Centrala venkatetrar (CVK) används både inom slutenvården och öppenvården, dock är användandet ej riskfritt. År 2018 var 12,9 % av de vårdrelaterade infektionerna i Sverige relaterade till centrala venkatetrar. Genom att följa evidensbaserade riktlinjer gällande handhavandet av CVK, sänks incidensen av dessa infektioner. Syftet med litteraturöversikten var att kartlägga vilka faktorer som påverkar sjuksköterskans följsamhet till evidensbaserade riktlinjer gällande handhavandet av CVK. Studien genomfördes som en allmän litteraturöversikt med induktiv ansats. Resultatet baserades på 13 vetenskapliga artiklar som visade att sjuksköterskans följsamhet påverkades av såväl resurser som begränsningar. Återkommande utbildning, skriftlig och muntlig återkoppling samt lättillgängligt material kunde öka följsamheten, medan brist på kunskap samt akuta situationer kunde minska sjuksköterskans följsamhet till riktlinjer. / Central venous catheters (CVC) are used both in inpatient and outpatient care, however, the use is not risk-free. In 2018, 12, 9 % of the healthcare-related infections in Sweden were related to central venous catheters. When following evidence-based guidelines of CVC maintenance, the incidence of CVC-related infections are reduced. The aim of this study was to investigate which factors affect the nurse's adherence to evidence-based guidelines regarding CVC maintenance. The study was designed as a structured literature review with an inductive approach. The result was based on 13 scientific articles and showed that the nurses’ adherence was affected by both resources and limitations. Recurrent education, written and oral feedback and easily accessible material could increase the adherence while lack of knowledge and emergencies may provide a reduced nurses’ adherence to guidelines.

Intravenous line placement is one of the most common procedures performed on children presenting to the Emergency Department. Anxiety about needles is widespread, and many children experience high levels of fear and/or pain with their IV line placements. Hypnosis is a behavioral intervention that shows significant promise for alleviating procedure-related pain and anxiety in children. Twenty-five developmentally normal, English-speaking children between the ages of five and fifteen who required IV line placement in the Pediatric Emergency Department at Yale-New Haven Childrens Hospital were randomized to receive either the standard of care or standard of care plus a brief hypnotic intervention. The groups were similar with regard to baseline demographic and socioeconomic status, previous experience with medical care, and presence or absence of chronic medical conditions. Childrens pre-procedural anxiety ratings on a 10cm visual analog scale (VAS) and expected procedural pain ratings by 10-point oucher and 10cm VAS were not significantly different between the groups. Children randomized to the hypnosis group reported less anxiety during the procedure (mean 5.0 vs 3.1, median 7.2 vs 2.2, p = 0.28) than children randomized to the standard of care group. Cases also had a decrease in anxiety from expected to actual of 1.6 on a 10cm scale, while those randomized to the control group had an increase from expected to actual anxiety of 1.1 (p=0.01). A smaller trend towards decreased pain in the hypnosis group was also present. As measured by VAS, cases had lower mean pain scores (3.4 vs 4.3) than controls. In a comparison of anticipated and actual pain scores between groups, the hypnosis group had a mean decrease of 0.8 on a 10cm VAS , while the control group had a mean increase of 0.5 (p=0.14). Recruitment of subjects is ongoing, but preliminary results suggest that hypnosis is effective for alleviating needle-related anxiety in children undergoing IV line placement and may be helpful for alleviating the pain of IV line placement as well.

Vascular access-related bloodstream infection (BSI) is frequent among patients undergoing hemodialysis increasing significantly their morbidity and mortality. Studies assessing centre- and patient-predictors of BSI have had inadequate sample size and follow-up time. The aims of this project are: to describe the incidence rates; and to determine patient- and centre-level predictors of BSI in a cohort of incident hemodialysis patients treated in teaching or community hospitals, and in First Nation dialysis units. The rates of BSI in our population were lower than those observed in other settings. Central venous catheters were the most important risk factor for BSI and their use in our study was much higher than recommended. Some variability in BSI rates was found among centres, but no centre-related variable was found to be associated with the risk of BSI. Effort to reduce catheter use in hemodialysis patients may significantly reduce the risk of BSI in this patient population.

