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      Progressão do cateter central de inserção periférica em região hemiclavicular de recém-nascidos Translated title: Progression of peripherally inserted central catheter in hemiclavicular region of newborns

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          Abstract

          RESUMO Objetivo avaliar a progressão do cateter central de inserção periférica em região hemiclavicular direita, através da veia basílica e cefálica direita, em recém-nascidos. Métodos pesquisa quase experimental, realizada em unidade neonatal. Amostra de 64 inserções de cateteres, em 58 recém-nascidos. A intervenção consistiu em manobra de elevação, protração e abaixamento do ombro, aplicada após não progressão do cateter, em região hemiclavicular, na punção direta em região cubital, em veia basílica ou cefálica direita. Resultados das 64 inserções, progrediram sem manobra 28(43,7%); em mais da metade, aplicou-se manobra, obtendo-se 28(77,8%) progressões, sendo que 15(41,7%) progrediram após elevação, 12(57,1%) após protração e 1(11,1%) abaixamento do ombro, destes que progrediram, 21(75%) estavam em posição central. Verificou-se significância estatística (p<0,05) entre progressão com manobra e veia cefálica, progressão sem manobra e veia basílica. Conclusão a intervenção facilitou progressão do cateter, principalmente por veia cefálica.

          Translated abstract

          ABSTRACT Objective to evaluate the progression of the peripherally inserted central catheter in the right hemiclavicular region, through the right basilic and cephalic vein, in newborns. Methods quasi-experimental research, carried out in a neonatal unit. Sample of 64 catheter insertions in 58 newborns. The intervention consisted of shoulder elevation, protraction and lowering maneuver, applied after the catheter had not progressed, in the hemiclavicular region by direct puncture in the cubital region, in the right basilic or cephalic vein. Results of the 64 insertions, 28(43.7%) progressed without maneuver; in more than half, a maneuver was applied, obtaining 28(77.8%) progressions, with 15(41.7%) progressing after elevation, 12(57.1%) after protraction, 1(11.1%) lowering the shoulder, of those that progressed, 21(75%) were in central position. There was statistical significance (p<0.05) between progression with maneuver and cephalic vein, progression without maneuver and basilic vein. Conclusion the intervention facilitated the progression of the catheter, mainly through the cephalic vein.

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          Peripheral venous catheter related complications are common among paediatric and neonatal patients.

          The aims of this study were to describe the characteristics of peripheral venous catheters (PVCs), including dwell time and reasons for removal, and explore predictors for PVC-related complications.
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            Use of real-time ultrasound for locating tip position in neonates undergoing peripherally inserted central catheter insertion: A pilot study

            Background & objectives: Securing long-term venous access is an essential part of sick newborn care. The malposition of central line tip leads to several complications. There is a need for an easily available bedside investigating tool to diagnose these malpositions. This study was done to compare the effectiveness of real-time ultrasound (RTUS) with X-ray in identifying the peripherally inserted central catheter (PICC) line tip. Methods: This pilot observational study was conducted in a level III Neonatal Intensive Care Unit of a tertiary care hospital in India, from June 2012 to June 2013. A total of 33 PICC lines in 31 infants were included in the study. After insertion of PICC line, X-ray and RTUS were done to locate the tip of the PICC line. Results: In this study, PICC line tip could be identified by bedside RTUS in 94 per cent of line insertions. Standard X-ray identified the tip in all cases. RTUS has been shown to have good diagnostic utility in comparison with X-ray with sensitivity and specificity being 96.55 and 100 per cent, respectively. In our study, majority of malpositions were identified and manipulated by RTUS, thus second X-rays were avoided. Interpretation & conclusions: The result of this pilot study shows that RTUS may be a reliable and safe bedside tool for determining the tip of PICC lines. However, studies with large sample size need to be done to confirm these findings.
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              The development of a risk score for unplanned removal of peripherally inserted central catheter in newborns1

              OBJECTIVE: to develop a risk score for unplanned removal of peripherally inserted central catheter in newborns. METHOD: prospective cohort study conducted in a neonatal intensive care unit with newborn babies who underwent 524 catheter insertions. The clinical characteristics of the newborn, catheter insertion and intravenous therapy were tested as risk factors for the unplanned removal of catheters using bivariate analysis. The risk score was developed using logistic regression. Accuracy was internally validated based on the area under the Receiver Operating Characteristic curve. RESULTS: the risk score was made up of the following risk factors: transient metabolic disorders; previous insertion of catheter; use of a polyurethane double-lumen catheter; infusion of multiple intravenous solutions through a single-lumen catheter; and tip in a noncentral position. Newborns were classified into three categories of risk of unplanned removal: low (0 to 3 points), moderate (4 to 8 points), and high (≥ 9 points). Accuracy was 0.76. CONCLUSION: the adoption of evidence-based preventative strategies based on the classification and risk factors faced by the newborn is recommended to minimize the occurrence of unplanned removals.
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                Author and article information

                Journal
                rene
                Rev Rene
                Rev. Rene
                Universidade Federal do Ceará (Fortaleza, CE, Brazil )
                1517-3852
                2175-6783
                2020
                : 21
                : e42980
                Affiliations
                [2] Rio de Janeiro Rio de Janeiro orgnameUniversidade Federal do Rio de Janeiro Brazil
                [1] Fortaleza Ceará orgnameUniversidade Federal do Ceará Brazil
                Article
                S1517-38522020000100317 S1517-3852(20)02100000317
                10.15253/2175-6783.20202142980
                6faef518-1afe-44df-87a4-f084f1d93a4f

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

                History
                : 03 March 2020
                : 06 December 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 15, Pages: 0
                Product

                SciELO Revista de Enfermagem

                Categories
                Artigos Originais

                Catheterization, Central Venous,Cateterismo Venoso Central,Cateterismo Periférico,Recém-Nascido,Infusões Intravenosas,Enfermagem Neonatal,Catheterization, Peripheral,Infant, Newborn,Infusions, Intravenous,Neonatal Nursing

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