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Infection Control Related to Central Venous Catheter Impregnated with Antiseptics: an Integrative Review

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Infection Control Related to Central Venous Catheter Impregnated with Antiseptics: an Integrative Review A RTIGO Controle de infecção relacionada a cateter venoso central impregnado com antissépticos: revisão integrativa* DE R EVISÃO INFECTION CONTROL RELATED TO CENTRAL VENOUS CATHETER IMPREGNATED WITH ANTISEPTICS: AN INTEGRATIVE REVIEW CONTROL DE INFECCIÓN RELACIONADA CON CATÉTER VENOSO CENTRAL IMPREGNADO CON ANTISÉPTICOS: REVISIÓN INTEGRADORA Maria Verônica Ferrareze Ferreira1, Denise de Andrade2, Adriano Menis Ferreira3 RESUMO ABSTRACT RESUMEN O uso de cateter venoso central é aponta- The use of central venous catheter is poin- El uso de catéter venoso central es señalado do como um dos principais fatores para in- ted out as a risk factor to blood stream como uno de los principales factores de in- fecção da corrente sanguínea. Objetiva-se, infection. The objective of this study was fección de la corriente sanguínea. El estudio neste estudo, buscar evidências científicas to reach scientific evidence on infection objetiva buscar evidencias científicas sobre sobre o controle de infecção relacionada control related to central venous catheter control de infección relacionada con catéter ao cateter venoso central impregnado com impregnated with antiseptics, used in hos- venoso central impregnado con antisépticos antissépticos utilizado em pacientes adultos pitalized adult patients. Studies were selec- utilizado en pacientes adultos hospitaliza- hospitalizados. Para seleção dos estudos, ted from the LILACS, CINAHL and MEDLINE dos. Para seleccionar estudios se utilizaron foram utilizadas as bases de dados LILACS, databases. Nine articles were selected by las bases de datos LILACS, CINAHL y ME- CINAHL e MEDLINE. Totalizaram-se nove means of integrative literature review. The DLINE. Se totalizaron 9 artículos mediante artigos por meio da revisão integrativa da li- publications on the use of catheters im- revisión integradora de literatura. Las publi- teratura. As publicações acerca da utilização pregnated with antiseptics showed statis- caciones referidas a utilización de catéteres de cateteres impregnados com antissépti- tically significant differences regarding the impregnados con antisépticos mostraron cos mostraram diferença estatisticamente reduction of microbial colonization; howe- diferencias estadísticamente significantes significante quanto à redução da coloniza- ver, only one study showed reduction in the en lo referente a reducción de colonización ção microbiana. Entretanto, apenas um es- occurrence of infection. The analysis of the microbiana, mientras apenas un estudio tudo demonstrou redução na ocorrência da studies revealed there is a need for further demostró reducción de ocurrencia de infec- infecção. Diante das análises dos estudos, research in different patient populations in ción. Ante el análisis de los estudios, existe há necessidade de pesquisas adicionais em order to obtain general conclusions. necesidad de investigaciones adicionales en diferentes populações de pacientes com a diferentes poblaciones de pacientes con la finalidade de efetuar generalizações. finalidad de efectuar generalizaciones. DESCRITORES DESCRIPTORS DESCRIPTORES Infecção hospitalar Cross infection Infección hospitalaria Controle de infecções Infection control Control de infecciones Cateterismo venoso central Catheterization, central venous Cateterismo venoso central Bacteremia Bacteremia Bacteriemia Medicina baseada em evidências Evidence-based medicine Medicina basada en evidencia * Extraído da dissertação “Revisão Integrativa do controle de infecção relacionada a cateter venoso central: bases para a prática baseada em evidências”, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, 2007. 1 Enfermeira. Mestre em Enfermagem Fundamental pela Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo. Ribeirão Preto, SP, Brasil. [email protected] 2 Professora Livre Docente do Departamento de Enfermagem Geral e Especializada da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo. Ribeirão Preto, SP, Brasil. dandrade@ eerp.usp.br 3 Enfermeiro. Pós-Doutor pela Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo. Professor Doutor do Departamento de Enfermagem da Universidade Federal de Mato Grosso do Sul. Três Lagoas, MT, Brasil. [email protected] Rev Esc Enferm USP Recebido: 16/12/2008 Controle de infecção relacionada aP cateterortuguês venoso / Inglês central 2011; 45(4):1002-6 Aprovado: 18/11/2010 impregnado com antissépticos: revisãowww.scielo.br/reeusp integrativa 1002 www.ee.usp.br/reeusp/ Ferreira MVF, Andrade D, Ferreira AM INTRODUÇÃO Os critérios de inclusão foram: artigos disponíveis na in- tegra; o uso de cateter venoso central sem cuff, não tuneli- A infecção