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      Incidencia de Flebitis asociada a Catéteres Centrales de Inserción Periférica en UCI Adultos: Implementación de un Protocolo para Enfermería Translated title: Phlebitis Incidence Associated to Peripherally Inserted Central Catheters in Adults ICU: Implementation of a Nursing Protocol

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          Abstract

          Resumen: Justificación La flebitis es una de las complicaciones más frecuentes de los Catéteres Centrales de Inserción Periférica. La evidencia científica sobre la utilidad de las escalas de medición para el diagnóstico de flebitis es escasa. Objetivos: Comparar la incidencia de flebitis antes y después de la implementación de un protocolo. Material y métodos: Estudio de cohortes retrospectivo en 159 pacientes ingresados en UCI, a los que se les ha colocado un PICC, en dos periodos equivalentes de dos años consecutivos, Periodo 1 (n=59); frente a un grupo del Periodo 2 (n=100) en el que se aplicó un nuevo protocolo para el diagnóstico y manejo de flebitis (definición de flebitis, aplicación de la Visual Infusion Phlebitis Score y valoración continua). Resultados: El riesgo de ser diagnosticado de flebitis fue significativamente menor en el P2 (OR: 0.09, I.C.95% 0.01-0.52) Conclusiones: La incorporación del protocolo redujo un 90% los diagnósticos de flebitis.

          Translated abstract

          Abstract: Justification: Phlebitis incidence related to peripherally inserted central catheters (PICCs): New nursing protocol application. Phlebitis is one of the most common complications of peripherally inserted central catheters (PICCs). The scientific evidence about the utility of measuring scales to phlebitis diagnosis is very limited. Objectives: To compare phlebitis incidence rate before and after the introduction of a new protocol. Materials and Methods: Retrospective cohort study in 159 patients admitted to the intensive care unit (ICU) for two years. First we assess phlebitis in 59 patients (group 1). After that we apply a new protocol to identify phlebitis with visual score and continuous evaluation to 100 patients (group 2) Results: The probability of being diagnosed of phlebitis is significantly smaller in intervention group (OR: 0.09; 95% C.I.: 0.02-0.57). Conclusions: Protocol application reduced the diagnosis of phlebitis in 90%

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          Focus on peripherally inserted central catheters in critically ill patients.

          Venous access devices are of pivotal importance for an increasing number of critically ill patients in a variety of disease states and in a variety of clinical settings (emergency, intensive care, surgery) and for different purposes (fluids or drugs infusions, parenteral nutrition, antibiotic therapy, hemodynamic monitoring, procedures of dialysis/apheresis). However, healthcare professionals are commonly worried about the possible consequences that may result using a central venous access device (CVAD) (mainly, bloodstream infections and thrombosis), both peripherally inserted central catheters (PICCs) and centrally inserted central catheters (CICCs). This review aims to discuss indications, insertion techniques, and care of PICCs in critically ill patients. PICCs have many advantages over standard CICCs. First of all, their insertion is easy and safe -due to their placement into peripheral veins of the arm- and the advantage of a central location of catheter tip suitable for all osmolarity and pH solutions. Using the ultrasound-guidance for the PICC insertion, the risk of hemothorax and pneumothorax can be avoided, as well as the possibility of primary malposition is very low. PICC placement is also appropriate to avoid post-procedural hemorrhage in patients with an abnormal coagulative state who need a CVAD. Some limits previously ascribed to PICCs (i.e., low flow rates, difficult central venous pressure monitoring, lack of safety for radio-diagnostic procedures, single-lumen) have delayed their start up in the intensive care units as common practice. Though, the recent development of power-injectable PICCs overcomes these technical limitations and PICCs have started to spread in critical care settings. Two important take-home messages may be drawn from this review. First, the incidence of complications varies depending on venous accesses and healthcare professionals should be aware of the different clinical performance as well as of the different risks associated with each type of CVAD (CICCs or PICCs). Second, an inappropriate CVAD choice and, particularly, an inadequate insertion technique are relevant-and often not recognized-potential risk factors for complications in critically ill patients. We strongly believe that all healthcare professionals involved in the choice, insertion or management of CVADs in critically ill patients should know all potential risk factors of complications. This knowledge may minimize complications and guarantee longevity to the CVAD optimizing the risk/benefit ratio of CVAD insertion and use. Proper management of CVADs in critical care saves lines and lives. Much evidence from the medical literature and from the clinical practice supports our belief that, compared to CICCs, the so-called power-injectable peripherally inserted central catheters are a good alternative choice in critical care.
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            Peripherally inserted central catheters (PICCs): do they have a role in the care of the critically ill patient?

            Over an eight-month period, 177 patients were admitted to a study to determine whether there was any significant difference between the peripherally inserted central catheter (PICC) in relation to the central venous catheter (CVC) and the peripheral venous access device in respect of the length of stay, incidence of phlebitis and the need for removal for suspected sepsis and infection. The results demonstrated no significant difference in terms of gender, age, or severity of illness. The PICC line had a significally higher length of stay and less incidence of phlebitis. In conclusion, PICC placement does have a place in the critical care setting. It should not be expected to replace existing methods of vascular access but used to provide a safe and effective alternative.
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              Peripherally inserted central catheters: a report of 2506 catheter days.

              The establishment of reliable central venous access is essential in the management of patients with major complications, including pneumothorax and hemopneumothorax. Although peripherally inserted central catheters (PICCs) offer advantages over traditional central venous approaches, PICC lines are associated with a number of insertion and maintenance problems, including clotting and catheter fracture. These complications often result in catheter removal before completion of prescribed therapy.
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                Author and article information

                Journal
                eg
                Enfermería Global
                Enferm. glob.
                Universidad de Murcia (Murcia, Murcia, Spain )
                1695-6141
                2017
                : 16
                : 45
                : 416-437
                Affiliations
                [1] orgname España
                [2] orgnameComplejo Hospitalario de Navarra España
                Article
                S1695-61412017000100416 S1695-6141(17)01604500416
                10.6018/eglobal.16.1.248081
                65f746ab-4185-4978-b723-bea07d63f673

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 International License.

                History
                : 15 January 2016
                : 01 April 2016
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 21, Pages: 22
                Product

                SciELO Spain

                Categories
                Originales

                UCI,Flebitis: Visual Infusion Phlebitis Score,Peripherally inserted central catheters (PICCs,) Phlebitis,Visual Infusion Phlebitis Score,Catéter Central de Inserción Periférica,Protocolo,ICU,Protocol

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