Maria Luzia Chollopetz da Cunha

Adverse Events Related to the Use of Central Venous Catheters in Hospitalized Newborns

This study identifies the adverse events related to the use of central venous catheters (CVC) in newborns admitted to a neonatal care unit. This is a quantitative, descriptive and retrospective study. The population consisted of 167 newborns admitted in the neonatal unit of the Hospital de Clínicas at Porto Alegre, RS, Brazil which used CVCs inserted through percutaneous puncture (PICC) and surgical insertion, totaling 241 catheters. There was a higher prevalence of mechanical adverse events in the PICC line insertions, with a preponderance of catheter occlusions (19.44%) and ruptures (8.8%). The surgically inserted CVCs had a higher prevalence of catheter-related infectious adverse events with the most common being clinical sepsis (16%). This study suggests that the correct insertion technique should be used and a specialized team should monitor the CVCs to ensure safety and prevent adverse events.O objetivo deste estudo foi identificar os eventos adversos relacionados ao uso de cateteres venosos centrais (CVC), em recem-nascidos internados em unidade neonatal. Trata-se de pesquisa quantitativa, descritiva, retrospectiva. A populacao foi constituida por 167 neonatos internados na unidade neonatal do Hospital de Clinicas de Porto Alegre que utilizaram CVCs, inseridos por puncao percutânea (PICC) e insercao cirurgica, totalizando 241 cateteres. Nos PICCs houve maior prevalencia de eventos adversos mecânicos, predominando a oclusao (19,44%) e a ruptura do cateter (8,8%). Os CVCs por insercao cirurgica apresentaram maior prevalencia dos eventos adversos infecciosos relacionados ao cateter, sendo o mais frequente a sepse clinica (16%). O estudo sugere que, para maior seguranca do uso de CVCs, e importante que seja utilizada a tecnica correta de insercao do cateter e realizado o acompanhamento dos CVCs por equipe especializada e atenta para a prevencao de eventos adversos.

Effect of Bathing on Skin Flora of Preterm Newborns

OBJECTIVE:To assess the effect of bathing with water only or with mild pH neutral soap and water on skin flora of preterm newborns.METHOD:Randomized blinded clinical trial that enrolled 73 preterm newborns whose gestational age was between 28 and 35 weeks and birth weight between 800 and 1800 g. At the age of 3 days the infants were randomly assigned to a group that was given daily baths either with water only, or with soap and water for 7 or more days. Antibiotic treatment delayed onset of the trial in some preterm infants. On the final day of bathing axillary bacterial cultures were obtained before and 30 minutes after bathing.RESULTS:At the time of axillary culturing, the mean age of the newborns was 19 days. Coagulase-negative Staphylococcus was the most prevalent microorganism in both groups. No significant difference was found in the count of microorganism colonies between both groups. The comparison of the number of bacterial colonies between the time before and after bath, carried out by repeated-measures ANOVA showed a significant difference over time in the two groups, without a significant difference between the two groups.CONCLUSIONS:Bathing preterm newborns with water only or with soap and water produces similar effects on skin colonization of a preterm neonate. Both are effective to decrease the number of colonies of Gram-positive and Gram-negative bacteria.

Effect of the first bath with chlorhexidine on skin colonization with Staphylococcus aureus in normal healthy term newborns

A masked randomized clinical trial was conducted in 93 neonates who received the first bath with chlorhexidine (experimental) (n=44) or neutral liquid soap (control) (n=49). Three samples were collected for culture from the neonates’ right axilla skin before bath, 30 min and 24 h after bath. Immediately before bath, Staphylococcus aureus colonization prevalence was 10.2% (n=5) in control and 4.5% (n=2) in the experimental group (p=0.74). 30 min after bath, S. aureus prevalence was 20.4% (n=10) in control and 2.3% (n=1) in the experimental group (p=0.017). 24 h after bath, S. aureus prevalence was 36.7% (n=18) in control and 13.6% (n=6) in the experimental group (p=0.021). There was no occurrence of sepsis in the first month in both groups. In conclusion, a first bath with chlorhexidine reduced S. aureus colonization on the newborns skin in a 24-h period.

Prevenção e manejo não farmacológico da dor no recém-nascido

OBJECTIVE To describe the main non-pharmacological interventions for pain relief in newborns available in Neonatal Intensive Care Unit. METHOD An exploratory search of the MedLine, Lilacs and Scielo online databases was conducted to retrieve references of studies published from 2004 to 2013. RESULTS Several non-pharmacological interventions were shown to be effective, to represent low risk for neonates and to have a low operational cost. The ones most often discussed in the literature were: oral administration of glucose/sucrose, non-nutritive sucking, breastfeeding, skin-to-skin contact, facilitated tucking and swaddling. CONCLUSION Healthcare teams should be familiar with these methods and use them more effectively in Neonatal Intensive Care Unit daily routines, so as to ensure that newborns receive qualified and more human care.