associada ao cuidado à saúde é uma séria zado, de curta permanência, impregnado com antissépticos problemática e um desafio em âmbito mundial ainda mais utilizado em pacientes adultos hospitalizados; indexados nas diante da variabilidade de procedimentos diagnósticos e bases supracitadas; publicados em inglês, espanhol e portu- terapêuticos. guês, no período de 1996 a 2006, com Níveis de evidência I e II, de acordo Ganong(5), e com classificação de Steller(6). Especificamente, a infecção relacionada ao cateter vascular é preocupante face a sua gravidade e letalida- de(1-2). Tem etiologia complexa e multifatorial. Estudos RESULTADOS E DISCUSSÃO destacam a situação clínica do paciente, o tipo de cate- ter, sua composição, a técnica de inserção, a localização, Totalizou-se nove publicações acerca do CVC impreg- a frequên cia de manipulação do sistema e a duração da nado com antissépticos, das quais sete (77,8%) correspon- cateterização aspectos que merecem atenção. deram a ensaios clínicos randomizados controlados (nível II de evidência), e duas (22,2%) à meta-nálises (nível I de O uso de antissépticos tem sido investigado como uma evidência). Todas as publicações pertenceram ao idioma das possibilidades de modificar as propriedades da super- inglês. O Quadro 1 representou uma sinopse dos princi- fície do dispositivo, e diminuir a colonização microbiana pais aspectos analisados nas publicações. do cateter. O reconhecimento dessa possibilidade tem implementado nas últimas décadas o uso de cateteres im- Os pesquisadores dos ensaios clínicos randomizados pregnados com antissépticos(1-3). avaliaram a eficácia da utilização de CVC impregnados com clorexidine e sulfadiazina de prata na super- Diante do exposto, o presente estudo fície externa quanto à redução de infecções utilizou a Prática Baseada em Evidências ...estabeleceu-se relacionadas a cateteres(7-12). (PBE), uma vez que sua abordagem pro- com objetivo principal porciona a aplicação sistemática da melhor Os estudos demonstraram que a maioria evidência disponível para a avaliação de op- desse estudo, buscar dos pacientes esteve sob elevado risco de in- ções e tomada de decisão no cuidado inte- evidencias sobre a fecção relacionada a cateter. Quanto ao núme- gral do paciente(4). associação entre ro de lumens, a maioria correspondeu a duplo o uso de Cateter e triplo-lúmen. Nesse contexto, uma meta- Nesse sentido, estabeleceu-se como -análise demonstrou que aqueles com múlti- Venoso Central objetivo principal desse estudo buscar evi- plos lumens tiveram maior possibilidade de in- dências sobre a associação entre o uso de (CVC) impregnado fecção em comparação aos de lúmen único(13). Cateter Venoso Central (CVC) impregnado com antissépticos com antissépticos e a redução da Infecção e a redução da Em relação à média de permanência com o cateter, o período variou de 7,8 a 8,4 dias e da Corrente Sanguínea (ICS). Infecção da Corrente 14,3 a 16,6 dias. Nesse particular, alguns au- Sanguínea (ICS). tores relataram eficácia desses cateteres so- MÉTODO mente se utilizados por aproximadamente 10 dias; e que, após esse período, a infecção é Trata-se de um estudo de revisão integrativa da litera- predominantemente intraluminal. Acresce-se que o efeito tura que permite que pesquisas anteriores sejam suma- bactericida dos dispositivos esteve restrito à superfície do rizadas e conclusões estabelecidas a partir da análise cri- cateter, e não se estendeu para os lumens(14-15). teriosa do delineamento metodológico e dos resultados acerca do tema investigado(5-6). O uso de fio-guia para troca de cateteres em um mes- mo sítio de inserção foi referido em apenas um estudo. Para guiar o estudo formulou-se a seguinte questão: Vale destacar que alguns estudiosos não recomendaram Quais são as evidências disponíveis na literatura sobre o trocar rotineiramente o CVC com o propósito de reduzir a controle da infecção relacionada a cateter venoso central incidência de infecção e aceitaram a utilização do fio-guia sem cuff, não tunelizado, de curta permanência, impreg- somente nos casos de mau funcionamento e se não hou- nado com antissépticos, utilizado em pacientes adultos ver evidência de infecção(16-17). hospitalizados? Quatro estudos recomendaram a utilização de técnica Na busca das publicações, utilizaram-se as bases de asséptica na inserção do CVC enquanto que duas publi- dados Literatura Latino-Americana e do Caribe em Ciên- cações não especificaram a utilização de Equipamento de cias da Saúde (LILACS), Medical Literature Analysis and Proteção Individual (EPI), mas relataram o rigor de assep- Retrieval Sistem on-line (MEDLINE) e Cumulative Index to sia na inserção do dispositivo. A despeito da paramenta- Nursing and Allied Health Literature (CINAHL) por meio ção na inserção de CVC (uso de avental, luvas e campos das palavras-chave: controle de infecções e cateterismo estéreis, gorro e máscara),
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