Bakgrunn: Sentralvenøse katetre (SVK) er et tilbud til mange pasientgrupper når det foreligger indikasjoner. Dette medfører at SVK håndteres av helsepersonell på alle enheter i helsetjenesten. Samtidig som SVK er livgivende, kan anvendelse av katetre i blodbanen resultere i alvorlige blodbaneinfeksjoner (SVK-BBI). Blodbaneinfeksjoner assosiert med innleggelse og håndtering av SVK, er en av de alvorligste komplikasjonene som kan oppstå. Fokus på forebygging av SVK-BBI har spredd seg fra å gjelde intensivavdelinger tilå gjelde hele helsetjenesten. Hensikten med denne studien erå se på etterlevelse av infeksjonsforebyggende retningslinjer for å forebygge SVK-BBI utenom intensivavdelinger. Fokuseropplæring, aseptisk teknikk, håndhygiene ogdesinfeksjon av koblingene. Metode: Studien er en tverrsnittsstudie hvor det gjennomføres observasjoner av etterlevelse av håndtering og stell av SVK,samten spørreundersøkelse som kartlegger opplæringav helsepersonelli forhold tildette. 40 sykepleiere deltar i observasjonsstudien og 112 helsepersonelldeltar i spørreundersøkelsen. Hovedresultat: Etterlevelse av aseptisk teknikk under prosedyre var 72,5 %.Etterlevelse av håndhygiene før SVK-prosedyre var 42%. Etterlevelse av desinfeksjon før tilgang/ skifte av koblinger var 89,6 %. 96 % av desom håndterte SVK,har fått opplæring. 68 % er opplært med multimodale metoder. Konklusjon: Studien viser at defleste som håndterteSVK har hatt opplæring. Kommentarene til spørreundersøkelsen viser likevel at det etterlyses bedre opplæring hvor praktisk trening og oppdatering av kunnskap er vektlagt. Til tross for stort fokus på opplæring viser observasjonene av etterlevelse av SVK-prosedyren at vesentlige infekjsonsforebyggende tiltak svikter. / Background:Central venous catheters (CVCs) are usedfor a wide range of indications and handled by health care professionals throughout the hospital. While CVCsare life-giving, their use may result in serious bloodstream infections. Catheter-related bloodstream infections (CRBSIs) are among the most serious complications in health care. Consequently, hospitals now focus on CRBSIs prevention throughout the entire hospital. Aim. The purpose of this study is to look at adherence to infection control guidelines for preventing CRBSIs outside intensive care units. Studied issues are education/ training of health care workers, aseptic technique, hand hygiene and disinfection of the hubs/ connections prior to use. Method.This cross-sectional study aimed to observe guideline compliance by 40 nurses during handling procedures and care of CVCs. We also conducted a sample survey of healthcare workers (n=112) to map the training of healthcare workers handling CVCs. Main results. Adherence to aseptic technique during the procedure was 72.5%, and compliance with hand hygiene before CVCs procedure was 42%. Compliance with use of disinfectant prior to access/change of hubs/connections was 89.6%. The survey revealed that 96% of respondents had been trained in properly handling CVCs; 68 % were trained with multimodal methods. Conclusion. Most healthcare workers were trained to handle CVCs. Some workers requested better training that emphasizes practical issues and updated knowledge. Despite a strong focus on education/training, our observations show that many healthcare workersremain noncompliant in CVC procedure / <p>ISBN 978-91-86739-76-8</p>

