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The Use of Peripherally Inserted Central Venous Catheter

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The Use of Peripherally Inserted Central Venous Catheter ORIGINAL ARTICLE The use of peripherally inserted central venous catheter in the Neonatal Intensive Care Unit A utilização de cateteres venosos centrais de inserção periférica na Unidade Intensiva Neonatal Carolina Pereira Ferreira1 , Danielle Lemos Querido1 , Marialda Moreira Christoffel1 , Viviane Saraiva de Almeida1 , Marilda Andrade2 , Helder Camilo Leite1 ABSTRACT To analyze the use of peripherally inserted central venous catheter in newborns hospitalized in the Neonatal Intensive Care Unit. Retrospective, descriptive and quantitative research, carried out in 80 medical records of a federal maternity school in Rio de Janeiro, in the period April to July 2018. The use of the device was higher in preterm newborns (83%), the predominant weight was below 1,500 grams (60.9%), the most frequent indication for catheter insertion was low weight, associated or not with prolonged intravenous therapy (35.2%) and the length of stay was over five days (81.8%). The occurrence of adverse events was present in 31.8% of cases. It should be emphasized the importance of correct indication, handling, care in the use of the device, beyond identification of adverse events to establish prevention measures and training of the team in order to reduce risks and promote the safety of newborns. Descriptors: Infusions, Intravenous; Patient Safety; Catheterization, Central Venous; Intensive Care Units, Neonatal; Neonatal Nursing. RESUMO Analisar a utilização dos cateteres centrais de inserção periférica em recém-nascidos internados na Unidade de Terapia Intensiva Neonatal. Pesquisa retrospectiva, descritiva e quantitativa, realizada em 80 prontuários de uma maternidade escola federal do Rio de Janeiro, no período de abril a julho de 2018. A utilização do dispositivo foi maior em recém-nascidos pré-termo (83%), o peso predominante foi abaixo de 1.500 gramas (60,9%), a indicação mais frequente para a inserção do cateter foi o baixo peso, associado ou não a terapia intravenosa prolongada (35,2%) e o tempo de permanência foi superior a cinco dias (81,8%). A ocorrência de eventos adversos estava presente em 31,8% dos casos. Ressalta-se a importância da correta indicação, manuseio, cuidado no uso do dispositivo, além de identificação dos eventos adversos, para que se estabeleçam medidas de prevenção e treinamento da equipe, a fim de diminuir os riscos e promover a segurança dos recém-nascidos. Descritores: Infusões Intravenosas; Segurança do Paciente; Cateterismo Venoso Central; Unidades de Terapia Intensiva Neonatal; Enfermagem Neonatal. 1Federal University of Rio de Janeiro – Rio de Janeiro (RJ), Brazil. E-mails: [email protected], [email protected], [email protected], [email protected], [email protected] 2Fluminense Federal University – Niterói (RJ), Brazil. E-mail: [email protected] How to cite this article: Ferreira CP, Querido DL, Christoffel MM, Almeida VS, Andrade M, Leite HC. The use of peripherally inserted central venous catheter in the Neonatal Intensive Care Unit. Rev. Eletr. Enferm. [Internet]. 2020 [cited on: _________];22:56923. Available at: https://doi.org/10.5216/ree.v22.56923. Received on: 01/30/2019. Accepted on: 01/15/2020. Available on: 06/05/2020. 1 Rev. Eletr. Enferm., 2020; 22:56923, 1-8 Ferreira CP et al. INTRODUCTION When PICC is related to the care of the newborn in NICU, Intravenous therapy is becoming an increasingly safe and some particularities that involve both the newborn and the quality practice thanks to the technological resources that procedure are highlighted, due to singular characteristics are increased in your daily life, from intravenous catheters that may significantly influence the effectiveness of the (peripheral and central), accessories with safety devices, to use of this device, and the professional should be aware of the latest generation infusion pumps. In addition to these the responsibility of the procedure. Thus, the nurse is one resources, the qualification of the professional, especially the of the main responsible for the evaluation of the PICC nurse, becomes a key point for the promotion of safer care indication, as well as its insertion, follow-up and evaluation. regarding the use of technologies employed in this therapy(1). This professional has a fundamental role in the prevention of The Peripherally Inserted Central Venous Catheter, from complications, an essential factor for the rehabilitation of the the English Peripherally Inserted Central Catheter (PICC) has NB and the success of the treatment(7). been used as an alternative for stable and effective venous It is worth highlighting that intravenous therapy should access for neonates. However, its insertion involves a highly be