Ongoing evaluation of current practice and incorporation of evidence based research into guidelines and protocols is a requirement for the provision of high quality, cost efficient care. Despite some literature describing observational data, midline catheters (MCs) are not an appropriate vascular access device for Newborn Intensive Care Unit (NICU) patients due to insufficient high level evidence demonstrating safety and efficacy. In addition, national guidelines for MC use in neonatal and infant patients lacks sufficient information for safe and effective use of MCs. The results of this small, online survey indicate that while some neonatal nurses and Nurse Practitioners report the use of MC use in the NICU, there is a wide range of practice pertaining to MC unit-specific protocols, competencies, success with placement, and clinician agreement of appropriate use for this vascular access device (VAD). Multicenter, randomized control trials are needed to evaluate current MC practice in the NICU, and institutions must incorporates current, evidence based practice into policies, procedures, and guidelines.

This study aimed to evaluate the conformity of care practice of nursing staff in handling the central vascular catheter. This is a descriptive, prospective, observational study in the Intensive Care Unit of a reference hospital in the state of Sergipe. Data collection occurred from January to March 2016, in three shifts, from direct and structured observation of procedures involving the manipulation of central vascular catheter. The sample was not probabilistic, intentional and consisted of three procedures watching opportunities performed by nursing staff administering medication, changing needleless components and dressing change. For data analysis we calculated the overall compliance rates and specific from the recommended process indicators by ANVISA, subject to a stated Positivity Index (PI) equal to or greater than 80%, which corresponds to safe care. They were also made associations between variables (professional category, shift and sex) and the three observed procedures (medication administration, exchange equipo and dressing change) from the chi-square test and Fisher exact test, adopting a level of 5% significance. The project was approved by the Ethics Committee of the Federal University of Sergipe and nursing professionals signed the consent form consenting to observe its practices. 912 observations were made care involving the manipulation of the central venous catheter 378 (41.4%) observations of drug administrations, 267 (29.3%) of staff changes and 267 (29.3%) of dressings . 72 professionals were observed, most female 54 (72%). Of the total of professionals 55 (76%) were nursing technicians and 17 (24%) were nurses, distributed between the morning shift, 16 (22%), in the afternoon, 13 (18%) and night, 43 (60 %). The desired overall compliance has not been achieved in the three procedures observed, indicating a classified assistance as unwanted. As regards the administration of drugs, 3 (33%) observed actions reached specific line desired by the study, exchanging mans, 2 (25%) and dressing change, 8 (72%) shares have greater than or equal accordance 80%. Actions involving hand hygiene before aseptic procedure had lower specific compliance rate in the three procedures. When the variables associated work shift and sex of the nursing professional to assessed procedures, the night shift and the male nurses had most actions accordingly. There was no difference between the professional categories Nurse and Technician Nursing. It was evident that the conformity of the observed procedures are less than expected, demonstrating the importance of evaluation of work processes to improve care. The findings contribute to the development of educational strategies to ensure improved care practices, correcting the vulnerabilities found in the study. / O presente estudo objetivou avaliar a conformidade da prática assistencial da equipe de enfermagem no manuseio do cateter vascular central. Trata-se de um estudo descritivo, prospectivo, observacional realizado na Unidade de Terapia Intensiva de um Hospital referência do estado de Sergipe. A coleta de dados ocorreu de janeiro a março de 2016, nos três turnos de trabalho, a partir da observação direta e estruturada dos procedimentos envolvendo a manipulação do cateter vascular central. A amostra foi não probabilística, do tipo intencional e constituiu-se das oportunidades de observação de três procedimentos executados pela equipe de enfermagem: administração de medicamentos, troca de equipo e troca de curativo. Para análise dos dados foram calculadas as taxas de conformidade geral e específica, a partir dos indicadores de processo recomendados pela ANVISA, sendo estabelecido um Índice de Positividade (IP) igual ou maior que 80%, que corresponde a uma assistência segura. Foram realizadas também associações entre as variáveis (categoria profissional, turno e sexo) e os três procedimentos observados (administração de medicamentos, troca de equipo e troca de curativo) a partir do teste de Qui- Quadrado e Exato de Fisher, adotando um nível de significância de 5%. