Panorama nacional da prática de profissionais de enfermagem na cateterização intravenosa periférica
Data
2022-10-21
Autores
Silva, Bianka Sousa Martins [UNIFESP]
Orientadores
Kusahara, Denise Miyuki [UNIFESP]
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A cateterização intravenosa periférica (CIP) é um procedimento invasivo, de alta complexidade e realizado por profissionais com diferentes graus de formação. Apesar de amplamente utilizada, a CIP não está isenta de riscos, podendo resultar em complicações que impactam no estado clínico e na evolução do paciente. Reconhecer práticas relacionadas à CIP possibilita o planejamento de estratégias que possam maximizar o êxito no procedimento com redução do número de tentativas de cateterização, e consequente promover uma assistência de enfermagem segura e de qualidade. Objetivo: Analisar práticas relacionadas à cateterização intravenosa periférica realizadas por profissionais de enfermagem atuantes nas macrorregiões brasileiras. Método: Estudo transversal descritivo realizado nas cinco macrorregiões do Brasil com amostra não probabilística de 2.584 profissionais de enfermagem (enfermeiro, técnico de enfermagem e/ou auxiliar de enfermagem) que atuavam no cuidado direto ao paciente submetido a CIP. A coleta de dados foi feita por meio de questionário online contendo informações demográficas, experiência e formação acadêmica dos profissionais executantes da CIP, variáveis relacionadas à seleção da veia e do dispositivo de acesso vascular (DAV), à técnica e conceitos relacionados à CIP. Realizada análise descritiva e aplicado o Teste T de Student para amostras independentes, Teste ANOVA 1 fator, Teste de comparações múltiplas de Tukey, Teste de Qui Quadrado para k amostras independentes, análise de resíduos ajustados e Teste da Razão de Verossimilhança considerando nível de significância de 5% e Intervalo de confiança de 95% (IC95%). Resultados: A amostra foi constituída por 1.214 (46,9%) enfermeiros, 1.166 (45,2%) técnicos de enfermagem e 204 (7,9%) auxiliares de enfermagem. Os profissionais que majoritariamente realizam a CIP são os técnicos (média de 9,55 DAVs inseridos/12h) e auxiliares de enfermagem (média de 10,9 DAVs inserido/12h). Parte dos profissionais de enfermagem não realizam cuidados essenciais antes da tentativa de CIP, como higienização das mãos, manejo da dor e preparo do paciente, apesar de terem tido aula sobre acesso venoso periférico durante a formação acadêmica (86,9%) e capacitação no serviço sobre DAV nos últimos 12 meses (75,7%). Dentre os enfermeiros, a maioria (88,8%) utiliza ferramenta clínica para avaliação de rede venosa difícil e 19,9% deles utiliza como critério para seleção de veias periféricas. A obtenção do acesso venoso na primeira tentativa foi a definição escolhida para conceituar o sucesso pela maioria dos técnicos (83,3%) e auxiliares de enfermagem (66,7%), independente da unidade de atuação, já a maioria dos enfermeiros (61,6%) considera sucesso quando após a infusão de 2 mL de cloreto de sódio (NaCl) a 0,9% não se observa no sítio de cateterização sinais de hematoma, infiltração ou dor relatada pelo paciente ou quando após a cateterização se obtém retorno venoso através do DAV. Apenas 25,2% dos enfermeiros responderam que ele é o profissional legalmente responsável pela CIP. O processo formativo dos profissionais de enfermagem é incipiente com conteúdo ministrado de forma superficial e focado na técnica de cateterização venosa. No ambiente laboral foram mencionadas fragilidades no cuidado oferecido ao paciente antes da inserção do dispositivo de acesso vascular. Conclusão: prática de CIP apresenta variações dentre os profissionais executantes, sendo muitas vezes destoantes das melhores evidências disponíveis, demonstrando que o nível de conhecimento dos profissionais de enfermagem ainda é insatisfatório no tocante à referida técnica.