initiated with the objective of providing optimal care to complex procedure requiring specific knowledge(2). neonates, with property and capacity to increase success in The use of PICC is intended to promote intravenous obtaining venous access, prioritizing the patient’s safety, with therapy for a long time and in a safely way, preserving the reduction of physical and psychological damages and adverse peripheral venous network, in addition to reducing pain events, seeking increased satisfaction with the care and and stress from repeated punctures. It is indicated in cases assistance of the team(8). that require venous access for a period longer than six days Thus, faced with the need for a long-term and safe venous and administration of hypertonic and/or vesicant solutions, access for the newborn’s therapy, the wide use of PICC in such as total parenteral nutrition (osmolarity above NICU and the possible occurrence of adverse events during 600 mlOsmol/L or glucose serum with concentration above the use of this device, the study aimed to analyze the use 12.5%). Its indication requires expertise, technique, capacity of PICC in newborns hospitalized in a Neonatal Intensive of clinical judgment and conscious, safe and effective decision Care Unit. making by the health professional(3). Despite its benefits, PICC is not exempt from adverse events. After its insertion, some problems are reported, such METHOD as inadequate location of the catheter tip (intracardiac), which Descriptive, quantitative, retrospective research carried may cause cardiac alterations, requiring immediate traction. out in medical records of newborns who were hospitalized in Other complications culminate in the need for non-elective a NICU of a Maternity School of the Federal University of catheter removal, such as leakage, accidental catheter removal, Rio de Janeiro (ME–UFRJ), located in the municipality of external rupture, occlusion and infection(4). Rio de Janeiro, a reference for high fetal risk, which admits Some studies have presented high percentages of newborns coming from the own institution, from other units unscheduled withdrawal from the PICC, with values above in the municipality or state of Rio de Janeiro that needs 40%(4). One of these studies, which aimed at analyzing specialized and intensive care. adverse events occurring in newborns up to 28 days of life in All newborns whose PICC insertion took place between the Health Surveillance Notification System in the years 2007 September 1, 2016 and September 1, 2017 were included. to 2013, presented a 40.3% rate of unplanned removal(5), Newborns with PICC who had been transferred to another indicating that problems with the maintenance of this device institution were excluded from the study due to the have been recurrent in many Neonatal Intensive Care Units impossibility of obtaining information regarding the outcome (NICU) in the country. variables. Data were collected from April to July 2018. It becomes clear that even with the numerous benefits Data were collected from 80 medical records however, four achieved with the use of PICC, adverse events related to newborns were submitted to more than one PICC insertion the procedure are still reported and may occur at the time process, resulting in 88 central venous catheterization of its insertion, maintenance or removal. For this reason, procedures of peripheral insertion for analysis. studies related to the use of PICC and follow-up of results For data collection an instrument was used that recorded obtained in each clinical scenario are important for a better information, containing the variables of the study regarding care structuring, allowing interventions for the individual the characterization of the population: gender; gestational management of the newborn to be elaborated, promoting age corrected at the date of insertion; weight at the date of catheter removal upon discharge from treatment and insertion; medical diagnosis at hospitalization. Besides other preventing complications that may compromise the quality variables related to the process of central venous catheterization of intravenous therapy(6). of peripheral insertion: reason for insertion of the catheter; 2 Rev. Eletr. Enferm., 2020; 22:56923, 1-8 The use of peripherally inserted central venous catheter in the Neonatal Intensive Care Unit length of stay of the device; reason for removal of the catheter; each (2.5%); and cardiac malformations, neonatal sepsis, and the most prevalent adverse events. hyperbilirubinemia, postoperative correction of gastroschisis, The descriptive data analysis was presented in the form Down syndrome and neonatal asphyxia with one each (1.25%). of tables, with the variables described by absolute and relative Of the four newborns who were undergo more than one frequencies. The information obtained from
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