Made available in DSpace on 2014-06-11T19:32:55Z (GMT). No. of bitstreams: 0 Previous issue date: 2006-08-01Bitstream added on 2014-06-13T19:43:46Z : No. of bitstreams: 1 storti_a_dr_arafcf.pdf: 1083866 bytes, checksum: 46bd528115c854e2d63db0b4111bbd28 (MD5) / Universidade Estadual Paulista (UNESP) / Os cateteres venosos centrais são muito usados nas Unidades de Terapia Intensiva (UTIs). O seu uso está freqüentemente associado a complicações incluindo infecções fatais. Durante o período de janeiro de 2004 a janeiro de 2005, foram analisadas 118 pontas de cateteres e 42 amostras de sangue provenientes de 100 pacientes hospitalizados em Unidade de Terapia Intensiva de um hospital da região Noroeste do estado de São Paulo. O objetivo deste estudo foi analisar, por meio de cultura e microscopia eletrônica de varredura, a colonização do cateter intravenoso central de vialon Intracath de lúmem único. Para detectar a produção de slime dos microrganismos isolados foi usado o método de Christensen et al., (1985) e o perfil de sensibilidade aos antimicrobianos de acordo com o (NCCLS-M2-A7-2000). Das 118 pontas de cateteres estudadas pelo método semi-quantitativo, 34 (28,8%) estavam colonizadas (d15 UFC/placa) em que foram isolados 55 microrganismos. Desses, 32 (58,2%) foram classificados como Gram-positivos com freqüência maior para 15 (27,3%) Staphylococcus aureus, seis (10,9%) Staphylococcus epidermidis; 19 (34,5%) classificados como Gram-negativos com freqüência maior para seis (10,9%) Acinetobacter baumannii, três (5,4%) Pseudomonas aeruginosa, Enterobacter aerogenes respectivamente e ainda quatro (7,3%) classificadas como leveduras sendo duas (3,6%) Candida albicans e duas (3,6%) Candida parapsilosis.... / The aim of the present study was to evaluate the hepatotoxicity, pharmacokinetic parameters and biotransformation of isoniazid when rats were treated with isoniazid (INH); rifampicin (RMP); and INH + RMP. Daily doses of the tuberculostatic drugs were administrated intragastrically to the animals (Wistar rats) for one period of 21 days as follow: sterile water (group I, control); INH (100mg/Kg) (group II), RMP (100mg/Kg) (group III); INH (100mg/Kg) + RMP (100mg/Kg) (group IV). The serum levels of the biomarkers aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were determined before the administration of the drugs (basal) and after the 21 days treatments. On day 21, blood samples were obtained before and 15þ; 30þ; 45þ; 60þ; 1,5; 3h; 6h; 12h and 24 hours after the dose. (five animals for each point). The blood samples were deproteinized with 10% trichloroacetic acid, derivatized by 1% cinnamaldehyde and analyzed by liquid chromatograph. For the determination of the acetylated metabolites acetylisoniazid (AcINH) and acetylhydrazine (AcHz) a previous hydrolysis with 6 M hydrochloride acid was performed. The results are presented as mean and SEM. ...(Complete abstract, click electronic address below).

Lowering of central venous pressure in hepatic surgery is nowadays widely recommended and used procedure. Low central venous pressure anesthesia is associated with decreased blood loss and improved clinical outcome. There are several approaches how to reach low central venous pressure. Till now none of them is recommended as superior in terms of patient safety and clinical outcome. Concurrently there is still debate if to use the low central venous pressure anesthesia principle or if it could be replaced with a principle of anesthesia with high stroke volume variation (or another dynamic preload parameter) with the use of a more sophisticated hemodynamic monitoring method. Results of our study didn't show any significant difference between two approaches used for reduction of central venous pressure, but suggest that the principle of low central venous pressure anesthesia could be possibly replaced by the principle of high stroke volume variation anesthesia which presumes the use of advanced hemodynamic monitoring. KEYWORDS Hepatic resection, central venous pressure, Pringle maneuver, hemodynamics, hemodynamic monitoring, fluid therapy, anesthesia

