Complicações relacionadas ao uso de cateteres intravenosos periféricos em pacientes adultos internados em um hospital de ensino na Amazônia ocidental brasileira
Data
2014-12-17
Autores
Enes, Sandra Maria Sampaio 
Orientadores
Pedreira, Mavilde da Luz Goncalves
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
A terapia intravenosa é uma das mais importantes intervenções terapêuticas na assistência à saúde. Para sua implementação são empregados diferentes dispositivos, destacando-se cateteres intravenosos periféricos (CIP) que podem acarretar complicações relacionadas ao seu uso. Objetivos: Descrever complicações decorrentes do uso de CIP e os fatores relacionados à sua ocorrência, em pacientes adultos de um hospital de ensino na Amazônia Ocidental Brasileira. Método: Estudo exploratório realizado em uma unidade de clínica médica de um hospital de ensino localizado em Rio Branco, Acre. A amostra foi composta por 122 CIP instalados em 122 pacientes com idade igual ou superior a 18 anos. A coleta dos dados ocorreu de setembro de 2013 a fevereiro de 2014, após aprovação do Comitê de Ética em Pesquisa (nº296912). Investigaram-se variáveis relativas à caracterização demográfica, da terapia intravenosa (TIV) pregressa e atual; da punção venosa periférica; dos motivos da retirada e tempo de permanência do CIP, e complicações associadas. Para a análise estatística foram aplicados os testes do Qui-quadrado e Teste Exato de Fisher, com nível de significância fixado em 5%. Resultados: Quanto as variáveis demográficas verificou-se distribuição exatamente igual da amostra quanto ao gênero (50,0%), com média de idade de 46,1(± 17,6) anos e cor da pele parda (57,3%). Quanto a TIV pregressa, a maior parte dos pacientes não havia tido internações anteriores (83,6%), mas o uso prévio e recente de TIV e CIP foi relatado por 79,5%, com tempo inferior a 72 horas (96,9%), e 52,5% refeririam complicações prévias. Quanto a TIV atual obteve-se tempo médio de uso de 8,81(± 6,89) dias, para infusão contínua e intermitente (61,5%), pelo método de infusão gravitacional e bolus (74,6%) e de soluções e fármacos (82,0%). Usar tratamento com risco, de fármacos com extremo de pH (62,5%) e vesicantes (62,5%) foi presente para a maioria, assim como apresentar doença crônica (71,1%) como condição predisponente à complicação. O tipo de CIP mais utilizado foi o sobre agulha (99,0%), de calibre 20G (39,3%), instalados nas veias do arco dorsal da mão (36,9%), em membro dominante (48,4%), fixados com fita tipo esparadrapo (98,4%), a punção realizada por técnicos de enfermagem (91,8%) e com grau de cuidado com o CIP insatisfatório (Grau 1= 73,0%). O tempo de permanência do CIP foi de 68,4(±46,28) horas e apenas 22,9% foram retirados por alta do tratamento. A complicação foi o principal motivo de retirada (67,2%), destacando-se flebite (31,1%), infiltração (24,6%), hematoma (23,8%) e obstrução (14,8%). Os fatores relacionados a complicações foram: antecedentes de complicações (p=0,002), TIV inferior a sete dias (p=0,015), infusão contínua e intermitente (p=0,007), em bolus e gravitacional (p=0,001), de soluções e fármacos (p<0,001), de mais de dois fármacos (p=0,001) e de fármacos vesicantes e com extremos de pH (p=0,034). Conclusão: Foi identificada alta proporção de complicações, principais motivos de retirada do CIP, destacando-se a flebite. Fatores relacionados ao paciente e a punção venosa periférica não influenciaram complicações, e sim antecedentes de complicações e características da TIV atual.