Cross-cultural adaptation and clinical validation of the Neonatal Skin Condition Score to Brazilian Portuguese

OBJECTIVE: to describe the process of cross-cultural adaptation and clinical validation of the Neonatal Skin Condition Score. METHODS: this methodological cross-cultural adaptation study included five steps: initial translation, synthesis of the initial translation, back translation, review by an Committee of Specialists and testing of the pre-final version, and an observational cross-sectional study with analysis of the psychometric properties using the Adjusted Kappa, Intraclass Correlation Coefficient, and Bland-Altman Method statistical tests. A total of 38 professionals were randomly recruited to review the clarity of the adapted instrument, and 47 newborns hospitalized in the Neonatology Unit of the Clinical Hospital of Porto Alegre were selected by convenience for the clinical validation of the instrument. RESULTS: the adapted scale showed approximately 85% clarity. The statistical tests showed moderate to strong intra and interobserver item to item reliability and from strong to very strong in the total score, with a variation of less than 2 points among the scores assigned by the nurses to the patients. CONCLUSIONS: the scale was adapted and validated to Brazilian Portuguese. The psychometric properties of the Brazilian version of the Neonatal Skin Condition Score instrument were similar to the validation results of the original scale.

Eventos adversos relacionados ao uso de cateteres venosos centrais em recém-nascidos hospitalizados

This study identifies the adverse events related to the use of central venous catheters (CVC) in newborns admitted to a neonatal care unit. This is a quantitative, descriptive and retrospective study. The population consisted of 167 newborns admitted in the neonatal unit of the Hospital de Clínicas at Porto Alegre, RS, Brazil which used CVCs inserted through percutaneous puncture (PICC) and surgical insertion, totaling 241 catheters. There was a higher prevalence of mechanical adverse events in the PICC line insertions, with a preponderance of catheter occlusions (19.44%) and ruptures (8.8%). The surgically inserted CVCs had a higher prevalence of catheter-related infectious adverse events with the most common being clinical sepsis (16%). This study suggests that the correct insertion technique should be used and a specialized team should monitor the CVCs to ensure safety and prevent adverse events.O objetivo deste estudo foi identificar os eventos adversos relacionados ao uso de cateteres venosos centrais (CVC), em recem-nascidos internados em unidade neonatal. Trata-se de pesquisa quantitativa, descritiva, retrospectiva. A populacao foi constituida por 167 neonatos internados na unidade neonatal do Hospital de Clinicas de Porto Alegre que utilizaram CVCs, inseridos por puncao percutânea (PICC) e insercao cirurgica, totalizando 241 cateteres. Nos PICCs houve maior prevalencia de eventos adversos mecânicos, predominando a oclusao (19,44%) e a ruptura do cateter (8,8%). Os CVCs por insercao cirurgica apresentaram maior prevalencia dos eventos adversos infecciosos relacionados ao cateter, sendo o mais frequente a sepse clinica (16%). O estudo sugere que, para maior seguranca do uso de CVCs, e importante que seja utilizada a tecnica correta de insercao do cateter e realizado o acompanhamento dos CVCs por equipe especializada e atenta para a prevencao de eventos adversos.

Prevention and non-pharmacological management of pain in newborns.

OBJECTIVE To describe the main non-pharmacological interventions for pain relief in newborns available in Neonatal Intensive Care Unit. METHOD An exploratory search of the MedLine, Lilacs and Scielo online databases was conducted to retrieve references of studies published from 2004 to 2013. RESULTS Several non-pharmacological interventions were shown to be effective, to represent low risk for neonates and to have a low operational cost. The ones most often discussed in the literature were: oral administration of glucose/sucrose, non-nutritive sucking, breastfeeding, skin-to-skin contact, facilitated tucking and swaddling. CONCLUSION Healthcare teams should be familiar with these methods and use them more effectively in Neonatal Intensive Care Unit daily routines, so as to ensure that newborns receive qualified and more human care.

Late-onset neonatal sepsis in preterm infants with birth weight under 1.500 g

OBJECTIVE The research objective was to characterize preterm infants with birth weight under 1500 g, and to identify the incidence of late-onset neonatal sepsis among this population. METHODS A prospective cohort study with a sample of 30 preterm newborns that weighed under 1500 g and were hospitalized in the NICU of the university hospital. Data were collected from January to December 2013 using a structured instrument. RESULTS Of the 30 neonates included in the study, 14 developed late-onset neonatal sepsis with a prevalence of coagulase-negative staphylococci. CONCLUSIONS The incidence of late-onset neonatal sepsis indicates a vulnerability in preterm infants due to immunological immaturity. These results reveal that knowledge of the profile of newborn infants admitted to the NICU and the risk factors to which they are exposed are central to the planning of nursing care for these patients. Future studies should address strategies for preventing nosocomial infection.