Os pacientes submetidos ao transplante de células-tronco hematopoéticas (TCTH) necessitam da inserção do cateter venoso central (CVC) de longa permanência e semi-implantado. No entanto, a obstrução trombótica do CVC é uma complicação que pode ocasionar o funcionamento inadequado do dispositivo intravascular e levar sua remoção precoce. Este estudo trata-se de uma revisão integrativa da literatura, com o objetivo de sintetizar as medidas relacionadas à prevenção e tratamento da obstrução trombótica relacionada ao CVC de longa permanência e semi-implantado, nos pacientes submetidos ao TCTH. A amostra constituiu-se de sete estudos primários, sendo dois ensaios clínicos randomizados, três estudos de coorte e duas séries de casos. Quanto as categorias temáticas, quatro estudos abordaram medidas de prevenção da obstrução trombótica relacionada ao CVC, dois estudos abordaram as medidas de tratamento e um abordou as medidas de prevenção e tratamento. Dentre os estudos que abordaram medidas de prevenção, obteve-se um único que se mostrou efetivo na prevenção da obstrução, trata-se de um coorte sobre o uso da varfarina oral, iniciado no dia da inserção do dispositivo venoso central. Os demais estudos não evidenciaram diferenças estatisticamente significantes entre o tratamento padrão e a intervenção testada. Quanto às medidas de tratamento, três estudos evidenciaram sucesso, sendo que um apontou a eficácia do uso de estreptoquinase ou uroquinase, outro estudo mostrou benefício no uso de heparina de baixo peso molecular e outro tratou a obstrução com heparina e uroquinase com sucesso. Nota-se que a evolução da pesquisa referente a perviedade do CVC foi restrita, não acompanhando a evolução da terapia com CTH, principalmente, no que tange os cuidados de enfermagem, visto que todos tratam de intervenções medicamentosas, sem abordar os aspectos não medicamentosos, como, por exemplo, volume e freqüência do flush com solução fisiológica, descrição da técnica com pressão positiva, tamanho ideal da seringa, pressão exercida durante a infusão de medicamentos e dispositivos para vedação dos lumens do cateter com pressão positiva. Tais resultados mostram a necessidade da realização de novos estudos controlados, para testar as intervenções de enfermagem na prevenção da obstrução trombótica relacionada ao cateter. / Patients submitted to hematopoietic stem cell transplantation (HSCT) need indwelling and semi-implanted central venous catheterization. Thrombotic obstruction of CVC, however, is a complication that can lead to the inadequate functioning of the intravascular device and its early removal. This integrative literature review aimed to summarize measures for the prevention and treatment of thrombotic obstruction related to indwelling and semi-implanted CVC, in patients submitted to HSCT. The sample included seven primary studies, with two randomized clinical trials, three cohorts and two case series. As for the theme categories, four studies discussed CVC-related thrombotic obstruction prevention measures, two addressed treatment measures and one prevention and treatment measures. Among the studies that discussed prevention measures, one single research showed effective obstruction prevention, which was a cohort on the use of oral warfarin, started on the day the central venous device was inserted. The other studies showed no statistically significant differences between standard treatment and the tested intervention. Regarding treatment measures, three studies showed to be successful: one appointed the efficacy of streptokinase or urokinase use, another showed the benefits of using low molecular weight heparin and the third successfully treated the obstruction with heparin and urokinase. The restricted evolution of research regarding CVC patency was observed, which did not accompany the evolution of HSC therapy, mainly regarding nursing care, as all addressed discuss medication interventions, without discussing non-medication aspects, such as the flush volume and frequency with physiological salt solution, description of positive pressure technique, ideal syringe size, pressure exerted during medication infusion and catheter lumen sealing devices with positive pressure. These results show the need for further controlled studies to test nursing interventions in the prevention of catheter-related thrombotic obstruction.

