Livia Maria Garbin

Central catheter dressing in a simulator: the effects of tutor's assistance or self-learning tutorial

AIMS to compare the performance of undergraduate students concerning semi-implanted central venous catheter dressing in a simulator, with the assistance of a tutor or of a self-learning tutorial. METHOD Randomized controlled trial. The sample consisted of 35 undergraduate nursing students, who were divided into two groups after attending an open dialogue presentation class and watching a video. One group undertook the procedure practice with a tutor and the other with the assistance of a self-learning tutorial. RESULTS in relation to cognitive knowledge, the two groups had lower performance in the pre-test than in the post-test. The group that received assistance from a tutor performed better in the practical assessment. CONCLUSION the simulation undertaken with the assistance of a tutor showed to be the most effective learning strategy when compared to the simulation using a self-learning tutorial. Advances in nursing simulation technology are of upmost importance and the role of the tutor in the learning process should be highlighted, taking into consideration the role this professional plays in knowledge acquisition and in the development of critical-reflexive thoughts and attitudes. (ClinicalTrials.gov Identifier: NCT 01614314).Objetivo: comparar el desempeno de graduandos en la realizacion del parche del cateter venoso central semi-implantado, en simulador, con el auxilio del tutor o de un guia auto-instruccional. Metodo: estudio experimental controlado hecho aleatorio. La muestra fue compuesta por 35 alumnos de Graduacion en Enfermeria que fueron asignados en dos grupos despues de asistir a una clase expositiva dialogada y a un video. Un grupo realizo el entrenamiento del procedimiento con el tutor y el otro con el auxilio de un guia auto- instruccional. Resultados: con relacion al conocimiento cognoscitivo, los dos grupos presentaron desempeno menor en la pre-prueba comparada al pos-prueba. El grupo con presencia del tutor presento mejor desempeno en la evaluacion practica. Conclusion: la utilizacion de simulacion aliada a la presencia del tutor mostro ser una estrategia de ensenanza mas efectiva del que la simulacion dirigida por guia autoinstruccional. Avances en simulacion en el area de enfermeria son de extrema importancia y la figura del tutor merece destaque en el proceso enseno-aprendizaje, teniendo en vista el papel que este profesional desempena durante la adquisicion de conocimiento y en el desarrollo de pensamientos y actitudes criticos reflexivos. (ClinicalTrials.gov Identifier: NCT 01614314). Descriptores: Tutoria; Simulacion; Enfermeria; Cateteres.

The Use Of Polyurethane Transparent Film In Indwelling Central Venous Catheter

Dressing is an intervention aimed to prevent infection in central venous catheter. This study aimed to analyze the frequency of catheter-related infection and skin toxicity in the use of transparent film in Hickmans catheter in patients who underwent allogeneic hematopoietic stem cell transplantation. A case series with 10 cases was carried out. Due to the presence of exudate on the average for 12 days, sterile gauze dressing was used for 12.9 days (average). Transparent film was used, on average, for 15.1 days. Catheters were precociously removed due to infection in four cases. The highest degree of skin toxicity occurred in a case that used gauze dressing and in three cases with film. The transparent film permitted visualization of the exit site of the catheter and changes with longer intervals.O curativo e intervencao que visa a prevencao de infeccao no cateter venoso central. O estudo teve como objetivo analisar a frequencia de infeccao, relacionada ao cateter, e toxicidade cutânea, na utilizacao do curativo de poliuretano no cateter de Hickman, implantado em pacientes submetidos ao transplante de celulas-tronco hematopoeticas alogenico. Para tal, realizou-se uma serie de casos, constituida por 10 casos. O exsudato esteve presente em media por 12 dias, sendo necessario o uso do curativo de gaze esteril, com fita adesiva, por 12,9 dias (media). O curativo de poliuretano foi utilizado, em media, por 15,1 dias. A retirada precoce do cateter por infeccao ocorreu em quatro casos. O maior grau de toxicidade cutânea aconteceu em um caso que utilizou o curativo de gaze e em tres casos com filme. O filme transparente permitiu a visualizacao do sitio de saida do cateter e a troca com intervalos maiores.

