Eny Dórea Paiva

Fatores de risco para infecção de corrente sanguínea associada ao cateter central de inserção periférica em neonatos

Objective To identify the risk factors for bloodstream infection associated with peripherally inserted central catheters in neonates. Methods A prospective cohort study conducted in the neonatal intensive care unit with newborns undergoing insertion of 401 peripherally inserted central catheters. Clinical characteristics of the newborn, catheter insertion technique, intravenous therapy and catheter dwell time were tested as risk factors for removal due to catheter associated bloodstream infection, using bivariate analysis and multivariate analysis with Poisson regression. Results The data suggest that the lowest mean in weight and corrected gestational age, as well as the largest catheter dwell time time were associated with the occurrence of bloodstream infection associated with the catheters. The corrected gestational age, clinical diagnosis of transitional metabolic disorder or apnea, and the use of two-lumen catheters have been identified as risk factors. Conclusion The lowest correct gestational age of the newborn, the clinical diagnosis of metabolic disorder or apnea, and the use of two-lumen catheters were identified as risk factors for bloodstream infection associated with peripherally inserted central catheters in neonates.

Complications related to the type of epicutaneous catheter in a cohort of neonates

Objetivos: analisar a relacao entre o tipo de cateter epicutâneo instalado e o tempo ate a ocorrencia de complicacoes que motivam a remocao precoce do dispositivo. Metodo: Coorte prospectiva, realizada em uma unidade de cuidados intensivos neonatais de um hospital privado na cidade de Sao Paulo, no periodo de 01 de julho de 2010 a 30 de junho de 2011. A coorte foi composta por neonatos submetidos a instalacao do cateter epicutâneo duplolumen de poliuretano ou monolumen de silicone. Resultados e discussao: Foram analisados 270 cateteres. Nao houve associacao entre o tipo de cateter epicutâneo e o tempo ate a ocorrencia de complicacoes (p=0,45). O cateter duplolumen de poliuretano apresentou maior tempo medio de permanencia do cateter (p≤0,01). Conclusao: Os dois tipos de cateteres epicutâneos permitiram a infusao intravenosa por mais de 10 dias e nao apresentaram complicacoes mais graves.

Orientações sobre quimioterapia junto à criança com câncer: método criativo sensível

Aims: to identify the guidelines on chemotherapy aimed at children with cancer as seen by family members; to discuss the importance of these instructions which are provided by health professionals regarding these children. Method:This is a qualitative approach research, implemented according to the sensitive creative method.Participants were seven family members of children on chemotherapy in a hospital in Rio de Janeiro. Results: through thematic analysis the categories “chemotherapy on instructions provided to children with cancer” and “the role of professionals in carrying out the instructions provided on chemotherapy to children with cancer” emerged. Discussion: professionals should pass on the guidelines to children because family members have difficulty doing this. The strategies used must be appropriate for children, and must be performed at the beginning of the chemotherapy. Conclusion: one must take into account the ability of children to understand their disease and treatment, and target them, respecting their level of development. Descriptors: Oncologic Nursing; Chemotherapy; Family; Child.Objetivos: identificar as orientacoes sobre o tratamento quimioterapico que devem ser realizadas junto a crianca com câncer na visao dos familiares; e discutir a importância dessas orientacoes sobre quimioterapia realizadas pelos profissionais de saude junto a crianca. Metodo: pesquisa de abordagem qualitativa, implementada segundo o metodo criativo sensivel. Participaram sete familiares de criancas em quimioterapia em um hospital do Rio de Janeiro. Resultados: com a analise tematica emergiram as categorias: orientacoes sobre quimioterapia realizadas junto a crianca com câncer, e o papel dos profissionais na realizacao das orientacoes sobre quimioterapia realizadas junto a crianca com câncer. Discussao: as criancas devem ser orientadas pelos profissionais, poisos familiares apresentam dificuldades para realiza-las. Devem-se utilizar estrategias adequadas a crianca, e realiza-las no inicio da quimioterapia. Conclusao: e preciso levar em consideracao a capacidade que as criancas possuem para compreender sua doenca e tratamento, e orienta-las respeitando o nivel de desenvolvimento.