Submitted by ALINI CORRÊA null (alinicorrea@yahoo.com.br) on 2018-03-18T22:49:51Z No. of bitstreams: 1 Dissertação de Mestrado Final 02 fev 2018 Final - Aline.pdf: 2102740 bytes, checksum: 20c05cd86371335809d233c979ef6968 (MD5) / Approved for entry into archive by Luciana Pizzani null (luciana@btu.unesp.br) on 2018-03-19T14:26:56Z (GMT) No. of bitstreams: 1 correa_a_me_bot.pdf: 2102740 bytes, checksum: 20c05cd86371335809d233c979ef6968 (MD5) / Made available in DSpace on 2018-03-19T14:26:56Z (GMT). No. of bitstreams: 1 correa_a_me_bot.pdf: 2102740 bytes, checksum: 20c05cd86371335809d233c979ef6968 (MD5) Previous issue date: 2017-09-01 / Introdução: Os serviços de urgência e emergência têm o objetivo de diminuir a morbimortalidade e as sequelas incapacitantes. A capacidade médica e da equipe de enfermagem para a passagem do cateter venoso central se explica pelo fato dos riscos existentes na realização desse procedimento. As complicações relacionadas a cateter venoso central incluem punção de artéria carótida, pneumotórax, hemotórax, tamponamento cardíaco, infecções, embolia e hidrotórax. Objetivo: O objetivo deste estudo foi avaliar o procedimento de passagem de cateter venoso central realizado pela equipe médica em pacientes atendidos em sala de emergência. Metodologia: Trata-se de estudo clínico epidemiológico, transversal, descritivo e observacional com 104 pacientes que deram entrada na sala de emergência adulto do pronto-socorro referenciado de um hospital público do interior de São Paulo, caracterizado como hospital terciário, onde realiza atendimento ao paciente pelo Sistema Único de Saúde. A coleta de dados foi realizada no período de 01/08/2016 a 01/12/2016 pela pesquisadora e por cinco enfermeiros previamente treinados contemplando os turnos de trabalho diurno e noturno. Para as avaliações foi utilizado um instrumento de coleta de dados baseado nos padrões de conformidade do ministério da saúde para a passagem de cateter venoso central, dados do prontuário eletrônico do paciente e resultados de cultura de ponta de cateter e hemocultura central e periférica dos pacientes que foram submetidos ao procedimento de cateter venoso central. Resultados e Discussão: Foram analisados 104 pacientes com idade variando entre 26 a 87 anos, sendo 51,9% do sexo masculino. Destes pacientes, 53 (51%) eram do município de Botucatu e 72,1% da especialidade clínica, A indicação do uso de cateter venoso central se deu em sua maioria por droga vasoativa (58,7%) seguida de gravidade (43,3%). Houve associação significante entre idade e complicações durante a passagem de cateter venoso central (OR=0,94, p=0,033). A chance de complicação em função do número de procedimento foi menor em homens bem como a chance de óbito. A chance de infecção em função ao número de procedimentos foi menor nos homens. A chance de óbito foi significativa menor em função ao número de procedimentos em relação a especialidade cirúrgica quando comparada com a clínica A chance de pacientes com trauma evoluírem a óbito foi de 20 vezes maior e de pacientes graves 13 vezes maior. Em pacientes graves. Sabe-se que o uso do cateter venoso central não é isento de complicações. Tradicionalmente, os dispositivos são inseridos por meio de técnica de reparos anatômicos externos na qual a visualização e a palpação de reparos anatômicos servem de referência para se inferir o melhor local para punção. No entanto, essa técnica é sujeita a falhas, principalmente por conta de variações anatômicas na população e também por falta de protocolo pré-estabelecido. Conclusão: Perante todos os achados do estudo, foi desenvolvido, um protocolo de passagem de acesso venoso central que será apresentado a equipe de infecção hospitalar do Hospital das Clínicas e posteriormente implantado no pronto-socorro para que os profissionais médicos sigam um padrão de execução do procedimento de passagem de CVC. / Introduction: Emergency and emergency services aim to reduce morbidity and mortality and disabling sequelae. The medical and nursing team's ability to pass the central venous catheter is explained by the fact that there are risks involved in performing this procedure. Complications related to central venous catheters include carotid artery puncture, pneumothorax, hemothorax, cardiac tamponade, infections, embolism and hydrothorax. Objective: The objective of this study was to evaluate the procedure of central venous catheter passage performed by the medical team in patients seen in an emergency room. Methodology: This is a cross-sectional, descriptive, and observational epidemiological study of 104 patients admitted to the emergency room of the referenced emergency room of a public hospital in the interior of São Paulo, characterized as a tertiary hospital managed by the Sistema Único The data collection was performed in the period from 08/01/2016 to 01/12/2016 by the researcher and by five nurses previously trained contemplating the shifts of day and night work. For the evaluations, a data collection instrument was used following the compliance standards of the ministry of health and the pre-established protocol of the University of the State of São Paulo for the passage of a central venous catheter, data from the patient's electronic medical record, and results of Culture of the catheter and central and peripheral blood cultures of the patients who underwent the central venous catheter procedure. Results and Discussion: A total of 104 patients, ranging from 26 to 87 years old, were analyzed, 51.9% of whom were male. Of these patients, 53 (51%) were from the city of Botucatu and 72.1% from the clinical specialty. The indication for the use of central venous catheter was mostly vasoactive (58.7%) followed by severity (43, 3%). There was a significant association between age and complications during the passage of a central venous catheter (OR = 0.94, p = 0.033). The chance of complication due to the number of procedure was lower in men as well as the chance of death. The chance of infection due to the number of procedures was lower in men. The chance of death was significantly lower due to the number of procedures compared to the surgical specialty when compared to the clinic. The chance of patients with trauma evolving to death was 20 times higher and that of severe patients 13 times greater. In severe patients. It is known that the use of the central venous catheter is not free of complications. Traditionally, the devices are inserted through an external anatomical repair technique in which the visualization and palpation of anatomical repairs serve as a reference to infer the best place for puncture. However, this technique is subject to failures, mainly due to anatomical variations in the population and also due to lack of pre-established protocol. Conclusion: In view of all the findings of the study, a central venous access protocol was developed as a product that will be presented to the hospital infection team of the Hospital das Clínicas and later implanted in the emergency room so that medical professionals follow a pattern of Application of procedure.

Made available in DSpace on 2014-12-17T14:13:48Z (GMT). No. of bitstreams: 1 AnaluciaFGB_DISSERT.pdf: 1230364 bytes, checksum: 6032df4ca0cbafaa9bb3b4fae914b890 (MD5) Previous issue date: 2010-05-05 / This is a study descriptive cross-sectional and quantitative approaches, which aimed to analyze the association between hospital infection rate for insertion, maintenance of central venous catheter and the breakdown of protocols (rules and routines) by health professionals assisting patients in the ICU of a university hospital in Natal / RN. The process of data collection was through observation with structured form, refers to medical records and structured questionnaires with health professionals. The results were organized, tabulated, categorized and analyzed using SPSS 14.0. The characterization of the subjects was performed using descriptive and inferential statistics, taking into account the nature of the variables, with analysis of variance (ANOVA) and Spearman correlation test, it was a discussion of the information obtained, considering the mean, standard deviation, coefficient of variance and standard error. The variables that showed a higher level of correlation were treated with the application of significance tests. As the results, 71% of participants were female and 29% male, age ranged from 18 to 85 years (52.6 ? 22.5). The insertion, there was a variation from 0 to 5 errors (1.2 ? 1.4), during maintenance, the average was 2.3 ? 0.9 errors, ranging from 0 to 4. During the insertion and maintenance of CVC, patients who had been an infection ranging from 2 to 9 mistakes (4.2 ? 1.7), since those who did not show the variation goes from 0 to 5 errors (2, 8 ? 