junction (MTJ) devices. Corrosion causes catastrophic consequences for industries. Preventive measures could save up to 35% of annual corrosion-related costs. An advanced corrosion sensing technique is developed based on iron nanowires. The iron nanowires are magnets which lose their magnetization when corroded. Their magnetization loss is monitored using sensitive MTJ sensor. Combined, the nanowires and the MTJ sensor realize a highly integrated sensor concept that enables corrosion sensing with an ultra-low power consumption of less than 1 nW, a sensitivity of 0.1 %/min, a response time of 30 minutes and an area of 128 μm2. Surgical tool development is accelerating in the healthcare sector. Cardiac catheterization specifically is a minimally invasive surgery that relies heavily on x-ray imaging and contrast dyes. A flexible tri-axis MTJ sensor is developed to help minimizing the need for x-ray imaging during the procedure. The flexible sensor can bend to a diameter of 500 μm without compromising the performance and can endure over 1000 bending cycles without fatigue. Three flexible sensors are mounted onto the tip of a 3 mm cardiac catheter, realizing a novel sensor-on-tube (SOT) tri-axis sensor concept. The sensor has a high sensitivity of 9 Ω/° and an MR ratio of 29%. It weighs 16 μg only, adds 5 μm to the catheter’s diameter and a total size 300 μm2. The prototype system estimated the heading angle with an RMS error value of 7° and tracked the orientation of the sensor with an acceptable accuracy. However, the sensor has a misalignment issue caused by the manual placement of the sensors. A high precision tool is needed for the assembly, and any further misplacement -within a reasonable margin of error- could be corrected by calibration algorithms.

This dissertation aims to explore the role of patient and family engagement in the context of two current health issues: catheter-associated urinary tract infections (CAUTI) and antibiotic resistance. Chapter One contains an introduction to patient and family engagement, CAUTI, and antibiotic resistance, followed by gaps in the science, a description of the theoretical framework, and specific aims addressed in this dissertation. Chapter Two is a systematic review of existing CAUTI prevention interventions that involve patient and family engagement. Chapter Three is a study designed to meet the learning needs of parents by developing a graphically-enhanced CAUTI-prevention educational resource using participatory design methods. Chapter Four is an environmental scan that summarizes the content and format of existing resources about antibiotic resistance and antibiotic use available from children’s hospital websites across the United States. Finally, Chapter Five contains an overall summary of the findings of this dissertation, a discussion of results within the guiding theoretical framework, practice and policy implications, and suggestions for future research.

No description available.

A telenfermagem é a utilização dos recursos tecnológicos e dos sistemas de comunicação em prol do desenvolvimento da enfermagem. Vários países utilizam a telenfermagem na gestão de cuidados de saúde com resultados positivos. Na Enfermagem brasileira este é um campo a ser explorado, assim o objetivo desse trabalho foi de desenvolver estratégias de telenfermagem no atendimento a pacientes com bexiga neurogênica, usuários de cateterismo urinário intermitente limpo, atendidos em um centro de reabilitação de um hospital universitário. O estudo foi realizado em 3 etapas: etapa 1 - revisão integrativa da literatura para investigar na literatura a aplicação da telenfermagem; etapa 2 - elaboração e validação do protótipo de manual de telenfermagem para subsidiar o enfermeiro na implantação da intervenção de telenfermagem no atendimento ao paciente com bexiga neurogênica, usuário de cateterismo urinário intermitente limpo; etapa 3: estudo piloto sobre a implantação de intervenção de telenfermagem no atendimento ao paciente em uso de cateterismo urinário intermitente limpo. O manual de telenfermagem foi construído procurando contextualizar a telenfermagem no Brasil e no exterior, com seleção da teoria de Orem para direcionar o teleatendimento ao paciente, e um referencial sobre os