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal de Sergipe e os profissionais de enfermagem assinaram o TCLE, consentindo a observação de suas práticas assistenciais. Foram realizadas 912 observações do cuidado, envolvendo a manipulação do cateter vascular central, 378 (41,4%) observações de administrações de medicamentos, 267 (29,3%) de trocas de equipe e 267 (29,3%) de troca de curativos. Foram observados 72 profissionais, sendo a maioria do sexo feminino 54 (72%). Do total de profissionais 55 (76%) eram Técnicos de Enfermagem e 17 (24%) eram Enfermeiros, distribuídos entre os turnos da manhã, 16 (22%), da tarde, 13 (18%) e da noite, 43 (60%). A conformidade geral almejada não foi alcançada nos três procedimentos observados, evidenciando uma assistência classificada como indesejada. No que se refere à administração de medicamentos, 3 (33%) ações observadas alcançaram conformidade específica almejada pelo estudo, a troca de equipo, 2(25%) e a troca de curativo, 8 (72%) ações apresentaram conformidade maior ou igual a 80%. As ações envolvendo a higienização das mãos antes do procedimento asséptico apresentaram menor taxa de conformidade específica nos três procedimentos. Quando associadas as variáveis turno de trabalho e sexo do profissional de enfermagem aos procedimentos avaliados, o turno da noite e os profissionais de enfermagem do sexo masculino apresentaram maioria das ações em conformidade. Não houve diferença entre as categorias profissionais Enfermeiro e Técnico de Enfermagem. Evidenciou-se que as conformidades dos procedimentos observados se encontram aquém do esperado, demonstrando a importância da avaliação dos processos de trabalho para a melhoria do cuidado. Os dados encontrados contribuirão para a elaboração de estratégias educativas capazes de assegurar a melhoria das práticas assistenciais, corrigindo as vulnerabilidades encontradas no estudo.

La douleur abdominale post chirurgicale reste une douleur difficile à gérer. Cette douleur présente 2 composantes : (1) une composante pariétale liée à l’agression des muscles de la paroi abdominale et du péritoine pariétal et (2) une composante viscérale liée à l’agression du péritoine viscérale et des viscères. La douleur pariétale est bien systématisée, elle correspond à des métamères bien identifiés. Par contre la douleur viscérale est souvent mal localisée, irradiée ou transférée à un site cutané. Les AL administrés par l’intermédiaire d’un cathéter d’infiltration pariétal, d’un bloc de la paroi abdominale ou par voie systémique montrent une efficacité clinique dans l’analgésie post opératoire d’une chirurgie abdominale. Cependant le mécanisme d’action des AL en fonction de leurs voies d’administration n’est pas bien élucidé. Le but de nos études est d’explorer l’effet des AL sur les deux composantes de la douleur abdominale dans un modèle animal en fonction de leur voie d’administration. Nous avons réalisé 3 études expérimentales :1-Dans l’étude 1 nous avons comparé l’effet de la ropivacaïne administrée par voie systémique ou par un cathéter pré péritonéal sur la douleur pariétale et viscérale dans un modèle de laparotomie chirurgicale chez le rat.. 2-Dans l’étude 2 nous avons validé un bloc de la paroi abdominale chez le rat.. 3-Dans l’étude 3 nous avons comparé l’effet de la bupivacaïne par voie systémique à l’effet obtenu par l’administration de la bupivacaïne par un bloc de la paroi abdominale. Nous avons également comparé l’effet des Al par voie systémique à une vagotomie chimique préventive. L’ensemble de ces travaux montrent que lors d’une laparotomie, les AL sont efficaces dans le traitement de la nociception aussi bien par voie systémique que par voie locorégionale. Nous avons démontré qu’un bloc de la paroi abdominale, ainsi qu’une infiltration pré péritonéale diminuaient la transmission de la nociception viscérale vers le SNC par action directe sur les terminaisons nerveuses pariétales. De plus, lors d’une laparotomie, l’administration systémique d’AL montre une efficacité dans l’inhibition de la transmission de la nociception viscérale vers le SNC associée à un effet anti inflammatoire local et systémique supérieure à celui d’une administration locorégionale. / The abdominal post surgical pain has two components : (1) a parietal component due toaggression of the abdominal wall muscles and the parietal peritoneum and (2) a visceralcomponent due to aggression of the visceral peritoneum and viscera. Parietal pain is welllocalized; it corresponds to identified dermatomes. Otherwhise, visceral pain is often badlylocalized. Local anesthetics injected through a parietal catheter of infiltration, an abdominal wall blockor by a systemic administration show clinical efficiency in post operative analgesia afterabdominal surgery. However, the