Práticas dos enfermeiros na cateterização intravenosa: um estudo descritivo

Abstract

Background: Peripheral intravenous catheter (PIVC) insertion and maintenance are the procedures most commonly performed by nurses in clinical settings. However, current catheter failure rates are high, thus compromising the patient's therapeutic plan and well-being. Objective: To understand nurses' practices during PIVC insertion and maintenance. Methodology: A transversal and descriptive study was conducted in a cardiology ward in central Portugal. Nurses' (n = 26) practices during PIVC management were observed and recorded by a research nurse during the morning shift, using a checklist based on transnational standard of care (SoC) recommendations. Results: During PIVC insertion (n = 38) the main digressive areas included glove usage (55.2%), use of the aseptic non-touch technique (44.7%), hand hygiene (18.4%-84.2%), and patient education (28.9%). Regarding PIVC maintenance (n = 66), catheter hub disinfection (78.8%), catheter flushing (53.3%-78.8%), and patient education (24.2%) were the main deviating areas found. Significant PIVC failure rates were found (25.8%). Conclusion: Overall, a substantial number of PIVC-related practices does not comply with current SoC recommendations, which may pose a risk to patient safety and care quality.

Double-chamber syringe versus classic syringes for peripheral intravenous drug administration and catheter flushing: a study protocol for a randomised controlled trial

“…The prevention of catheter-related complications implies some essential precautions regarding catheterization practice and catheter surveillance [17]. This is particularly important due to the higher prevalence of nosocomial infections in Portugal [25,26], as well as the substantial incidence of phlebitis, infiltration, and occlusion [5,13,28].…”

“…In our study, we have several primary outcomes regarding PIVC-related complications. Therefore, the sample size was calculated considering the lower prevalence value in Portuguese contexts for one of the primary outcomes (namely occlusion, with a 19% prevalence rate) [13,28]. Also, the sample size determination was established using G*Power software, taking into consideration the type I (α) error level, the statistical power (type II error, β), and the standard deviation of the measurement for continuous outcomes.…”

“…These invasive devices are inserted into patients' peripheral veins and enable the intravenous administration of fluids, blood products, and drugs directly into the bloodstream [1,2]. However, a wide range of complications can occur, such as mechanically induced complications (partial dislodgement or accidental removal, infiltration, extravasation, occlusion) [3][4][5][6][7][8][9][10][11][12][13], those of an infectious nature (bacterial or fungal sepsis) [7,8,10,12,14], or phlebitis [3][4][5]15].…”

“…Phlebitis (irritation or inflammation of the vein wall, associated with warmth, tenderness, erythema, or palpable cord) is the most frequent PIVC-related complication, which may have mechanical, chemical, or bacterial causes [5,13]. Thus, assessment of the PIVC insertion site must be performed daily and use of a transparent sterile dressing for stabilizing and protecting the catheter [16] is essential to allow for visual inspection of the catheter site.…”

“…International standards of care recommend the flush volume to be at least equal to twice the internal volume of the catheter system (catheter, extension set, and/or needleless injection system) [17]. In fact, professionals' flushing practices appear to vary widely with regard to solutions, frequency, volumes, and techniques [13,21,28,29]. PIVCs should be flushed at the time of medication administration [17,30].…”