Causas de remocao nao eletiva do cateter epicutaneo em neonatos

This study aimed to describe the incidence and reasons for nonelective removal of epicutaneous catheters in neonates, identifying its association with the catheter insertion site. This was a prospective cohort study, conducted in a neonatal intensive care unit of a private tertiary hospital in the city of Sao Paulo, Brazil. We analyzed 266 epicutaneous catheter insertions. The incidence of non-elective removal was 39.1%. The most frequent post-insertion complications were suspicion of catheter-related bloodstream infection (25%) and rupture (23.1%). Most catheters were inserted through the right side of the body (65%), in upper limbs (77.1%), and using the axillary veins (31.2%). The findings did not suggest association between the incidence of non-elective removal and the insertion site of the epicutaneous catheter in neonates. Nurses should implement strategies to improve care and decrease incidence of non-elective epicutaneous catheter removals among neonates.This study aimed to describe the incidence and reasons for nonelective removal of epicutaneous catheters in neonates, identifying its association with the catheter insertion site. This was a prospective cohort study, conducted in a neonatal intensive care unit of a private tertiary hospital in the city of São Paulo, Brazil. We analyzed 266 epicutaneous catheter insertions. The incidence of non-elective removal was 39.1%. The most frequent post-insertion complications were suspicion of catheter-related bloodstream infection (25%) and rupture (23.1%). Most catheters were inserted through the right side of the body (65%), in upper limbs (77.1%), and using the axillary veins (31.2%). The findings did not suggest association between the incidence of non-elective removal and the insertion site of the epicutaneous catheter in neonates. Nurses should implement strategies to improve care and decrease incidence of non-elective epicutaneous catheter removals among neonates.

A correlação entre procedimentos assistenciais invasivos e a ocorrência de sepse neonatal

Objetivo: Correlacionar os procedimentos assistenciais invasivos realizados nos recem-nascidos de muito baixo peso com a ocorrencia de sepse neonatal. Metodos: Estudo de coorte retrospectivo, longitudinal, por meio de pesquisa de dados secundarios, durante os anos de 2008-2012. As caracteristicas dos recem-nascidos foram analisadas pelo teste de Mann-Whitney (medias) e o teste do qui quadrado para comparacao de frequencias. Todas as variaveis com significância de p<0,20 na analise bivariada compuseram um modelo de regressao logistica. Resultados: Os dados demonstraram quatorze recem-nascidos com episodio de sepse tardia. A idade gestacional media foi de trinta semanas. Genero feminino e parto cesareo foram os mais frequentes. O peso de nascimento e o uso do cateter umbilical arterial explicaram a ocorrencia de sepse, tendo este oferecido 8,5 vezes maior risco para o desfecho. Conclusao: Acessos vasculares necessitam rigor nas tecnicas de insercao e manuseio para a melhoria dos indicadores de saude.

The development of a risk score for unplanned removal of peripherally inserted central catheter in newborns

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.Objetivo: elaborar um escore de risco para remocao nao eletiva do cateter central de insercao periferica em neonatos. Metodo: estudo de coorte prospectivo conduzido em unidade de terapia intensiva neonatal com recem-nascidos submetidos a instalacao de 524 cateteres centrais de insercao periferica. As caracteristicas clinicas do neonato, a tecnica de insercao do cateter e a terapia intravenosa foram testadas como fatores de risco para remocao nao eletiva do cateter na analise bivariada. O escore de risco foi elaborado a partir da regressao logistica, validado internamente e sua acuracia avaliada por meio da area sob a curva receiver operating characteristic. Resultados: o escore de risco foi composto pelos fatores de risco: diagnostico de transtorno transitorio do metabolismo, insercao previa do cateter, uso de cateter duplo lumen de poliuretano, infusao de multiplas solucoes endovenosas atraves de cateter mono lumen e posicao nao central da ponta do cateter. Sua aplicacao permitiu classificar os recem-nascidos em tres categorias de risco: baixo (0 a 3 pontos), moderado (4 a 8 pontos) e alto (≥ 9 pontos) para remocao nao eletiva, com acuracia de 0,76. Conclusao: recomenda-se adotar estrategias preventivas baseadas em evidencias de acordo com a classificacao e fatores de risco do recemnascido, visando minimizar a ocorrencia de remocao nao eletiva do cateter.