action mechanisms of local anesthetics according to theiradministration route are not well clarified. The purpose of our studies is to explore localanesthetics effect on both components of the abdominal pain in an animal model according totheir administration route.In this purpose we realized three experimental studies :1- In the first study, we compared the effect of systemic administration or through a preperitoneal catheter of ropivacaïne on parietal and visceral pain in a model of surgicallaparotomy in the rat. 2- In the second study, we established a block of the abdominal wall in the rat. 3- In the third study, parietal and peritoneal inflammation were induced by carrageenaninjection in the abdominal wall or in the peritoneal cavity in the rat according to theexperimental group. Then, we compared the effect of a systemic administration of bupivacaïneto its administration by an abdominal wall block. Furthermore, the systemic effect of localanesthetics was compared to a preventive chemical vagotomy. These works showed that during laparotomy, local anesthetics are effective in thetreatment of the nociception as well as by systemic or locoregional administration. We showedthat an abdominal wall block as well as a pre peritoneal administration decreased thetransmission of the visceral nociception towards the central nervous system by direct action onthe parietal nerve endings. Furthermore, during a laparotomy, systemic administration of localanesthetics inhibited the transmission of visceral nociception towards the central nervoussystem associated with a local and systemic anti inflammatory effects. This anti inflammatoryeffect was higher than that what we showed by locoregional administration of bupivacaïne.

La fibrilación auricular es una de las arritmias cardíacas más comunes observadas en la práctica clínica. Por lo tanto, es de vital importancia desarrollar nuevas tecnologías destinadas a diagnosticar y acabar con este tipo de arritmia, para mejorar la calidad de vida de los pacientes y reducir los costes de los sistemas nacionales de salud. En los últimos años ha aumentado el uso de las nuevas técnicas de mapeo auricular, basadas en sistemas multi-electrodo para mapear la actividad eléctrica en humanos. Dichas técnicas permiten localizar y ablacionar los impulsores de la fibrilación auricular, como son las fuentes focales o los rotores. Sin embargo, todavía existe incertidumbre sobre su precisión y los procedimientos experimentales para su análisis están limitados debido a su carácter invasivo. Por lo tanto, las simulaciones computacionales son una herramienta muy útil para superar estas limitaciones, al permitir reproducir con fidelidad las observaciones experimentales, dividir el problema bajo estudio en sub-estudios más simples, y realizar investigaciones preliminares imposibles de llevar a cabo en el práctica clínica. Esta tesis doctoral se centra en el análisis de la precisión de los sistemas de mapeo multi-electrodo a través de modelos y simulaciones computacionales. Para ello, desarrollamos modelos realistas multi-escala con el objetivo de simular actividad eléctrica auricular reentrante, en primer lugar en una lámina de tejido auricular, y en segundo lugar en las aurículas completas. Posteriormente, analizamos los efectos de las configuraciones geométricas multi-electrodo en la precisión de la localización de los rotores, mediante el uso de agrupaciones multi-electrodo con distancias inter-electrodo equidistantes, así como a través de catéteres de tipo basket con distancias inter-electrodo no equidistantes. Después de calcular los electrogramas unipolares intracavitarios, realizamos mapas de fase, detecciones de singularidad de fase para rastrear los rotores, y mapas de frecuencia dominantes. Finalmente, descubrimos que la precisión de los sistemas de mapeo multi-electrodo depende de su posición dentro de la cavidad auricular, de la distancia entre los electrodos y el tejido, de la distancia inter-electrodo, y de la contribución de las fuentes de campo lejano. Además, como consecuencia de estos factores que pueden afectar a la precisión de los sistemas de mapeo multi-electrodo, observamos la aparición de rotores falsos que podrían contribuir al fracaso de los procesos de ablación de la fibrilación auricular. / Atrial fibrillation is one of the most common cardiac arrhythmias seen in clinical practice. Therefore, it is of vital importance to develop new technologies aimed at diagnosing and terminating this kind of arrhythmia, to improve the quality of life of patients and to reduce costs to national health systems. In the last years, new atrial mapping techniques based on multi-electrode systems are increasingly being used to map the atrial electrical activity in humans and localise and target atrial fibrillation drivers in the form of focal sources or rotors. However, significant concerns remain about their accuracy and experimental approaches to analyse them are limited due to their