1.5). The correlation coefficient between the risk of infection throughout the process and the risk of infection at the insertion showed strong and significant (r = 0.845 p = 0.000) and in relation to risk of infection in maintenance was moderate and significant (r = 0.551 p = 0.001). The mistakes made by professionals in the procedures for insertion and maintenance of the catheter, associated with other conditions, shown as a risk factor for the of IH / Trata-se de uma pesquisa descritiva com delineamento transversal e abordagens quantitativas, que objetivou analisar a associa??o entre o ?ndice de infec??o hospitalar por inser??o, manuten??o de cateter vascular (cateter venoso central) e a quebra de protocolos (normas e rotinas) pelos profissionais de sa?de que assistem pacientes na UTI de um hospital universit?rio em Natal/RN. O processo de coleta de dados ocorreu por meio de observa??o, que para subsidi?-la utilizou-se um formul?rio estruturado, consulta ao prontu?rio e aplica??o de question?rio estruturado com os profissionais de sa?de. Os resultados foram organizados, tabulados, categorizados e analisados no programa SPSS 14.0. A caracteriza??o dos sujeitos foi realizada por meio de estat?stica descritiva e inferencial, levando-se em conta ? natureza das vari?veis estudadas, com an?lise de vari?ncia (ANOVA) e de teste Correla??o Spearman, em que foi apresentada uma discuss?o das informa??es obtidas, considerando-se a m?dia, desvio padr?o, coeficiente de vari?ncia e erro-padr?o. As vari?veis que apresentaram maior n?vel de correla??o foram tratadas com a aplica??o de testes de signific?ncia. Quanto aos resultados, 71% dos pacientes eram do sexo feminino e 29% masculino, a idade variou de 18 a 85 anos (52,6 ? 22,5). Na inser??o, observou-se uma varia??o de 0 a 5 erros (1,2 ? 1,4), durante a manuten??o, a m?dia foi de 2,3 ? 0,9 erros, variando de 0 a 4. Durante o processo de inser??o e manuten??o de CVC, naqueles pacientes que apresentaram infec??o houve uma varia??o de 2 a 9 erros (4,2 ? 1,7), j? nos que n?o apresentaram, a varia??o foi de 0 a 5 erros (2,8 ? 1,5). A correla??o de Spearman entre o risco de infec??o em todo processo e o risco de infec??o na inser??o mostrou-se forte e significante (r =0,845 p= 0,000) e em rela??o ao risco de infec??o na manuten??o foi moderada e significante (r= 0,551 p=0,001). Os erros cometidos pelos profissionais nos procedimentos de inser??o e manuten??o do cateter, associados ?s outras condi??es, mostraram-se como um fator de risco para o desenvolvimento de IH

Introdução: A cateterização venosa central caracteriza-se pelo posicionamento de um dispositivo vascular cuja extremidade alcance o terço final da veia cava superior, independente do local de inserção. Grande parte dos pacientes com afecções cardiopulmonares são eletivos à sua implantação, por apresentarem rede venosa periférica fragilizada e necessidade de infusão prolongada de soluções. No entanto, tal procedimento possui caráter invasivo, associado a complicações. Objetivos: Analisar as complicações relacionadas ao uso de cateter venoso central semi-implantável não tunelizado. Material e método: Estudo de coorte prospectivo (6 meses) realizado em unidades de terapia intensiva e clínicas médico-cirúrgicas do Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, em pacientes adultos com afecções cardiopulmonares em uso de cateter central de inserção periférica (PICC) ou cateter de duplo lúmen (CDL), pela observação diária do cateter até sua retirada ou saída hospitalar, associada a consultas ao prontuário para obter informações sobre paciente e condições do cateter. Variáveis de estudo relacionadas a dados demográficos e de morbidade, de inserção de cateter, de uso e manutenção, de complicações relacionadas ao uso de cateter, de remoção de cateter. Análise de dados: Medidas de tendência central e de variabilidade, teste de qui-quadrado ou Mann-Whitney para dados qualitativos, teste t-students e ANOVA ou teste de Kruskall-Wallis para comparação de médias. Resultados: Houve predominância dos CDL, utilizados em 127 (67,2%) situações, e o PICC em 62 (32,8%). Dos cateteres, 55 (43,3%) CDL e 21 (37,0%) PICC apresentaram algum tipo de complicação. Houve diferença estatística (p=0,017) entre as complicações de acordo com os tipos de PICC, sendo maior nos de ponta aberta. Houve diferença entre as complicações de acordo com os sítios de inserção, porém sem diferença estatística (p=0,479). A obstrução ocorreu em apenas 3,9% (5) dos CDL, enquanto que nos PICCs esteve presente em 11,3% (7) dos casos. A flebite grau 1 esteve presente em 23 (18,1%) casos de CDL e 10 (16,1%) casos de PICC. O exsudato purulento no CDL foi verificado em 9 (7,0%) casos, enquanto que no PICC esteve presente