cuidados para a realização de um teleatendimento. Descrição de recursos tecnológicos disponíveis que podem ser utilizados no teleatendimento, além de informações sobre os cuidados de saúde ao paciente com bexiga neurogênica e na realização do cateterismo urinário intermitente limpo. O manual foi validado em aparência e conteúdo por peritos com auxílio de um instrumento de avaliação. A intervenção de telenfermagem mostrou resultados importantes como forma de implementação do tratamento de saúde tradicional ao paciente, bem como evidenciou barreiras que precisam ser superadas para que esse tipo de atendimento seja realizado, como uma pesquisa efetiva com possibilidades de implementação posterior ao serviço de saúde. Os dados foram analisados através de estatística descritiva (frequência e porcentagem) com auxílio do programa SPSS (Statistical Package for Social Science), versão 15.0. O nível de concordância entre os peritos foi considerado de 70% para cada aspecto do instrumento utilizado / Telenursing is the use of technological resources and communication systems for the development of nursing. A great number of countries employ telenursing on healthcare management with positive results, however, it is a field yet to be explored in Brazilian nursing. The aim of this study was to develop telenursing strategies in the care to patients with neurogenic bladder, users of clean intermittent urinary catheterization, treated in a university hospital rehabilitation center. The study was carried out in 3 stages: stage 1 - integrative literature review to research the application of telenursing; stage 2 - development and validation of a telenursing booklet prototype to support nurses in implementing telenursing intervention on care to patients with neurogenic bladder, users of clean intermittent urinary catheterization; stage 3 - pilot study on the application of telenursing intervention in care to patients using clean intermittent urinary catheterization. The telenursing booklet was developed to contextualize telenursing in Brazil and abroad, selecting Orem\'s theory to guide the telecare to the patient and a framework about the care needed to carry out telecare. Description of available technological resources that can be used in telecare, as well as information about healthcare to patients with neurogenic bladder and in the procedure of clean intermittent urinary catheterization. The booklet underwent face and content validation by experts with aid from an assessment instrument. Telenursing intervention showed important results as a way to implement the traditional health treatment to the patient, also pointing out barriers that must be overcome in order to perform this kind of treatment, such as an effective research with possibilities of subsequent implementation at the health service. Data were analyzed through descriptive statistics (frequency and percentage) using SPSS (Statistical Package for Social Science) software version 15.0. The level of concordance considered among the experts was of 70% for each aspect of the used instrument

by Chan Ping Lung. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2006. / Includes bibliographical references (leaves 108-118). / Abstracts in English and Chinese. / Abstract (in Chinese) --- p.ii / Abstract (in English) --- p.iv / Acknowledgements --- p.vii / Table of Contents --- p.viii / List of Tables --- p.xiii / List of Figures --- p.xiv / List of Appendices --- p.xv / List of Abbreviations --- p.xvi / Chapter Chapter 1 --- Introduction --- p.1 / Chapter 1.1 --- Epidemiology of catheter associated infections --- p.1 / Chapter 1.1.1 --- Catheter associated infections --- p.1 / Chapter 1.1.2 --- Risk and mortality of CAI --- p.2 / Chapter 1.1.3 --- Etiology of CAI --- p.3 / Chapter 1.1.3.1 --- Venous catheters --- p.4 / Chapter 1.1.3.2 --- Urinary catheters --- p.4 / Chapter 1.2 --- Pathogenesis of CAI --- p.5 / Chapter 1.2.1 --- Central venous catheters (CVC) --- p.6 / Chapter 1.2.2 --- Urinary catheters --- p.7 / Chapter 1.3 --- Adhesion mechanisms --- p.7 / Chapter 1.3.1 --- Definition of adhesion --- p.7 / Chapter 1.3.2 --- Adhesion mechanism --- p.8 / Chapter 1.3.2.1 --- The phase one --- p.8 / Chapter 1.3.2.2 --- The phase two --- p.10 / Chapter 1.4 --- Catheters --- p.10 / Chapter 1.5 --- Biology of Candida albicans --- p.11 / Chapter 1.5.1 --- Taxonomy of Candida albicans --- p.11 / Chapter 1.5.2 --- Morphology --- p.12 / Chapter 1.5.3 --- Genome --- p.13 / Chapter 1.5.4 --- Biology of Candida albicans cell wall --- p.14 / Chapter 1.5.4.1 --- Constituting molecules of Candida albicans cell wall --- p.14 / Chapter 1.5.4.2 --- Organization of Candida albicans cell wall --- p.15 / Chapter 1.6 --- Agglutinin like sequence gene family --- p.16 / Chapter 1.6.1 --- Gene structure of agglutinin like sequence genes --- p.16 / Chapter 1.6.2 --- Sequence similarity --- p.17 / Chapter 1.6.3 --- Sequence variability --- p.18 / Chapter 1.6.4 --- Expression of ALS genes --- p.19 / Chapter 1.6.5 --- The Als proteins --- p.20 / Chapter 1.6.6 --- Functions of Als proteins --- p.21 / Chapter 1.7 --- Adhesion assay --- p.23 / Chapter 1.7.1 --- Adhesion model --- p.24 / Chapter 1.7.2 --- Factors affecting static adhesion model --- p.25 / Chapter 1.7.3 --- Quantitation methods of adherent cells --- p.27 / Chapter 1.7.3.1 --- Sonication --- p.27 / Chapter 1.7.3.2 --- Staining methods --- p.28 / Chapter 1.7.3.3 --- ATP bioluminescence --- p.28 / Chapter 1.8 --- Research model --- p.29 / Chapter Chapter 2 --- Aim of study --- p.31 / Chapter Chapter 3 --- Materials and Methods --- p.32 / Chapter 3.1 --- Preparation of bacteriological reagents --- p.32 / Chapter 3.2 --- Confirmation of identity of Candida albicans and of Saccharomyces cerevisiae --- p.33 / Chapter 3.3 --- Cell culture of fibroblasts --- p.36 / Chapter 3.3.1 --- Preparation of cell culture reagents --- p.36 / Chapter 3.3.2 --- Recovery of freezing fibroblasts --- p.37 / Chapter 3.3.3 --- Establishment of cell line --- p.37 / Chapter 3.4 --- Preliminary study of adherence of Candida albicans to fibroblasts and to catheters --- p.38 / Chapter 3.4.1 --- Adherence to fibroblasts --- p.38 / Chapter 3.4.1.1 --- Preparation of fibroblasts --- p.38 / Chapter 3.4.1.2 --- Preparation of culture of Candida albicans and of Saccharomyces cerevisiae --- p.39 / Chapter 3.4.1.3 --- Adhesion assay --- p.41 / Chapter 3.4.2 --- Adherence to catheters --- p.42 / Chapter 3.4.2.1 --- Preparation of catheters --- p.42 / Chapter 3.4.2.2 --- Adhesion assay --- p.42 / Chapter 3.5 --- "Confirmation of expression of ALS1, ALS5 smaller allele, and ALS6 of Candida albicans in YPD broth" --- p.44 / Chapter 3.5.1 --- RNA extraction of Candida albicans --- p.45 / Chapter 3.5.2 --- "RT-PCR of ALS1, ALS5 smaller allele, and ALS6" --- p.46 / Chapter 3.5.2.1 --- Primers --- p.46 / Chapter 3.5.2.2 --- RT-PCR --- p.47 / Chapter 3.6 --- Establishment of quantitation system of adhesion assay --- p.49 / Chapter 3.6.1 --- Absorbance measurement of Candida albicans stained with safranin --- p.49 / Chapter 3.6.1.1 --- Preparation of Candida albicans culture --- p.49 / Chapter 3.6.1.2 --- Staining of Candida albicans --- p.50 / Chapter 3.6.1.3 --- Viable count of Candida albicans adhered on the 6-well plate --- p.51 / Chapter 3.6.2 --- ATP bioluminescence --- p.52 / Chapter 3.7 --- Effect of inoculum size on adhesion to catheters --- p.53 / Chapter 3.7.1 --- Preparation of adhesion chambers --- p.53 / Chapter 3.7.2 --- Preparation of catheters --- p.54 / Chapter 3.7.3 --- Preparation of Candida albicans culture --- p.54 / Chapter 3.7.4 --- Adhesion assay --- p.55 / Chapter 3.8 --- "Transformation of Saccharomyces cerevisiae with ALS1, ALS5 smaller allele, and ALS6" --- p.57 / Chapter 3.8.1 --- DNA extraction of Candida albicans --- p.58 / Chapter 3.8.2 --- "PCR of ALS1, ALS5 smaller allele, and ALS6" --- p.59 / Chapter 3.8.3 --- Gel extraction --- p.60 / Chapter 3.8.4 --- Restriction digestion of PCR products of ALS genes and cloning plasmids --- p.61 / Chapter 3.8.5 --- "Ligation of ALS1, ALS5 smaller allele, ALS6 with pYES6CT cloning plasmids" --- p.62 / Chapter 3.8.6 --- Transformation of ligated plasmid into Escherichia coli --- p.63 / Chapter 3.8.7 --- Miniprep of plasmids --- p.64 / Chapter 3.8.8 --- DNA sequencing --- p.65 / Chapter 3.8.9 --- Transformation of Saccharomyces cerevisiae --- p.66 / Chapter 3.8.10 --- "Detection of Alsl，Als5, and Als6 protiens expression" --- p.68 / Chapter 3.8.10.1 --- Preparation of cultures in SC synthetic medium --- p.68 / Chapter 