invasive character. Therefore, computer simulations are a helpful tool to overcome these limitations since they can reproduce with fidelity experimental observations, permit to split the problem to treat into more simple substudies, and allow the possibility of performing preliminary investigations impossible to carry out in the clinical practice. This PhD thesis is focused on the analysis for accuracy of the multielectrode mapping systems through computational models and simulations. For this purpose, we developed realistic multiscale models in order to simulate atrial electrical reentrant activity, first in a sheet of atrial tissue and, then, in the whole atria. Then, we analysed the effects of the multi-electrode geometrical configurations on the accuracy of localizing rotors, by using multi-electrode arrays with equidistant inter-electrode distances, as well as multi-electrode basket catheters with non-equidistant inter-electrode distances. After computing the intracavitary unipolar electrograms, we performed phase maps, phase singularity detections to track rotors, and dominant frequency maps. We finally found out that the accuracy of multi-electrode mapping systems depends on their position inside the atrial cavity, the electrode-to-tissue distance, the inter-electrode distance, and the contribution of far field sources. Furthermore, as a consequence of these factors, false rotors might appear and could contribute to failure of atrial fibrillation ablation procedures. / La fibril·lació auricular és una de les arítmies cardíaques més comuns observades en la pràctica clínica. Per tant, és de vital importància desenvolupar noves tecnologies destinades a diagnosticar i acabar amb aquest tipus d'arítmia, per tal de millorar la qualitat de vida dels pacients i reduir els costos dels sistemes nacionals de salut. En els últims anys, ha augmentat l'ús de les noves tècniques de mapeig auricular, basades en sistemes multielèctrode per a mapejar l'activitat elèctrica auricular en humans. Aquestes tècniques permeten localitzar i ablacionar els impulsors de la fibril·lació auricular, com són les fonts focals o els rotors. No obstant això, encara hi ha incertesa sobre la seua precisió i els procediments experimentals per al seu anàlisi estan limitats a causa del seu caràcter invasiu. Per tant, les simulacions computacionals són una eina molt útil per a superar aquestes limitacions, en permetre reproduir amb fidelitat les observacions experimentals, dividir el problema sota estudi en subestudis més simples, i realitzar investigacions preliminars impossibles de dur a terme en el pràctica clínica. Aquesta tesi doctoral es centra en l'anàlisi de la precisió del sistemes de mapeig multielèctrode mitjançant els models i les simulacions computacionals. Per a això, desenvolupàrem models realistes multiescala per tal de simular activitat elèctrica auricular reentrant, en primer lloc en una làmina de teixit auricular, i en segon lloc a les aurícules completes. Posteriorment, analitzàrem els efectes de les configuracions geomètriques multielèctrode en la precisió de la localització dels rotors, mitjançant l'ús d'agrupacions multielèctrode amb distàncies interelèctrode equidistants, així com catèters de tipus basket amb distàncies interelèctrode no equidistants. Després de calcular els electrogrames unipolars intracavitaris, vam realitzar mapes de fase, deteccions de singularitat de fase per a rastrejar els rotors, i mapes de freqüència dominants. Finalment, vam descobrir que la precisió dels sistemes de mapeig multielèctrode depèn de la seua posició dins de la cavitat auricular, de la distància entre els elèctrodes i el teixit, de la distància interelèctrode, i de la contribució de les fonts de camp llunyà. A més, com a conseqüència d'aquests factors, es va observar l'aparició de rotors falsos que podrien contribuir al fracàs de l'ablació de la fibril·lació auricular. / Martínez Mateu, L. (2018). Mapping of the electrical activity of human atria. Multiscale modelling and simulations [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/104604 / TESIS

Bakgrund: Intensivvårdssjuksköterskan har en central roll beträffande hantering av centralvenösa infarter och det infektionsförebyggande arbetet som medföljer dem. Nationella riktlinjer för centralvenösa infarter är byggda utifrån evidens och patientsäkerhet. Trots detta så brister följsamheten vilket kan leda till förlängd vårdtid, vårdlidande och ökade samhällskostnader. Vad dessa brister beror på valdes att undersökas, utifrån ett intensivvårdssjuksköterskeperspektiv. Syfte: Syftet med studien var att belysa intensivvårdssjuksköterskans upplevelser av följsamhet till nationella riktlinjer för hantering av centralvenösa infarter. Metod: En kvalitativ empirisk metod med induktiv ansats antogs. Nitton intensivvårdssjuksköterskor intervjuades och datamaterialet analyserades genom en manifest innehållsanalys. Resultat: Datamaterialet resulterade i tre kategorier; Tidens