Elaboração de um escore de risco para remoção não eletiva do cateter central de inserção periférica em neonatos

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.Objetivo: elaborar um escore de risco para remocao nao eletiva do cateter central de insercao periferica em neonatos. Metodo: estudo de coorte prospectivo conduzido em unidade de terapia intensiva neonatal com recem-nascidos submetidos a instalacao de 524 cateteres centrais de insercao periferica. As caracteristicas clinicas do neonato, a tecnica de insercao do cateter e a terapia intravenosa foram testadas como fatores de risco para remocao nao eletiva do cateter na analise bivariada. O escore de risco foi elaborado a partir da regressao logistica, validado internamente e sua acuracia avaliada por meio da area sob a curva receiver operating characteristic. Resultados: o escore de risco foi composto pelos fatores de risco: diagnostico de transtorno transitorio do metabolismo, insercao previa do cateter, uso de cateter duplo lumen de poliuretano, infusao de multiplas solucoes endovenosas atraves de cateter mono lumen e posicao nao central da ponta do cateter. Sua aplicacao permitiu classificar os recem-nascidos em tres categorias de risco: baixo (0 a 3 pontos), moderado (4 a 8 pontos) e alto (≥ 9 pontos) para remocao nao eletiva, com acuracia de 0,76. Conclusao: recomenda-se adotar estrategias preventivas baseadas em evidencias de acordo com a classificacao e fatores de risco do recemnascido, visando minimizar a ocorrencia de remocao nao eletiva do cateter.

Elaboración de un puntaje de riesgo para remoción no electiva de catéter central de inserción periférica en neonatos

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.Objetivo: elaborar um escore de risco para remocao nao eletiva do cateter central de insercao periferica em neonatos. Metodo: estudo de coorte prospectivo conduzido em unidade de terapia intensiva neonatal com recem-nascidos submetidos a instalacao de 524 cateteres centrais de insercao periferica. As caracteristicas clinicas do neonato, a tecnica de insercao do cateter e a terapia intravenosa foram testadas como fatores de risco para remocao nao eletiva do cateter na analise bivariada. O escore de risco foi elaborado a partir da regressao logistica, validado internamente e sua acuracia avaliada por meio da area sob a curva receiver operating characteristic. Resultados: o escore de risco foi composto pelos fatores de risco: diagnostico de transtorno transitorio do metabolismo, insercao previa do cateter, uso de cateter duplo lumen de poliuretano, infusao de multiplas solucoes endovenosas atraves de cateter mono lumen e posicao nao central da ponta do cateter. Sua aplicacao permitiu classificar os recem-nascidos em tres categorias de risco: baixo (0 a 3 pontos), moderado (4 a 8 pontos) e alto (≥ 9 pontos) para remocao nao eletiva, com acuracia de 0,76. Conclusao: recomenda-se adotar estrategias preventivas baseadas em evidencias de acordo com a classificacao e fatores de risco do recemnascido, visando minimizar a ocorrencia de remocao nao eletiva do cateter.

Jogo dos sete erros no processo de submissão de artigos científicos (Parte 7): quem não lê manual não sabe (para quem e como) escrever

To end the game of seven errors regarding the submission process of scientific papers, this editorial discusses the importance of reading the rules of journals and the publication of manuscripts. Regarding the article submission, first, it is imperative that the authors know the scope of the magazines to which they will submit the results of their studies. Any author can offer a scientific paper to be reviewed for publication in a magazine; however, these authors should read the rules for submission of manuscripts and follow them. In order to facilitate the process of publishing articles, the OBJN offers on its homepage, tutorials to instruct authors, and the creation of a new submission section entitled Research Notes, aiming at the publication of short research articles with the presentation of their partial results. It is, therefore, important that authors read thoroughly the publication standards in order to facilitate the preparation of their manuscripts and consequent publication of the results of their studies. Descriptors: Research Design; Publication Formats; Evidence-Based Nursing.

Seven errors game in the scientific papers submission process (Part 6): discussions between Faust and Mephistopheles

This editorial proposes a reflection on information technology in regard to digital inclusion and the scientific articles submission process. When it comes to the publication of scientific articles, there is a tendency for journals to be no longer printed, but to be made electronically, not only for environmental purposes but for the advancement of technology itself. During the manuscript submission process, many authors have difficulties in managing the platforms of these journals. In order to reduce this difficulty, part of the magazines prepares tutorials; however, these tutorials are not always used or are poorly understood. Nevertheless, outsourcing the digital technological handling concerning the need for digital inclusion as a kind of protection and impermeability is a reckless and anachronistic act. Periodicals have an important share in this digital education process as a way to safeguard its most precious possession: the knowledge producers.