3.8.10.2 --- Protein extraction --- p.69 / Chapter 3.8.10.3 --- Dot blot of cell wall lysates --- p.69 / Chapter 3.9 --- Adhesion of transformed Saccharomyces cerevisiae to fibroblasts --- p.71 / Chapter 3.9.1 --- Preparation of fibroblasts and of Saccharomyces cerevisiae cultures --- p.71 / Chapter 3.9.2 --- Adhesion assay --- p.72 / Chapter 3.10 --- "Adhesion of transformed Saccharomyces cerevisiae to FEP, polyurethane, and silicone catheters" --- p.72 / Chapter 3.10.1 --- "Preparation of catheters, adhesion chambers and transformed Saccharomyces cerevisiae cultures" --- p.73 / Chapter 3.10.2 --- Adhesion to catheter fragments --- p.73 / Chapter 3.11 --- Statistical analysis --- p.74 / Chapter Chapter 4 --- Results --- p.75 / Chapter 4.1 --- Confirmation of identity of Candida albicans and of Saccharomyces cerevisiae --- p.75 / Chapter 4.1.1 --- Candida albicans --- p.75 / Chapter 4.1.2 --- Saccharomyces cerevisiae --- p.75 / Chapter 4.2 --- Cell culture of fibroblasts --- p.76 / Chapter 4.3 --- "Preliminary studies of adherence of Candida albicans to fibroblasts and to FEP, polyurethane, and silicone catheters" --- p.76 / Chapter 4.3.1 --- Adherence to fibroblasts --- p.76 / Chapter 4.3.2 --- Adherence to catheters --- p.77 / Chapter 4.4 --- "Confirmation of expression of ALSl, ALS5 smaller allele, and ALS6 of Candida albicans in YPD broth" --- p.78 / Chapter 4.5 --- Establishment of quantitation system of adhesion assay --- p.79 / Chapter 4.5.1 --- Absorbance measurement of Candida albicans stained with safranin --- p.79 / Chapter 4.5.2 --- ATP bioluminescence --- p.79 / Chapter 4.6 --- Effect of inoculum size on adhesion to catheters --- p.80 / Chapter 4.7 --- "Transformation of Saccharomyces cerevisiae with ALS1, ALS5 smaller allele, and ALS6" --- p.81 / Chapter 4.7.1 --- "PCR of ALSl, ALS5 smaller allele, and ALS6" --- p.81 / Chapter 4.7.2 --- Ligation of PCR products with pYES6CT plasmids --- p.82 / Chapter 4.7.3 --- "DNA sequencing results of ALS1, ALS5 smaller allele, and ALS6 ligated plasmids" --- p.83 / Chapter 4.7.4 --- "Detection of Alsl, Als5, and Als6 proteins expression" --- p.84 / Chapter 4.8 --- Adhesion of transformed Saccharomyces cerevisiae to fibroblasts --- p.84 / Chapter 4.9 --- "Adhesion of transformed Saccharomyces cerevisiae to FEP, polyurethane and silicone catheters" --- p.85 / Chapter Chapter 5 --- Discussion --- p.89 / Chapter 5.1 --- Limitations of static adhesion assay model --- p.89 / Chapter 5.2 --- Quantitation System --- p.90 / Chapter 5.2.1 --- Staining method --- p.90 / Chapter 5.2.2 --- ATP bioluminescence assay --- p.91 / Chapter 5.3 --- "Preliminary studies of adherence of Candida albicans to fibroblasts and to FEP, polyurethane, and silicone catheters" --- p.93 / Chapter 5.4 --- Effect of inoculum size on adhesion to catheters --- p.94 / Chapter 5.5 --- Selection of ALS genes --- p.96 / Chapter 5.6 --- Adhesion assay of transformed Saccharomyces cerevisiae to fibroblasts --- p.97 / Chapter 5.7 --- Adhesion assay of transformed Saccharomyces cerevisiae to catheters --- p.99 / Chapter 5.8 --- Alternative research model --- p.101 / Chapter 5.9 --- Implications and future work --- p.102 / Chapter Chapter 6 --- Conclusion --- p.107 / References --- p.108 / Tables --- p.119 / Figures --- p.123 / Appendices --- p.136

The peripherally inserted central catheter (PICC) is a catheter that is inserted in a peripheral vein, which get along to the superior or inferior cava vein, getting in a central localization, which promotes more safety and comfort to patients. A trained nurse, according to the Resolution of the Federal Nursing Council n º, inserts this catheter. 