betydelse, Teamets betydelse och Den kliniska erfarenhetens betydelse. Det visar på vikten av intensivvårdssjuksköterskans evidensbaserade kunskap, kliniska blick och ansvarskänsla. Brister förekom när det var en fråga om tid, icke fungerande teamarbete och när intensivvårdssjuksköterskan inte höll sig uppdaterad med ny evidensbaserad kunskap. Slutsats: Organisatorisk förändring krävs för att ge intensivvårdssjuksköterskan tid att se hela patientens behov och möjlighet att uppsöka ny evidens vilket kan ha inflytande på hela teamets arbete kring intensivvårdspatienten. En förbättrad följsamhet till nationella riktlinjer leder till en ökad patientsäkerhet och ett minskat vårdlidande för patienten. / Background: The ICU nurse has a central role when it comes to the management of central venous catheters and the prevention of central line associated blood stream infections. National guidelines for central venous catheters are established from evidence and patient safety. Despite this fact there is a lack of compliance with guidelines which can lead to a prolonged hospital stay, patient suffering and an increased cost societally. To find out the causes of lack of compliance was the basis for this study, from the perspective of the ICU nurse. Aim: The aim of the study was to highlight the ICU nurse’s experiences of compliance to national guidelines for central venous catheters. Method: A qualitative empirical method with an inductive approach was adopted. Nineteen intensive care nurses were interviewed and the data was analyzed through a manifest content analysis. Results: The collected data resulted in three categories; The importance of time, The importance of working as a team and The importance of clinical experience. It presents the significance of the ICU nurse’s evidence-based knowledge, experience and sense of responsibility. Lack of compliance occurred when there was a time pressure, the team did not function properly and when the ICU nurse did not stay up to date with new evidence-based knowledge. Conclusion: Organizational change is required to give the ICU nurse time to be able to see all the needs of the patient and the opportunity to seek new evidence and thereby improve compliance to national guidelines. An increased opportunity for knowledge development for the ICU nurse can have an impact on the entire team working with the intensive care patient. Improved compliance to national guidelines leads to increased patient safety and reduces patient suffering.

No description available.

La surdité de perception est généralement la conséquence de la mort des cellules ciliées et de la dégénérescence supplémentaire des innervations afférentes induite par une absence de stimulation. Les indications de l’implant cochléaire se sont élargies en direction des patients sourds qui présentent un reliquat d’audition exploitable dans les fréquences graves. La persistance d’un reliquat auditif suffisant après l’intervention permet parfois une stimulation électrique acoustique, amplifiée acoustique sur les fréquences graves préservées, et électrique sur les fréquences aiguës. Actuellement, plusieurs protocoles de préservation de l’audition sont en investigation. Chaque protocole vise à appliquer des procédures qui minimisent les deux mécanismes du traumatisme, à savoir trauma immédiat et trauma différé. En particulier, une insertion atraumatique du porte-électrode (Flex EAS et Flex Soft ; Med-El) a été proposée pour minimiser le traumatisme chirurgical intracochléaire. L’application local et concomitante de médicament devrait améliorer la tolérance du tissu et donc réduire les dommages intracochléaire au niveau cellulaire. Un cathéter (Med-El) intra cochléaire pour la délivrance de médicaments intracochléaire a été développé, destiné à l’utilisation d’agents pharmacologiques in situ avant l'insertion du porte-électrode. Les propriétés mécaniques de ce cathéter n’induit pas de traumatisme dans la cochlée. Une insertion séquentielle de cathéter et de porte-électrodes est réalisable et souvent atraumatique / Sensorineural deafness is generaly the result of hair cell death and additional degeneration of afferent innervation. In recent years the candidacy criteria for cochlear implantation have been expanding, and now include patients with severe to profound high-frequency hearing loss along with mild to moderate low-frequency loss. The single most important prerequisite for providing both electric and acoustic stimulation in the same ear is the preservation of acoustic hearing following the surgical procedure. Currently, several hearing preservation protocols are under investigation. Each protocol attempts to implement procedures that minimize both immediate and delayed mechanisms. Specifically, atraumatic approaches and electrode insertions (Flex EAS and Flex Soft) have been proposed that aim at minimizing the surgical aspect of intracochlear trauma. The concomitant application local of drugs should enhance tissue tolerability and thus reduce intracochlear damage on a cellular level. Acute and topical, intracochlear drug delivery prior to electrode array insertion with a disposable single-use catheter (Med-El) has been evaluated and developed. The flexible properties of this catheter are enough to be inserted without trauma in the cochlea. Sequential insertion of intracochlear catheters and electrode arrays is feasible and often atraumatic