Intravenous therapy (IVT) is one of the most important therapeutic interventions in health care. Several devices are available to IVT implementation, mainly peripheral intravenous catheter (PIC), that can lead to complications related to their use. Objectives: To describe the PIC related complications and the factors associated to its occurrence in adult patients at a teaching hospital from the Western Brazilian Amazon. Methods: Exploratory study conducted in the clinical ward of a teaching hospital located in the City of Rio Branco?Acre. The sample comprised 122 PIC, inserted in 122 patients, aged 18 years or older. Data collection occurred from September 2013 to February 2014, after approval by the Research Ethics Committee (n°296912). We investigated variables related to demographic characteristics, the previous and current IVT; peripheral venepuncture; the reasons for the PIC withdrawal, indwell time of CIP placement and the occurrence of complications. For the statistical analysis the chi-square and Fisher's exact tests were applied, with significance level set at 5%.Results:Regarding the demographic characteristics of the sample equal distribution of gender (50.0%) was identified, a mean age of 46.1 (± 17.6) years and Mulatto or brown skin (57,3%). Concerning the previous IVT study, most patients had no prior hospitalizations (83.6%), but prior IVT and recent use of PIC was reported by 79.5%, with time less than 72 hours (96 9%); 52.5% mentioned previous complications. The study of the current IVT demonstrated a mean duration of 8.81 (± 6.89) days, for continuous and intermittent infusions (61.5%), by gravitational and bolus methods (74.6%) of drugs and solutions (82.0%). The majority of the patients used drugs with extreme pH (62.5%) and vesicant (62.5%), as well as presenting chronic disease (71.1%) as a predisposing condition for the occurrence of complications. The most common inserted PIC was the over the needle catheter type (99.0%), size 20 gauge (39.3%) implanted in the veins of the dorsal arch of the hand (36.9%), at the dominant member (48.4%) fixed with a Esparadrapo® tape (98.4%); the punctures were predominantly performed by nursing technicians (91.8%) and the degree of care with the PIC was classified as unsatisfactory (grade 1 = 73.0%). The average indwell time was 68.4 (±46.28) hours and only 22.9% of PIC were removed by end of treatment. Complication was the main reason for withdrawal (67.2%), highlighting phlebitis (31.1%), infiltration (24.6%), hematoma (23.8%) and obstruction (14.8%). Variables statistically influencing complications were: previous history of complications (p = 0.002), use of IVT less than seven days (p=0.015), continuous and intermittent infusion in combination (p = 0.007), by bolus and gravitational methods (p = 0.001), of drug and solutions in association (p <0.001), with more than two drugs (p = 0.001) and with vesicant drugs and or with extreme pH levels (p=0.034). Conclusion: High proportion of complications were identified as the main reasons of PIC remotion, particularly due to phlebitis. Patient and peripheral venepuncture related characteristics did not affect complications rates. Complications were associated with history of previous complications and current IVT characteristics.
Intravenous therapy (IVT) is one of the most important therapeutic interventions in health care. Several devices are available to IVT implementation, mainly peripheral intravenous catheter (PIC), that can lead to complications related to their use. Objectives: To describe the PIC related complications and the factors associated to its occurrence in adult patients at a teaching hospital from the Western Brazilian Amazon. Methods: Exploratory study conducted in the clinical ward of a teaching hospital located in the City of Rio Branco?Acre. The sample comprised 122 PIC, inserted in 122 patients, aged 18 years or older. Data collection occurred from September 2013 to February 2014, after approval by the Research Ethics Committee (n°296912). We investigated variables related to demographic characteristics, the previous and current IVT; peripheral venepuncture; the reasons for the PIC withdrawal, indwell time of CIP placement and the occurrence of complications. For the statistical analysis the chi-square and Fisher's exact tests were applied, with significance level set at 5%.Results:Regarding the demographic characteristics of the sample equal distribution of gender (50.0%) was identified, a mean age of 46.1 (± 17.6) years and Mulatto or brown skin (57,3%). Concerning the previous IVT study, most patients had no prior hospitalizations (83.6%), but prior IVT and recent use of PIC was reported by 79.5%, with time less than 72 hours (96 9%); 52.5% mentioned previous complications. The study of the current IVT demonstrated a mean duration of 8.81 (± 6.89) days, for continuous and intermittent infusions (61.5%), by gravitational and bolus methods (74.6%) of drugs and solutions (82.0%). The majority of the patients used drugs with extreme pH (62.5%) and vesicant (62.5%), as well as presenting chronic disease (71.1%) as a predisposing condition for the occurrence of complications. The most common inserted PIC was the over the needle catheter type (99.0%), size 20 gauge (39.3%) implanted in the veins of the dorsal arch of the hand (36.9%), at the dominant member (48.4%) fixed with a Esparadrapo® tape (98.4%); the punctures were predominantly performed by nursing technicians (91.8%) and the degree of care with the PIC was classified as unsatisfactory (grade 1 = 73.0%). The average indwell time was 68.4 (±46.28) hours and only 22.9% of PIC were removed by end of treatment. Complication was the main reason for withdrawal (67.2%), highlighting phlebitis (31.1%), infiltration (24.6%), hematoma (23.8%) and obstruction (14.8%). Variables statistically influencing complications were: previous history of complications (p = 0.002), use of IVT less than seven days (p=0.015), continuous and intermittent infusion in combination (p = 0.007), by bolus and gravitational methods (p = 0.001), of drug and solutions in association (p <0.001), with more than two drugs (p = 0.001) and with vesicant drugs and or with extreme pH levels (p=0.034). Conclusion: High proportion of complications were identified as the main reasons of PIC remotion, particularly due to phlebitis. Patient and peripheral venepuncture related characteristics did not affect complications rates. Complications were associated with history of previous complications and current IVT characteristics.
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Citação
ENES, Sandra Maria Sampaio. Complicações relacionadas ao uso de cateteres intravenosos periféricos em pacientes adultos internados em um hospital de ensino na amazônia ocidental brasileira. 2014. 108 f. Dissertação (Mestrado) - Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, 2014.