258/2001. The general objective of this study was aimed to know nurses‟ perceptions when using the peripherally inserted central catheter on adult patients at a teaching hospital. The specific objectives were: to describe nurses‟ experiences in relation to the using of peripherally inserted central catheter on adult patients; and to identify the facilitating and complicating factors in relation to the use of peripherally inserted central catheter by nurses. The research constituted a qualitative, descriptive and exploratory study. The place of study was the Teaching Hospital of Santa Maria, specifically, at areas of adult patients. Data collection was carried out from May to August of 2015. The participants of study were 18 nurses who had training for peripherally inserted central catheter and worked with adult patients. Data was collected through semistructured interviews, which were recorded via audio and later transcribed. Data was also analyzed through thematic analysis. The ethical aspects according to the Resolution 466 of December 2012 from the National Health Council were respected, and the project approved by the Ethics Research Committee under the number CAAE 40675915.1.0000.5346. from the results, three categories emerged: the trained nurses‟ experience when using the peripherally inserted central catheter on adult patients; aspects that interfere when using peripherally inserted central catheter on adult patients; and the using of peripherally inserted central catheter by trained nurses on adult patients: seeking for autonomy. It was possible to verify that the nurses‟ experience when using this catheter on adult patients is recent and timorous. The interviewers cited as facilitating factors for using the catheter: stimulus from the institution, availability of catheter and the support of medical and nursing teams. On the other hand, the complicating factors were: few trained nurses; lack of divulgation of people that have the training; lack of training of nursing professionals; lack of people and time to insert the catheter; service characteristics, patients‟ profile and type of treatment; venous system of hard access; ultrasound machine missing; being a teaching hospital; lack of knowledge from medical and nursing teams; and the lack of eye of nurses to diagnose the necessity of catheter insertion. The results evidenced that PICC is seen as the last option for venous access for some nurses and physicians, being almost not used due to the lack of knowledge between medical and nursing teams. Thus, the nurse has a fundamental role when seeking to upgrade and update their knowledge on the catheter, having to remember their autonomy in order to amplify the using of PICC on adult patients. For this reason, he/she needs to be proactive, have a critical and reflexive thinking to evaluate the patient as soon as he gets into the Unity for earlier indication for this dispositive and train the team to use the same. / O Cateter Central de Inserção Periférica (PICC) é um cateter inserido em veia periférica que progride até a veia cava superior ou inferior, adquirindo localização central, promovendo maior segurança e conforto aos pacientes. Este cateter é inserido por enfermeiro capacitado, conforme Resolução do Conselho Federal de Enfermagem nº 258/2001. O estudo teve como objetivo geral conhecer as percepções de enfermeiros sobre a utilização do Cateter Central de Inserção Periférica em pacientes adultos em um Hospital Universitário. Os objetivos específicos foram: descrever a experiência dos enfermeiros em relação à utilização do Cateter Central de Inserção Periférica em pacientes adultos e identificar os fatores facilitadores e dificultadores em relação ao uso do Cateter Central de Inserção Periférica pelos enfermeiros. A pesquisa constituiu-se em um estudo qualitativo, descritivo e exploratório. O local de estudo foi o Hospital Universitário de Santa Maria, especificamente, nas áreas que atendiam pacientes adultos. A coleta dos dados ocorreu no período de maio a agosto de 2015. Os participantes do estudo foram 18 enfermeiros que tinham capacitação em inserção do Cateter Central de Inserção Periférica e que atuavam com pacientes adultos. Os dados foram coletados por meio de entrevista semiestruturada, que foram gravadas em áudio e após, transcritas. Os dados foram analisados por meio de análise temática. Foram respeitados todos os aspectos éticos conforme Resolução 466 de Dezembro de 2012 do Conselho Nacional de Saúde, sendo o projeto aprovado por Comitê de Ética em Pesquisa sob o nº CAAE 40675915.1.0000.5346. A partir dos resultados emergiram três categorias: a experiência dos enfermeiros capacitados na utilização do Cateter Central de Inserção Periférica em pacientes adultos; aspectos que interferem na utilização do Cateter Central de Inserção Periférica em pacientes adultos e a utilização do Cateter Central