Les cathéters veineux centraux sont utilisés pour des traitements dont la chimiothérapie, l’hydratation, l’antibiothérapie et la nutrition parentérale chez les patients ayant un cancer. Cependant, ces cathéters sont responsables de graves complications dont les infections. Elles peuvent entraîner la suspension ou l’arrêt des traitements et peuvent engager le pronostic vital des patients. Le taux d’incidence et les facteurs de risque des infections liées aux cathéters veineux centraux (ILCVC) en oncologie restent mal connus. Une étude prospective menée pendant 5 ans à l’hôpital Edouard Herriot et à l’hôpital de la Croix Rousse nous a permis de décrire les ILCVC chez 425 patients ayant un cancer digestif. Nous avons d’abord estimé le taux d’incidence des ILCVC selon la localisation du cancer primitif. Ensuite, nous avons analysé les facteurs de risque. Pour mieux estimer l’impact de la nutrition parentérale sur le risque d’ILCVC, nous avons utilisé le score de propension pour imiter certaines caractéristiques d’un essai randomisé. Enfin, nous avons analysé la mortalité dans les 30 jours qui ont suivi l’ILCVC. Les résultats ont montré que le taux d’incidence des ILCVC était plus élevé chez les patients ayant un cancer pancréas ou un cancer de l’œsophage que ceux qui ont un cancer colorectal. Les facteurs de risque indépendamment associés à une ILCVC étaient le performance status, les journées d’utilisation du cathéter, le cancer du pancréas et la nutrition parentérale. Le risque d’ILCVC était supérieur à 5 chez les patients qui recevaient de la nutrition parentérale associée à la chimiothérapie intraveineuse. Le diabète était un facteur de risque indépendamment associé à la mortalité dans les 30 jours qui suivent la survenue l’ILCVC. / Central venous catheters are commonly used in cancer patients for administration of chemotherapy, hydration, parenteral nutrition and antibiotic. However, their use is associated with complications such as infections. An often serious complication is bloodstream infections. This can cause a suspending of cancer treatment. Central venous catheter-related bloodstream infections also contribute to increased mortality in theses patients. The incidence rates and CVC-RBSI risk factors are not well known in patients with cancer. Then in a prospective study conducted during 5 years, we have analysed data from 425 patients with digestive cancer. Study took place at Edouard Herriot Hospital and Croix Rousse Hospital in Lyon. First, we estimated rate of CVC-RBSI according to the location of primary cancer. To the best estimation of parenteral nutrition effect on the risk of CVC-RBSI, we performed the propensity score analysis, which can mimic some characteristics of randomized trial. Finally, we analyzed the 30-day mortality after CVC-BSI. The results showed that the infection rate was higher in pancreatic and oesophageal cancer patients, compared with colorectal cancer patients. The risk factors independently associated with CVC-RBSI were pancreatic cancer, performance status, cumulative catheter utilization-days and parenteral nutrition. The risk of CVC-RBSI was at least 5 times greater in patients with parenteral nutrition. Attributable mortality rate within 1 month of CVC-RBSI was 16.6%. Diabetes mellitus was independently associated with death.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-12-02T14:01:04Z No. of bitstreams: 1 Alexei Rodrigues Gomes.pdf: 964184 bytes, checksum: d5767e205b935a48ac631790d805cce5 (MD5) / Made available in DSpace on 2015-12-02T14:01:04Z (GMT). No. of bitstreams: 1 Alexei Rodrigues Gomes.pdf: 964184 bytes, checksum: d5767e205b935a48ac631790d805cce5 (MD5) Previous issue date: 2013 / Mestrado Profissional em Enfermagem Assistencial / Introdução: a incidência do câncer cresce no Brasil e no mundo, devido, entre outros fatores, ao aumento da expectativa de vida. A maioria dos tratamentos medicamentosos indicados para os diversos tipos de doenças neoplásicas são feitos por via endovenosa. Para o tempo longo do tratamento, as irritabilidades endoteliais e os danos causados em caso de extravasamento para a região subcutânea, geralmente, é indicada a implantação de cateteres venosos centrais. Estes necessitam ser mantidos pérvios e geralmente usa-se solução fisiológica a 0,9 % com heparina (solução heparinizada) para isto. Observa-se que, na prática diária das instituições que manipulam tais dispositivos, há uma discrepância no que tange ao volume de líquidos a serem introduzidos no interior destes. Assim, este estudo foi norteado pelo