Infection prevention measures used in hematopoietic stem cell transplantation: evidences for practice

This integrative review aimed to identify and assess evidence available about the use of high-efficiency air filters, protective isolation and masks for infection prevention in patients submitted to hematopoietic stem cell transplantation during hospitalization. LILACS, PUBMED, CINAHL, EMBASE and the Cochrane Library were used to select the articles. Of the 1023 identified publications, 15 were sampled. The use of HEPA filters is recommended for patients submitted to allogeneic transplantation during the neutropenia period. The level of evidence of protective isolation is weak (VI) and the studies evaluated did not recommend its use. No studies with strong evidence (I and II) were evaluated that justify the use of masks, while Centers for Disease Control and Prevention recommendations should be followed regarding the use of special respirators by immunocompromised patients. The evidenced data can support decision making with a view to nursing care.Esta revisao integrativa teve como objetivo identificar e avaliar as evidencias disponiveis em relacao ao uso de filtros de ar de alta eficiencia, isolamento protetor e mascaras para a prevencao de infeccao em pacientes submetidos ao transplante de celulas-tronco hematopoeticas, durante a internacao. Para a selecao dos artigos foram utilizadas as bases de dados LILACS, PubMed, CINAHL, EMBASE e a Biblioteca Cochrane. Das 1023 publicacoes identificadas, 15 foram incluidas na amostra. O uso dos filtros HEPA e recomendado para pacientes submetidos ao transplante alogenico, durante o periodo de neutropenia. O nivel das evidencias do isolamento protetor e fraco (VI) e os estudos avaliados nao recomendam o seu uso. Nao foram avaliados estudos com evidencias fortes (I e II) que justifiquem o uso de mascaras, sendo indicado que sejam seguidas as recomendacoes dos Centers for Disease Control and Prevention quanto ao uso de respiradores especiais pelos pacientes imunocomprometidos. Os dados evidenciados podem auxiliar na tomada de decisao para a assistencia de enfermagem.

Thrombotic obstruction of the central venous catheter in patients undergoing hematopoietic stem cell transplantation

Correspondencia: Renata Cristina de Campos Pereira Silveira Universidade de Sao Paulo. Escola de Enfermagem de Ribeirao Preto Departamento de Enfermagem Geral e Especializada Av. dos Bandeirantes, 3900 Bairro: Monte Alegre CEP: 14040-902, Ribeirao Preto, SP, Brasil E-mail: recris@eerp.usp.br Obstruccion trombotica del cateter venoso central en pacientes sometidos al trasplante de celulas-tronco hematopoyeticas1This is an integrative literature review with the aim of summarizing the prevention measures and treatment of thrombotic obstruction of long-term semi-implanted central venous catheters, in patients undergoing hematopoietic stem cell transplantation. The sample consisted of seven studies, being two randomized controlled clinical trials, three cohort studies and two case series. Regarding the prevention measures, one single study demonstrated effectiveness, which was a cohort study on the oral use of warfarin. In relation to the treatment measures, three studies evidenced effectiveness, one highlighted the efficacy of streptokinase or urokinase, one demonstrated the benefit of using low-molecular-weight heparin and the other treated the obstruction with heparin or urokinase. Catheter patency research shows a restricted evolution that does not follow the evolution of transplantations, mainly regarding nursing care.

O uso do filme transparente de poliuretano no cateter venoso central de longa permanência

Dressing is an intervention aimed to prevent infection in central venous catheter. This study aimed to analyze the frequency of catheter-related infection and skin toxicity in the use of transparent film in Hickmans catheter in patients who underwent allogeneic hematopoietic stem cell transplantation. A case series with 10 cases was carried out. Due to the presence of exudate on the average for 12 days, sterile gauze dressing was used for 12.9 days (average). Transparent film was used, on average, for 15.1 days. Catheters were precociously removed due to infection in four cases. The highest degree of skin toxicity occurred in a case that used gauze dressing and in three cases with film. The transparent film permitted visualization of the exit site of the catheter and changes with longer intervals.O curativo e intervencao que visa a prevencao de infeccao no cateter venoso central. O estudo teve como objetivo analisar a frequencia de infeccao, relacionada ao cateter, e toxicidade cutânea, na utilizacao do curativo de poliuretano no cateter de Hickman, implantado em pacientes submetidos ao transplante de celulas-tronco hematopoeticas alogenico. Para tal, realizou-se uma serie de casos, constituida por 10 casos. O exsudato esteve presente em media por 12 dias, sendo necessario o uso do curativo de gaze esteril, com fita adesiva, por 12,9 dias (media). O curativo de poliuretano foi utilizado, em media, por 15,1 dias. A retirada precoce do cateter por infeccao ocorreu em quatro casos. O maior grau de toxicidade cutânea aconteceu em um caso que utilizou o curativo de gaze e em tres casos com filme. O filme transparente permitiu a visualizacao do sitio de saida do cateter e a troca com intervalos maiores.