de Inserção Periférica por enfermeiros capacitados em pacientes adultos: em busca de autonomia. Verificou-se que a experiência dos enfermeiros no uso deste cateter em pacientes adultos é recente e tímida. Os entrevistados citaram como fatores facilitadores para utilização deste cateter: estímulo da instituição, disponibilidade do cateter e, o apoio das equipes médica e de enfermagem. Já os fatores dificultadores foram: existência de poucos enfermeiros capacitados; falta de divulgação de quem tem o curso; falta de treinamento da equipe de enfermagem; falta de pessoal e falta de tempo para inserção do cateter; características do serviço, perfil dos pacientes e tipo de tratamento; rede venosa difícil; falta do aparelho de ultrassom; fato de ser um hospital escola; falta de conhecimento das equipes médicas e de enfermagem; e a falta de visão do enfermeiro para diagnosticar a necessidade de inserção do cateter. Os resultados evidenciaram que o PICC é visto como última opção de acesso venoso por alguns enfermeiros e médicos, sendo pouco utilizado devido a falta de conhecimento entre as equipes médica e de enfermagem. Portanto, constatou-se que o enfermeiro tem papel fundamental na busca de aprimoramento e atualização sobre o cateter, devendo valer-se de sua autonomia a fim de ampliar a utilização de PICC em pacientes adultos. Para isso ele precisa ser pró-ativo, ter pensamento crítico e reflexivo para avaliar o paciente logo que ele chega à Unidade para a indicação precoce deste dispositivo, devendo, também, treinar a equipe para utilização do mesmo.

A telenfermagem é a utilização dos recursos tecnológicos e dos sistemas de comunicação em prol do desenvolvimento da enfermagem. Vários países utilizam a telenfermagem na gestão de cuidados de saúde com resultados positivos. Na Enfermagem brasileira este é um campo a ser explorado, assim o objetivo desse trabalho foi de desenvolver estratégias de telenfermagem no atendimento a pacientes com bexiga neurogênica, usuários de cateterismo urinário intermitente limpo, atendidos em um centro de reabilitação de um hospital universitário. O estudo foi realizado em 3 etapas: etapa 1 - revisão integrativa da literatura para investigar na literatura a aplicação da telenfermagem; etapa 2 - elaboração e validação do protótipo de manual de telenfermagem para subsidiar o enfermeiro na implantação da intervenção de telenfermagem no atendimento ao paciente com bexiga neurogênica, usuário de cateterismo urinário intermitente limpo; etapa 3: estudo piloto sobre a implantação de intervenção de telenfermagem no atendimento ao paciente em uso de cateterismo urinário intermitente limpo. O manual de telenfermagem foi construído procurando contextualizar a telenfermagem no Brasil e no exterior, com seleção da teoria de Orem para direcionar o teleatendimento ao paciente, e um referencial sobre os cuidados para a realização de um teleatendimento. Descrição de recursos tecnológicos disponíveis que podem ser utilizados no teleatendimento, além de informações sobre os cuidados de saúde ao paciente com bexiga neurogênica e na realização do cateterismo urinário intermitente limpo. O manual foi validado em aparência e conteúdo por peritos com auxílio de um instrumento de avaliação. A intervenção de telenfermagem mostrou resultados importantes como forma de implementação do tratamento de saúde tradicional ao paciente, bem como evidenciou barreiras que precisam ser superadas para que esse tipo de atendimento seja realizado, como uma pesquisa efetiva com possibilidades de implementação posterior ao serviço de saúde. Os dados foram analisados através de estatística descritiva (frequência e porcentagem) com auxílio do programa SPSS (Statistical Package for Social Science), versão 15.0. O nível de concordância entre os peritos foi considerado de 70% para cada aspecto do instrumento utilizado / Telenursing is the use of technological resources and communication systems for the development of nursing. A great number of countries employ telenursing on healthcare management with positive results, however, it is a field yet to be explored in Brazilian nursing. The aim of this study was to develop telenursing strategies in the care to patients with neurogenic bladder, users of clean intermittent urinary