seguinte questionamento: qual a quantidade de solução adequada para manutenção do Cateter Venoso Central Totalmente Implantado, tendo em vista as especificidades do cateter e do usuário? Objetivos: verificar a diferença do volume que se usa e o que deveria ser usado para a manutenção desse cateter e que fatores estão associados a essa diferença. Metodologia: pesquisa com abordagem quantitativa descritiva realizada na Unidade I do Instituto Nacional do Câncer, sendo acompanhadas 69 implantações, realizadas por 5 cirurgiões. Para coleta de dados, utilizou-se formulário para levantamento das características do cateter; aplicação de formulário para identificação de dados referentes ao usuário, cirurgião e o procedimento propriamente dito; e formulário de observação não participante. Para os dados referentes à caracterização dos cateteres, elaborou-se uma tabela com tamanhos e respectivos volumes de prime; para o formulário aplicado aos cirurgiões foram elaboradas planilhas com dados para favorecer a análise estatística juntamente com os dados da observação a não participantes e aplicou-se o teste não paramétrico U de Mann Whitney. Resultados: foram encontradas variações entre 0,285 ml a 1,00 ml de volume necessário para o preenchimento do mesmo. A diferença média de volume em mililitros que se usa e que deveriam ser usados foi de cerca de 0,7 ml, tanto para pacientes infantis, quanto para adultos. Conclusão: a quantidade de solução adequada para a manutenção do cateter variou de acordo com o biótipo do usuário e as características dos cateteres, entre outros. Elaboraram-se tabelas com os volumes necessários para preenchimento dos cateteres, levando em consideração os tamanhos e diâmetros dos mesmos / Introduction: The incidence of cancer grows in Brazil and in the world, due, among other factors, to the increase in life expectancy. Most drug treatments indicated for the various types of neoplasic diseases are made intravenously. For the long duration of treatment, endothelial irritabilities, damage in case of leakage into the subcutaneous region are the usual indications for the implantat of central venous catheters. These need to be maintained patent, and generally up to 0.9% saline solution with heparin (heparin solution) is used for this. It is observed that in the daily practice of the institutions that handle such devices, there is a discrepancy with respect to the volume of liquid to be introduced into these. Thus, this study was guided by the following question: What is the appropriate amount of solution to maintain the Totally Implanted Central Venous Catheter in face of the catheter’s and patient’s specificities? Objectives: To investigate the difference of volume that is used and what should be used for the maintenance of the catheter, and what are the factors related to this difference. Methodology: A quantitative descriptive Survey carried out in Unit I of the National Cancer Institute, following 69 insertions performed by 5 surgeons. For data collection, a form was used to assess the catheter’s characteristics, a form to identify data about the user, the surgeon and the procedure itself; and a form for non-participant observation. A table with the sizes and the volume of prime is presented. Worksheets with data about the surgeons was created to prompt the statistical analysis, as well as data of non-participating observation. The nonparametric Mann-Whitney U test was applied. Results: Variations between 0.285 ml to 1.00 ml of volume were found to be required to fill the catheter. The average difference in volume that is used and that which should be used was of about 0.7 ml for both children and adult patients. Conclusion: The appropriate amount of solution to maintain the catheter varied depending on the biotype of the patient and the features of the catheters. Tables were prepared with the data about the required volumes to fill the catheter, taking into account their size and diameter

As infecções relacionadas à assistência à saúde (IRAS) desafiam constantemente a qualidade da assistência prestada no sistema de saúde como um todo. Apesar do conhecimento acerca do conceito de infecção hospitalar, suas origens, fatores relacionados e principalmente as medidas gerais de prevenção e controle das IRAS, o que normalmente se verifica, é a baixa adesão dos PAS às medidas preventivas. Existem várias medidas fortemente embasadas em evidências científicas, porém, a utilização dessas medidas, por profissionais de saúde, permanece um grande desafio. Estudos mencionam que o não cumprimento das diretrizes é um problema universal, e para desenvolver intervenções bem-sucedidas, são necessárias mais pesquisas sobre os determinantes comportamentais. Diante disso este estudo teve como objetivos avaliar a adesão às práticas de prevenção e controle de infecção dos (PAS) que atuam em UTI, tais como: cuidados de manipulação e curativo de cateteres venosos centrais (CVC) e manipulação direta do paciente e de seu ambiente