Cyclosporine level: difference between blood samples collected through peripheral and central venous access

AIMS AND OBJECTIVES To identify differences in cyclosporine levels between blood samples collected from a peripheral venous access, catheter line used for drug infusion and catheter line not used for drug infusion in adult patients receiving allogeneic haematopoietic stem cell transplantation. Background.  Cyclosporine is an immunosuppressant that prevents graft-versus-host disease, has a narrow therapeutic window and causes nephrotoxicity. For cyclosporine infusion, a tunnelled central venous access device is used; however, because of the lipophilic properties of the drug, it can adsorb to the catheter surface and falsely raise cyclosporine concentrations in blood specimens. DESIGN Prospective observational study. METHODS The study collected 135 blood samples from 16 patients. In 13 subjects, samples were obtained from the three lines at three time points (1, 7 and 14 days after the start of cyclosporine infusion), and for three subjects, samples were only obtained at 1 and 7 days after the start of infusion. The 5-ml blood discard method was used for samples collected from the catheter. Using this procedure, the catheter line was washed with saline solution, 5 ml of blood and saline solution were aspirated from the catheter line and discarded, and then sample blood used for the test was collected. The paired t-test with the Bonferroni correction was used to analyse the differences in cyclosporine serum levels. RESULTS Significant differences were observed when the drug serum levels obtained in the line used for drug infusion were compared with the levels obtained in the line not used for infusion or the peripheral venous line. No differences in drug levels were identified in blood collected from the peripheral venous line and the line not used for drug infusion. CONCLUSION Drug adsorption occurs in the line used for infusion. Therefore, the blood sample collected from the line not used for cyclosporine infusion can be considered reliable for drug concentration determination. RELEVANCE TO CLINICAL PRACTICE Nurses should standardise one line of the tunnelled central venous access device for cyclosporine infusion, which avoids the need for evasive procedures and provides patients with more comfort.

Curativo de cateter central em simulador: efeito da presença do tutor ou da aprendizagem autoinstrucional

AIMS to compare the performance of undergraduate students concerning semi-implanted central venous catheter dressing in a simulator, with the assistance of a tutor or of a self-learning tutorial. METHOD Randomized controlled trial. The sample consisted of 35 undergraduate nursing students, who were divided into two groups after attending an open dialogue presentation class and watching a video. One group undertook the procedure practice with a tutor and the other with the assistance of a self-learning tutorial. RESULTS in relation to cognitive knowledge, the two groups had lower performance in the pre-test than in the post-test. The group that received assistance from a tutor performed better in the practical assessment. CONCLUSION the simulation undertaken with the assistance of a tutor showed to be the most effective learning strategy when compared to the simulation using a self-learning tutorial. Advances in nursing simulation technology are of upmost importance and the role of the tutor in the learning process should be highlighted, taking into consideration the role this professional plays in knowledge acquisition and in the development of critical-reflexive thoughts and attitudes. (ClinicalTrials.gov Identifier: NCT 01614314).Objetivo: comparar el desempeno de graduandos en la realizacion del parche del cateter venoso central semi-implantado, en simulador, con el auxilio del tutor o de un guia auto-instruccional. Metodo: estudio experimental controlado hecho aleatorio. La muestra fue compuesta por 35 alumnos de Graduacion en Enfermeria que fueron asignados en dos grupos despues de asistir a una clase expositiva dialogada y a un video. Un grupo realizo el entrenamiento del procedimiento con el tutor y el otro con el auxilio de un guia auto- instruccional. Resultados: con relacion al conocimiento cognoscitivo, los dos grupos presentaron desempeno menor en la pre-prueba comparada al pos-prueba. El grupo con presencia del tutor presento mejor desempeno en la evaluacion practica. Conclusion: la utilizacion de simulacion aliada a la presencia del tutor mostro ser una estrategia de ensenanza mas efectiva del que la simulacion dirigida por guia autoinstruccional. Avances en simulacion en el area de enfermeria son de extrema importancia y la figura del tutor merece destaque en el proceso enseno-aprendizaje, teniendo en vista el papel que este profesional desempena durante la adquisicion de conocimiento y en el desarrollo de pensamientos y actitudes criticos reflexivos. (ClinicalTrials.gov Identifier: NCT 01614314). Descriptores: Tutoria; Simulacion; Enfermeria; Cateteres.

Inter-Unit Doctoral Program in Nursing of the University of São Paulo: characterization of Graduates and Theses Defended in a Decade

