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Nursing Interventions for Hemodialysis Patients

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Nursing Interventions for Hemodialysis Patients ISSN: 1981-8963 DOI: 10.5205/reuol.10544-93905-1-RV.1103201702 Guimarães GL, Goveia VR, Mendonza IYQ et al. Nursing interventions for hemodialysis... ORIGINAL ARTICLE NURSING INTERVENTIONS FOR HEMODIALYSIS PATIENTS THROUGH CENTRAL VENOUS CATHETER INTERVENÇÕES DE ENFERMAGEM NO PACIENTE EM HEMODIÁLISE POR CATETER VENOSO CENTRAL INTERVENCIONES DE ENFERMERÍA EM EL PACIENTE EN HEMODIÁLISIS POR CATÉTER VENOSO CENTRAL Gilberto de Lima Guimarães1, Vânia Regina Goveia2, Isabel Yovana Quispe Mendonza3, Allana dos Reis Corrêa4, Selme Silqueira de Matos5, Juliana Oliveira Guimarães6 ABSTRACT Objective: to discuss nursing interventions undertaken by nurses to nursing prescription in patients using temporary double-lumen central catheters for hemodialysis based on the Nursing Intervention Classification. Method: descriptive exploratory study with quantitative approach conducted in a private hemodialysis unit in the state of Minas Gerais (MG), Brazil, with 57 patients, aged >18 years and <60 years undergoing treatment for 90 days. Results: two nursing interventions were identified: care with the vascular device; maintaining access for dialysis. Eight activities were selected: measuring temperature; occlusive dressing; monitoring signs and symptoms of infection; maintaining the aseptic technique; standard precaution; changing protectors; use of heparin in the lumen; guiding the patient and the family. Conclusion: nursing intervention is effective for maintaining the catheter, controlling and avoiding complications; it has scientific basis and promotes safety and well-being. The nurse must perform nursing care in patients using temporary double-lumen central venous catheter. Descriptors: Renal Dialysis; Renal Insufficiency; Catheters; Quality of life; Nursing. RESUMO Objetivo: discutir as intervenções de enfermagem assumidas por enfermeiros para a prescrição de enfermagem nos pacientes em hemodiálise por cateter venoso central temporário de duplo lúmen a partir da Classificação das Intervenções de Enfermagem. Método: estudo descritivo-exploratório, de abordagem quantitativa, realizado em unidade de hemodiálise privada, no interior do estado de Minas Gerais (MG), Brasil, com 57 pacientes, idade >18 anos e < 60 anos, em tratamento há 90 dias. Resultados: foram identificadas duas intervenções de enfermagem: cuidados com o dispositivo vascular; manutenção do acesso para diálise. Selecionadas oito atividades: aferir temperatura; curativo oclusivo; monitorar sinais e sintomas de infecção; manter técnica asséptica; precaução padrão; trocar protetores; uso de heparina no lúmen; orientar o paciente e familiares. Conclusão: a intervenção de enfermagem é efetiva para a manutenção do cateter, controle e combate de suas complicações; possui base científica, promove a segurança e bem-estar. O enfermeiro deve realizar o cuidado de enfermagem no paciente em uso de cateter venoso central temporário de duplo lúmen. Descritores: Diálise Renal; Insuficiência Renal; Cateteres; Qualidade de Vida; Enfermagem. RESUMEN Objetivo: discutir las intervenciones de enfermería asumidas por enfermeros para la prescripción de enfermería en los pacientes en hemodiálisis por catéter venoso central temporario de doble lumen a partir de la Clasificación de las Intervenciones de Enfermería. Método: estudio descriptivo-exploratorio, de enfoque cuantitativo, realizado en unidad de hemodiálisis privada, en el interior del estado de Minas Gerais (MG), Brasil, con 57 pacientes, edad >18 años y < 60 años, en tratamiento hace 90 días. Resultados: fueron identificadas dos intervenciones de la enfermería: cuidados con el dispositivo vascular; mantenimiento del acceso para diálisis. Seleccionadas ocho actividades: medir temperatura; curativo oclusivo; monitorear señales y síntomas de infección; mantener técnica aséptica; precaución padrón; cambiar protectores; uso de heparina en el lumen; orientar al paciente y familiares. Conclusión: la intervención de enfermería es efectiva para el mantenimiento del catéter, control y combate de sus complicaciones; posee base científica, promueve la seguridad y bien estar. El enfermero debe realizar el cuidado de enfermería en el paciente en uso del catéter venoso central temporario de doble lumen. Descriptors: Diálisis Renal; Insuficiencia Renal; Catéteres; Calidad de Vida; Atención de Enfermería. 