Introduction: Peripheral intravenous catheterization (PIC) is an invasive, highly complex procedure performed by professionals with different degrees of training. Despite being widely used, PIC is not risk-free, and may result in complications that impact the clinical status and evolution of the patient. Recognizing practices related to PIC makes it possible to plan strategies that can maximize the success of the procedure by reducing the number of catheterization attempts, and consequently promoting safe and quality nursing care. Objective: To analyze practices related to peripheral intravenous catheterization performed by nursing professionals working in Brazilian macro-regions. Method: Descriptive cross-sectional study carried out in the five macro-regions of Brazil with a non-probabilistic sample of 2,584 nursing professionals (nurse, nursing technician and/or nursing assistant) who worked in direct care for patients undergoing PIC. Data collection was performed through an online questionnaire containing demographic information, experience and academic training of professionals performing PIC, variables related to the selection of the vein and vascular access device (VAD), the technique and concepts related to PIC. Descriptive analysis was performed and Student's T Test was applied for independent samples, 1-way ANOVA Test, Tukey's Multiple Comparison Test, Chi-Square Test for k independent samples, adjusted residual analysis and Likelihood Ratio Test considering significance level of 5% and 95% confidence interval (95%CI). Results: The sample consisted of 1,214 (46.9%) nurses, 1,166 (45.2%) nursing technicians and 204 (7.9%) nursing assistants. The professionals who mostly perform the PIC are technicians (average of 9.55 ADs inserted/12h) and nursing assistants (average of 10.9 ADLs inserted/12h). Part of the nursing professionals do not perform essential care before attempting PIC, such as hand hygiene, pain management and patient preparation, despite having had a class on peripheral venous access during academic training (86.9%) and training in the service on AD in the last 12 months (75.7%). Among nurses, most (88.8%) use a clinical tool to assess difficult venous networks and 19.9% use it as a criterion for selecting peripheral veins. Obtaining venous access on the first attempt was the definition chosen to conceptualize success by most technicians (83.3%) and nursing assistants (66.7%), regardless of the unit of action, whereas most nurses (61 .6%) is considered successful when, after the infusion of 2 mL of 0.9% sodium chloride (NaCl) there is no sign of hematoma, infiltration or pain reported by the patient at the catheterization site, or when a return is obtained after catheterization venous through the VAD. Only 25.2% of the nurses answered that he is the professional legally responsible for the PIC. The training process of nursing professionals is incipient with content taught superficially and focused on the technique of venous catheterization. In the work environment, weaknesses were mentioned in the care offered to the patient before insertion of the vascular access device. Conclusion: the practice of PIC presents variations among the professionals who perform it, often disagreeing with the best available evidence, demonstrating that the level of knowledge of nursing professionals is still unsatisfactory with regard to the aforementioned technique.
Introduction: Peripheral intravenous catheterization (PIC) is an invasive, highly complex procedure performed by professionals with different degrees of training. Despite being widely used, PIC is not risk-free, and may result in complications that impact the clinical status and evolution of the patient. Recognizing practices related to PIC makes it possible to plan strategies that can maximize the success of the procedure by reducing the number of catheterization attempts, and consequently promoting safe and quality nursing care. Objective: To analyze practices related to peripheral intravenous catheterization performed by nursing professionals working in Brazilian macro-regions. Method: Descriptive cross-sectional study carried out in the five macro-regions of Brazil with a non-probabilistic sample of 2,584 nursing professionals (nurse, nursing technician and/or nursing assistant) who worked in direct care for patients undergoing PIC. Data collection was performed through an online questionnaire containing demographic information, experience and academic training of professionals performing PIC, variables related to the selection of the vein and vascular access device (VAD), the technique and concepts related to PIC. Descriptive analysis was performed and Student's T Test was applied for independent samples, 1-way ANOVA Test, Tukey's Multiple Comparison Test, Chi-Square Test for k independent samples, adjusted residual analysis and Likelihood Ratio Test considering significance level of 5% and 95% confidence interval (95%CI). Results: The sample consisted of 1,214 (46.9%) nurses, 1,166 (45.2%) nursing technicians and 204 (7.9%) nursing assistants. The professionals who mostly perform the PIC are technicians (average of 9.55 ADs inserted/12h) and nursing assistants (average of 10.9 ADLs inserted/12h). Part of the nursing professionals do not perform essential care before attempting PIC, such as hand hygiene, pain management and patient preparation, despite having had a class on peripheral venous access during academic training (86.9%) and training in the service on AD in the last 12 months (75.7%). Among nurses, most (88.8%) use a clinical tool to assess difficult venous networks and 19.9% use it as a criterion for selecting peripheral veins. Obtaining venous access on the first attempt was the definition chosen to conceptualize success by most technicians (83.3%) and nursing assistants (66.7%), regardless of the unit of action, whereas most nurses (61 .6%) is considered successful when, after the infusion of 2 mL of 0.9% sodium chloride (NaCl) there is no sign of hematoma, infiltration or pain reported by the patient at the catheterization site, or when a return is obtained after catheterization venous through the VAD. Only 25.2% of the nurses answered that he is the professional legally responsible for the PIC. The training process of nursing professionals is incipient with content taught superficially and focused on the technique of venous catheterization. In the work environment, weaknesses were mentioned in the care offered to the patient before insertion of the vascular access device. Conclusion: the practice of PIC presents variations among the professionals who perform it, often disagreeing with the best available evidence, demonstrating that the level of knowledge of nursing professionals is still unsatisfactory with regard to the aforementioned technique.
Descrição
Citação
SILVA, Bianka Sousa Martins. Panorama nacional da prática de profissionais de enfermagem na cateterização intravenosa periférica. 2022. 152 f. Tese (Doutorado em Enfermagem) - Escola Paulista de Enfermagem, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2022.