This descriptive study aimed to characterize the graduates of the Inter-unit Doctoral Program in Nursing of the School of Nursing of the University of São Paulo, who defended their theses in the period 1998-2008, in relation to the location they developed their Masters and their pre and post-doctoral employment, also to investigate the theses defended in relation to the thematic areas and methodological approaches used. Data were collected from the Fenix-USP System and the Lattes Curriculum System. Of the 190 graduates, 178 had curricula available online. Of those, 58.4% performed teaching and research activities when they entered the doctoral program, which were activities mainly developed at Federal Universities (34.8%). This predominance was maintained after the conclusion of the doctoral studies. The thematic areas most studied were Womens Health (20.5%) and Adults/Elderly Health (13.2%). Regarding the methodological approach, 68.4% used qualitative methods. The data evidenced the contributions of this Program to research.Este e um estudo descritivo, cujos objetivos foram caracterizar os egressos do Programa Interunidades de Doutoramento em Enfermagem da Escola de Enfermagem da Universidade de Sao Paulo e Escola de Enfermagem de Ribeirao Preto, com teses defendidas entre 1998 e 2008, em relacao ao local de realizacao do mestrado, vinculo empregaticio anterior e posterior ao doutorado, e investigar as teses em relacao as areas tematicas e abordagens metodologicas utilizadas. Os dados foram coletados no Sistema Fenix-USP e Curriculo Lattes de 190 egressos, dos quais 178 tinham curriculo disponivel online. Desses, 58,4% realizavam atividades de docencia e pesquisa no momento do ingresso no doutorado, atividades essas desenvolvidas principalmente em universidades federais (34,8%), predominância que se manteve apos o termino do doutorado. As areas tematicas mais estudadas foram saude da mulher (20,5%) e do adulto/idoso (13,2%) e 68,4% utilizaram metodos qualitativos. Os dados evidenciam contribuicao desse Programa para a pesquisa.

Obstrucción trombótica del catéter venoso central en pacientes sometidos al trasplante de células-tronco hematopoyéticas

Correspondencia: Renata Cristina de Campos Pereira Silveira Universidade de Sao Paulo. Escola de Enfermagem de Ribeirao Preto Departamento de Enfermagem Geral e Especializada Av. dos Bandeirantes, 3900 Bairro: Monte Alegre CEP: 14040-902, Ribeirao Preto, SP, Brasil E-mail: recris@eerp.usp.br Obstruccion trombotica del cateter venoso central en pacientes sometidos al trasplante de celulas-tronco hematopoyeticas1This is an integrative literature review with the aim of summarizing the prevention measures and treatment of thrombotic obstruction of long-term semi-implanted central venous catheters, in patients undergoing hematopoietic stem cell transplantation. The sample consisted of seven studies, being two randomized controlled clinical trials, three cohort studies and two case series. Regarding the prevention measures, one single study demonstrated effectiveness, which was a cohort study on the oral use of warfarin. In relation to the treatment measures, three studies evidenced effectiveness, one highlighted the efficacy of streptokinase or urokinase, one demonstrated the benefit of using low-molecular-weight heparin and the other treated the obstruction with heparin or urokinase. Catheter patency research shows a restricted evolution that does not follow the evolution of transplantations, mainly regarding nursing care.

Parche de catéter central en simulador: efecto de la presencia del tutor o del aprendizaje auto-instruccional

AIMS to compare the performance of undergraduate students concerning semi-implanted central venous catheter dressing in a simulator, with the assistance of a tutor or of a self-learning tutorial. METHOD Randomized controlled trial. The sample consisted of 35 undergraduate nursing students, who were divided into two groups after attending an open dialogue presentation class and watching a video. One group undertook the procedure practice with a tutor and the other with the assistance of a self-learning tutorial. RESULTS in relation to cognitive knowledge, the two groups had lower performance in the pre-test than in the post-test. The group that received assistance from a tutor performed better in the practical assessment. CONCLUSION the simulation undertaken with the assistance of a tutor showed to be the most effective learning strategy when compared to the simulation using a self-learning tutorial. Advances in nursing simulation technology are of upmost importance and the role of the tutor in the learning process should be highlighted, taking into consideration the role this professional plays in knowledge acquisition and in the development of critical-reflexive thoughts and attitudes. (ClinicalTrials.gov Identifier: NCT 01614314).Objetivo: comparar el desempeno de graduandos en la realizacion del parche del cateter venoso central semi-implantado, en simulador, con el auxilio del tutor o de un guia auto-instruccional. Metodo: estudio experimental controlado hecho aleatorio. La muestra fue compuesta por 35 alumnos de Graduacion en Enfermeria que fueron asignados en dos grupos despues de asistir a una clase expositiva dialogada y a un video. Un grupo realizo el entrenamiento del procedimiento con el tutor y el otro con el auxilio de un guia auto- instruccional. Resultados: con relacion al conocimiento cognoscitivo, los dos grupos presentaron desempeno menor en la pre-prueba comparada al pos-prueba. El grupo con presencia del tutor presento mejor desempeno en la evaluacion practica. Conclusion: la utilizacion de simulacion aliada a la presencia del tutor mostro ser una estrategia de ensenanza mas efectiva del que la simulacion dirigida por guia autoinstruccional. Avances en simulacion en el area de enfermeria son de extrema importancia y la figura del tutor merece destaque en el proceso enseno-aprendizaje, teniendo en vista el papel que este profesional desempena durante la adquisicion de conocimiento y en el desarrollo de pensamientos y actitudes criticos reflexivos. (ClinicalTrials.gov Identifier: NCT 01614314). Descriptores: Tutoria; Simulacion; Enfermeria; Cateteres.