Manchester Triage System: main flowcharts, discriminators and outcomes of a pediatric emergency care

ABSTRACT Objetive: to characterize the care services performed through risk rating by the Manchester Triage System, identifying demographics (age, gender), main flowcharts, discriminators and outcomes in pediatric emergency Method: cross-sectional quantitative study. Data on risk classification were obtained through a search of computerized registration data from medical records of patients treated in the pediatric emergency within one year. Descriptive statistics with absolute and relative frequencies was used for the analysis. Results: 10,921 visits were conducted in the pediatric emergency, mostly male (54.4%), aged between 29 days and two years (44.5%). There was a prevalence of the urgent risk category (43.6%). The main flowchart used in the care was worried parents (22.4%) and the most prevalent discriminator was recent event (15.3%). The hospitalization outcome occurred in 10.4% of care performed in the pediatric emergency, however 61.8% of care needed to stay under observation and / or being under the health team care in the pediatric emergency. Conclusion: worried parents was the main flowchart used and recent events the most prevalent discriminator, comprising the hospitalization outcomes and permanency in observation in the pediatric emergency before discharge from the hospital.Objetivo: identificar a utilizacao das redes sociais na educacao em enfermagem. Metodo: revisao integrativa da literatura nas bases de dados: LILACS, IBECS, Cochrane, BDENF, SciELO, CINAHL, Scopus, PubMed, Portal de Periodicos CAPES e Web of Science, utilizando-se os descritores: social networking e nursing education e as palavras chaves: social networking sites e nursing education, realizada em abril de 2015. Resultados: dos 489 artigos encontrados somente 14 atenderam os criterios de inclusao e exclusao. A maioria dos estudos foi publicada a partir de 2013 (57%), oriunda dos Estados Unidos e do Reino Unido (77,8%). Observou-se a utilizacao das redes sociais com os alunos de enfermagem, de pos-graduacao, mentores e enfermeiros, em cursos de graduacao, educacao hibrida (blended-learning) e na educacao interprofissional. As redes sociais utilizadas no processo de ensino e aprendizagem foram o Facebook (42,8%), Ning (28,5%), Twitter (21,4%) e MySpace (7,1%), por meio de audios, videos, quizzes, animacoes, foruns, orientacoes, apoio, discussoes e em grupo de pesquisa. Conclusao: foram encontradas poucas experiencias utilizando as redes sociais na educacao em enfermagem, sendo que as contribuicoes evidenciam os varios beneficios e as dificuldades encontradas, tornando-se subsidios para o aprimoramento e reavaliacao de sua utilizacao no processo de ensino e aprendizagem.

Eventos adversos relacionados con el uso de catéteres venosos centrales en recién nacidos hospitalizados

This study identifies the adverse events related to the use of central venous catheters (CVC) in newborns admitted to a neonatal care unit. This is a quantitative, descriptive and retrospective study. The population consisted of 167 newborns admitted in the neonatal unit of the Hospital de Clínicas at Porto Alegre, RS, Brazil which used CVCs inserted through percutaneous puncture (PICC) and surgical insertion, totaling 241 catheters. There was a higher prevalence of mechanical adverse events in the PICC line insertions, with a preponderance of catheter occlusions (19.44%) and ruptures (8.8%). The surgically inserted CVCs had a higher prevalence of catheter-related infectious adverse events with the most common being clinical sepsis (16%). This study suggests that the correct insertion technique should be used and a specialized team should monitor the CVCs to ensure safety and prevent adverse events.O objetivo deste estudo foi identificar os eventos adversos relacionados ao uso de cateteres venosos centrais (CVC), em recem-nascidos internados em unidade neonatal. Trata-se de pesquisa quantitativa, descritiva, retrospectiva. A populacao foi constituida por 167 neonatos internados na unidade neonatal do Hospital de Clinicas de Porto Alegre que utilizaram CVCs, inseridos por puncao percutânea (PICC) e insercao cirurgica, totalizando 241 cateteres. Nos PICCs houve maior prevalencia de eventos adversos mecânicos, predominando a oclusao (19,44%) e a ruptura do cateter (8,8%). Os CVCs por insercao cirurgica apresentaram maior prevalencia dos eventos adversos infecciosos relacionados ao cateter, sendo o mais frequente a sepse clinica (16%). O estudo sugere que, para maior seguranca do uso de CVCs, e importante que seja utilizada a tecnica correta de insercao do cateter e realizado o acompanhamento dos CVCs por equipe especializada e atenta para a prevencao de eventos adversos.