próximo e investigar uma possível correlação entre a adesão dos PAS e o desempenho de seus testes psicológicos que avaliaram seus Estilos de pensamento, Autoestima, Qualidade de vida, Estresse e Personalidade. Realizou-se um estudo observacional, prospectivo, no período de julho de 2012 a dezembro de 2013 em quatro Unidades de Terapia Intensiva em um grande hospital escola. Foram realizadas 7.572 observações distribuídas entre as práticas selecionadas de 248 profissionais que atuaram em quatro UTIs, constituídos por médicos e enfermeiros (auxiliares de enfermagem, técnicos de enfermagem e enfermeiros). Para a equipe de enfermagem a proporção de adesão para o procedimento de cuidados com a manipulação variou entre 13% e 95%, ficando com a menor adesão as etapas que envolveram a higienização das mãos (HM) antes de manipular o cateter e a desinfecção da conexão do CVC. Para o procedimento de cuidados com o curativo do CVC a proporção de adesão variou entre 14% e 99%, ficando com a menor adesão novamente as etapas que envolveram a HM antes de iniciar a troca do curativo do CVC. Para avaliação da equipe médica foi observada a adesão à HM das mãos nos cinco momentos propostos pela OMS. A proporção de adesão variou entre 10% e 98%. Observou-se menor taxa de adesão para os momentos \"Antes do contato direto com o paciente\", \"Após contato com ambiente próximo ao paciente\" e \"Antes de procedimentos assépticos\". Utilizou-se um modelo de regressão logística ajustado para avaliar a associação entre à adesão às práticas de controle de infecção e os testes psicológicos dos profissionais de saúde e apenas a autoestima e aspectos de personalidade (agressão, assistência, deferência, afago e afiliação) obtiveram associação com a adesão às práticas de controle de infecção. Conhecer fatores biopsicossociais (características de personalidade e autoestima) capazes de gerar comportamentos que influenciam o ato de adesão dos PAS às práticas de controle de infecção, pode ser um passo importante para projetar estratégias de intervenção mais eficientes para modificar o comportamento dos profissionais de saúde e aumentar as boas práticas / Health care-associated infections (HAI) consistently challenge the quality of care provided in the health system as a whole. Despite knowledge about hospital infection, its origins, associated factors and the general measures of prevention and control, usually a low adherence of healthcare professional to preventive measures is observed. There are several scientifically-based preventive measures, however the use of these guidelines by health professionals remains a major challenge. Studies point out that failure to comply with the guidelines is a universal problem and for successful interventions to be developed further research on behavioral determinants is needed. The objective of this study was: -to evaluate the adherence to the prevention and infection control practices by healthcare professionals working in ICUs, during procedures such as handling and dressing of central venous catheters (CVC), and direct manipulation of the patient and the close environment to the patient; and -to investigate a possible correlation between adherence of healthcare professionals and their performance in psychological tests (Styles of Thought, Self Esteem, Quality of Life, Stress and Personality). An observational, prospective study was carried out from July 2012 to December 2013 in four Intensive Care Units in a large teaching hospital. A total of 7,572 observations was made, for 248 healthcare professionals who worked in four ICUs. These were doctors and nurses (nurse assistants, nurse technicians and registered nurses). For the nursing team the proportion of adherence to adequate procedures involving CVC manipulation varied between 13% and 95%. The steps with smaller adhesion were: hand hygiene (HM) before beginning the CVC manipulation and disinfection of the CVC hub. For the CVC dressing, adherence varied between 14% and 99%. Lowest adherence was observed for HM before beginning the dressing. For doctors, hand hygiene was observed during the five moments proposed by the WHO. Compliance varied between 10% and 98%. Lowest compliance was observed for the moments: \" Before direct contact with the patient \",\" After contact with environment close to the patient \"and\" Before aseptic procedure \". An adjusted regression logistics model was used to evaluate the correlation between adherence to infection control practices by the healthcare professionals and their psychological tests. Self-esteem and aspects of personality (aggression, attendance, affiliation and cuddle) were associated with compliance. We believe that knowing biopsychosocial factors (personality traits and self-esteem) that may influence adherence of healthcare professionals to infection control practices can be an important step to develop more efficient intervention strategies to modify behavior and increase quality of care for patients