catheterization, treated in a university hospital rehabilitation center. The study was carried out in 3 stages: stage 1 - integrative literature review to research the application of telenursing; stage 2 - development and validation of a telenursing booklet prototype to support nurses in implementing telenursing intervention on care to patients with neurogenic bladder, users of clean intermittent urinary catheterization; stage 3 - pilot study on the application of telenursing intervention in care to patients using clean intermittent urinary catheterization. The telenursing booklet was developed to contextualize telenursing in Brazil and abroad, selecting Orem\'s theory to guide the telecare to the patient and a framework about the care needed to carry out telecare. Description of available technological resources that can be used in telecare, as well as information about healthcare to patients with neurogenic bladder and in the procedure of clean intermittent urinary catheterization. The booklet underwent face and content validation by experts with aid from an assessment instrument. Telenursing intervention showed important results as a way to implement the traditional health treatment to the patient, also pointing out barriers that must be overcome in order to perform this kind of treatment, such as an effective research with possibilities of subsequent implementation at the health service. Data were analyzed through descriptive statistics (frequency and percentage) using SPSS (Statistical Package for Social Science) software version 15.0. The level of concordance considered among the experts was of 70% for each aspect of the used instrument

Direct measurement of blood pressure using a fluid-filled catheter and an electromechanical transducer is widely accepted in clinical practice. However, errors associated with the measurement are often not appreciated and these catheter-manometer systems are frequently unable to accurately reproduce applied pressures. To assess the accuracy of catheter-manometer systems used for invasive arterial blood pressure measurements, in vitro and in vivo evaluations were performed. The frequency response (described in terms of damped natural frequency and damping factor) for a variety of cannulae, pressure tubing and stopcocks (and combinations thereof) and their dependence on various parameters (catheter length, lumen diameter, fluid temperature and catheter material) were measured using an hydraulic pressure generator. The design and construction details of the pressure generator are presented. It was found that the damped natural frequency of the catheter-manometer system is directly proportional to lumen diameter of the pressure tubing/catheter. Furthermore, damping factor is inversely related to the damped natural frequency and stiffer catheter material (for identical radius ratios) results in higher damped natural frequency. Catheter length is inversely related to damped natural frequency and the resonant frequency decreases for an increase in fluid operating temperature. It was established that all catheter-manometer systems tested were under-damped (0.15 < β < 0.37) and that the damped natural frequency ranged from 10.5 Hz for 1500 mm to 27.0 Hz for pressure tubing of 300 mm in length. Furthermore, catheter-manometer systems which had pressure tubing in excess of 300 mm in length did not comply with the bandwidth requirements for accurate dynamic blood pressure measurement. For the in vivo assessment of the catheter-manometer system, the blood pressure waveform was analysed in the time and frequency domains. It was established that in 60 percent of the cases, the systolic pressure peak was higher when measured by a narrow bandwidth catheter-manometer system compared to that measured by a wide bandwidth system. Furthermore, values of dp/dt maximum were lower for wide bandwidth catheter-manometer systems than those measured by narrow bandwidth systems for heart rates above 90 beats per minute. In the frequency domain analysis, artifact was sometimes found to occur at frequencies higher than the bandwidth of the catheter-manometer system. This high frequency artifact was found to distort the blood pressure waveform and resulted in false high dp/dt and peak systolic pressures.