em apenas 1 (1,6%) dispositivo. A exteriorização esteve presente apenas nos CDL, ocorrendo em 9 (7%) casos. A suspeita de trombose foi verificada em 3 (4,8%) casos de PICC, sendo confirmada em apenas 1 (1,6%) deles, assim como a ruptura, presente em apenas 1 (1,6%) PICC. O tempo de permanência do CDL foi de 8,8 (±6,8) dias em média (mediana de 8) com variação de 1 a 38 dias. No caso do PICC, teve média de 19,4 (±21) dias (mediana de 14) e variação de 1 a 141 dias. A suspeita de infecção foi maioria, sendo que no CDL esteve presente em 30 (23,6%) casos e no PICC em 9 (14,5%). Apenas em 1 (2,6%) CDL foi confirmada infecção de corrente sanguínea associada ao cateter, com ponta de cateter e hemocultura positivas para Chryseobacterium Indologenes. Conclusão: A suspeita de infecção foi a complicação com maior incidência, porém confirmada em apenas um caso. Não houve diferença estatística significava entre as densidades de incidência de complicação do CDL e do PICC.Os resultados encontrados indicam a necessidade de acompanhamento de maior número de dispositivos por mais tempo e que as principais estratégias para prevenção de complicações nesta população continua sendo o cuidado diário na manutenção dos mesmos. / Introduction: Central venous catheterization is characterized by positioning a vascular device whose end reaches the final third of the superior vena cava, regardless of the insertion site. Most patients with cardiopulmonary diseases are elective for its implementation, for presenting a fragile peripheral venous network and need for prolonged infusion solutions. However, this procedure presents invasive character associated with complications. Aim: Analyze the complications related to the use of non-tunneled semi-implantable central venous catheter. Methods: A prospective cohort study (6 months) conducted in intensive care units and medical-surgical clinics from the Heart Institute of the Medicine Course in University of São Paulo (USP), in adult patients with cardiopulmonary diseases in using peripherally inserted central catheter (PICC) or double lumen catheter (CDL), the daily observation of the catheter until its withdrawal or hospital discharge, associated with access to medical records for information on the patient and the catheter conditions. Study variables related to morbidity and demographics data, catheter insertion, use and maintenance, complications related to the use of catheter, catheter removal. Anlysis: Measures of central tendency and variability, chi-square test or Mann-Whitney test for qualitative data, students t-test and ANOVA or Kruskal-Wallis test to compare means. Results: There was a predominance of CDL, used in 127 (67.2%) cases, and the PICC in 62 (32.8%). As of the catheters, 55 (43.3%) CDL and 21 (37.0%) PICC had some type of complication. There was a statistical difference (p = 0.017) among the complications according to the types of PICC, being it higher in the open ended ones. There were differences between the complications according to the insertion sites, however, with no statistical difference (p = 0.479). Obstruction occurred in only 3.9% (5) of the CDL, while in PICCs it was present in 11.3% (7) of the cases. The phlebitis grade 1 was present in 23 (18.1%) cases of CDL and 10 (16.1%) cases of PICC. The purulent exudate in the CDL was observed in 9 (7.0%) cases while in PICC was present in only 1 (1.6%) device. The manifestation was present only in the CDL, occurring in 9 (7%) cases. The suspicion of thrombosis was seen in 3 (4.8%) PICC being confirmed in only 1 (1.6%) of them, as well as the rupture present in only 1 (1.6%) PICC. The CDL length of stay was 8.8 (± 6.8) days on average (median 8) ranging from 1 to 38 days. In the case of PICC, it averaged 19.4 (± 21) days (median 14) and ranged 1-141 days. The suspected infection was the majority, being present in CDL in 30 (23.6%) cases and in PICC in 9 (14.5%). In only 1 (2.6%) CDL a bloodstream infection associated with the catheter was confirmed, with tipped catheter and positive blood culture for Chryseobacterium indologenes. Conclusion: The suspected infection was the complication with highest incidence, but confirmed in only one of the cases. There was no statistical difference between the densities of incidence of complication of CDL and PICC. The results indicate the need for monitoring in longer and greater number of devices, and that the main strategies to prevent complications in this population remains the daily care in their maintenance