1Nurse, PhD (Post-Doctor), Graduated in Nursing, Federal University of Minas Gerais/UFMG. Belo Horizonte (BH), Brazil. Email: [email protected]; 2Nurse, PhD Professor, Graduated in Nursing, Federal University of Minas Gerais/UFMG. Belo Horizonte (BH), Brazil. Email: [email protected]; 3Nurse, Professor, Undergraduate/Graduate Nursing Program/PPGENF, Federal University of Minas Gerais/UFMG. Belo Horizonte (BH), Brazil. Email: [email protected]; 3Nurse, Professor, Undergraduate/Graduate Nursing Program/PPGENF, Federal University of Minas Gerais/UFMG. Belo Horizonte (BH), Brazil. Email: [email protected]; 2Nurse, PhD Professor, Graduated in Nursing, Federal University of Minas Gerais/UFMG. Belo Horizonte (BH), Brazil. Email: [email protected]; 6Graphic Design, Communication Assistance, Faculty of Medicine, Federal University of Minas Gerais/UFMG. Belo Horizonte (BH), Brazil. Email: [email protected] English/Portuguese J Nurs UFPE on line., Recife, 11(3):1127-35, Mar., 2017 1127 ISSN: 1981-8963 DOI: 10.5205/reuol.10544-93905-1-RV.1103201702 Guimarães GL, Goveia VR, Mendonza IYQ et al. Nursing interventions for hemodialysis... trained professionals using maximum INTRODUCTION protection barriers, such as use of fields, Chronic kidney disease (CKD) has diabetes gloves and sterile aprons, beanies, goggles and hypertension as main causes and has and masks. Studies show that the incidence of become a worldwide public health problem central venous catheter infection in ICU due to its high prevalence rate. Because of patients is less than 8% over two weeks. In one this, increasing numbers of patients need month, 25% of catheters become infected and dialysis therapy for the rest of life, due to the this percentage doubles in the second month. irreversible failure of renal function. In Brazil, Catheter-related sepsis may occur between 2% estimates of the Brazilian Society of and 20% of cases. This calls for reflections on Nephrology indicate that there are 100,397 the use of CVC in hemodialysis patients, and patients undergoing dialysis, and that the for criticism on aspects related to its use and number is increasing in the order of 3% per maintenance.1,7-8 year.1-3 In the United States, more than 200,000 The substitutive method employed on large patients need hemodialysis and 30% do so scale in patients with chronic kidney failure through a catheter. It is estimated that (CKF) in Brazil and worldwide is hemodialysis. 250,000 catheters are implanted per year and This therapy requires a technological 87% of bloodstream infections are caused by apparatus involving machinery, materials, them. In Brazil, the overall rate of catheter- trained professionals and the preparation of related bloodstream infection is 17.05/1000 vascular access (VA) in the patient. The latter invasive devices per day, considering a can be obtained basically through two ways; percentile of 95%. This situation entails cost by creating an arteriovenous fistula (AVF) or to the health system because it can lead to by implanting a double-lumen central venous hospitalization, increasing the cost of catheter.4 treatment and reducing the quality of life of The catheter can be classified as long or hemodialysis patients, besides increasing short term. The first is implemented by a morbidity and mortality.6-7 vascular surgeon and has one or more Dacron Thus, the safe handling of CVC should be a cuff in its structure. The aim is to form a priority of the entire nursing staff that mechanical barrier against microorganism provides assistance to these patients, so that penetration in the subcutaneous and vascular technical and monitoring rigor and bed. The second type, the temporary double- surveillance happen to prevent and control lumen catheter (CVC), is usually implemented possible adverse events. Considering the by a nephrologist through percutaneous complexity of deployment and use of this type technique and has no cuff. This is one of the of vascular access, technical standardization main alternatives to obtain VA used in is indispensable. It is also important to note domestic clinical practice and its prevalence that prevention and control of CVC-related is 9.4%.2,5 complications are mostly of the nursing staff There is a tight link between the process of responsibility. This must ensure the quality of hemodialysis and life maintenance, as this health care, promoting safety for patients and treatment partially replaces kidney functions. professionals.6-7 For this, systematic nursing action becomes The justification and relevance of the study necessary for patient care in hemodialysis CVC is in the fact that the CVC is widely used in for maintenance and prevention against hemodialysis patients. Its use requires complications, whether infectious, thrombotic engagement from nurses in order to minimize or traumatic. The CVC is the faster and more risks to health by reducing morbidity and secure option of central venous access in the mortality in this clientele. Therefore, it is case of hemodialysis for short periods of necessary to know the nursing interventions time.1 used in the care of patients using CVC, so that The use of CVC was introduced in the mid the
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