Patrícia Ponce de Camargo

Localização inicial da ponta de cateter central de inserção periférica (PICC) em recém-nascidos

This is a cross-sectional study aiming to identify the initial tip position of peripherally inserted central catheters (PICC) and to verify the prevalence of success in inserting such catheters in neonates. The study was carried out in the neonatal care unit of Hospital das Clinicas, Universidade de Sao Paulo. Data were collected prospectively from March to September 2006. 37 neonates underwent PICC insertion were included in the study. The rate of success for this procedure was 72.3% (27 neonates). Of them, four (14.8%) had the catheter tips placed in the axilary or inominate veins. Three others (11.1%) had them placed in a jugular vein. When these catheters were removed, 13 (48.2%) catheter tip were placed in the right atrium, and they were relocated to the superior vena cava.This is a cross-sectional study aiming to identify the initial tip position of peripherally inserted central catheters (PICC) and to verify the prevalence of success in inserting such catheters in neonates. The study was carried out in the neonatal care unit of Hospital das Clinicas, Universidade de São Paulo. Data were collected prospectively from March to September 2006. 37 neonates underwent PICC insertion were included in the study. The rate of success for this procedure was 72.3% (27 neonates). Of them, four (14.8%) had the catheter tips placed in the axilary or inominate veins. Three others (11.1%) had them placed in a jugular vein. When these catheters were removed, 13 (48.2%) catheter tip were placed in the right atrium, and they were relocated to the superior vena cava.

Initial placement of the peripherally inserted central catheter's tip in neonates

This is a cross-sectional study aiming to identify the initial tip position of peripherally inserted central catheters (PICC) and to verify the prevalence of success in inserting such catheters in neonates. The study was carried out in the neonatal care unit of Hospital das Clinicas, Universidade de Sao Paulo. Data were collected prospectively from March to September 2006. 37 neonates underwent PICC insertion were included in the study. The rate of success for this procedure was 72.3% (27 neonates). Of them, four (14.8%) had the catheter tips placed in the axilary or inominate veins. Three others (11.1%) had them placed in a jugular vein. When these catheters were removed, 13 (48.2%) catheter tip were placed in the right atrium, and they were relocated to the superior vena cava.This is a cross-sectional study aiming to identify the initial tip position of peripherally inserted central catheters (PICC) and to verify the prevalence of success in inserting such catheters in neonates. The study was carried out in the neonatal care unit of Hospital das Clinicas, Universidade de São Paulo. Data were collected prospectively from March to September 2006. 37 neonates underwent PICC insertion were included in the study. The rate of success for this procedure was 72.3% (27 neonates). Of them, four (14.8%) had the catheter tips placed in the axilary or inominate veins. Three others (11.1%) had them placed in a jugular vein. When these catheters were removed, 13 (48.2%) catheter tip were placed in the right atrium, and they were relocated to the superior vena cava.

Dimensionamento da dor durante a instalação do cateter central de inserção periférica em neonatos

OBJETIVO: Medir la intensidad del dolor durante la instalacion del cateter central de insercion periferica, comparando el momento de la puncion venosa con la progresion del cateter. METODOS: Estudio descriptivo exploratorio con recoleccion prospectiva de los datos realizado en la unidad neonatal de un hospital-escuela de gran porte de la ciudad de Sao Paulo. Se evaluo la respuesta dolorosa al procedimiento de insercion del cateter en 28 neonatos, utilizandose la escala Premature Infant Pain Profile (PIPP) en las etapas de pre-puncion (15 segundos), puncion venosa (30 segundos) y progresion del cateter (30 segundos). RESULTADOS: El puntaje PIPP mayor o igual a siete, indicativo de dolor moderado a intenso ocurrio en 13 RN (59,1%) en la primera puncion venosa y 10 RN (45,5%) en la progresion del cateter del grupo que no recibio analgesico o sedativo. CONCLUSION: Los resultados apuntan que es necesario adoptar medidas analgesicas, ya que los neonatos internados en la unidad de terapia intensiva neonatal son frecuentemente sometidos a procedimientos invasores y dolorosos.

Analgesia and sedation during placement of peripherally inserted central catheters in neonates

This study aimed to characterize the analgesia and sedation strategies in neonates having a peripherally inserted central catheter (PICC) placed, and to relate it to the number of venipunctures, duration of procedure and catheter tip position. This was a cross-sectional study with prospective data collection, conducted in a neonatal intensive care unit of a private hospital in the city of Sao Paulo, during the period from August 31, 2010 to July 1, 2011, which evaluated 254 PICC insertions. The adoption of analgesic or sedative strategies occurred in 88 (34.6%) catheter placements and was not related to the number of venipunctures, duration of procedure or catheter tip position. Intravenous administration of midazolam, in 47 (18.5%), and fentanyl, in 19 (7.3%), catheter insertions were the most frequent strategies. Wider adoption of analgesic strategies is recommended before, during and after the procedure.This study aimed to characterize the analgesia and sedation strategies in neonates having a peripherally inserted central catheter (PICC) placed, and to relate it to the number of venipunctures, duration of procedure and catheter tip position. This was a cross-sectional study with prospective data collection, conducted in a neonatal intensive care unit of a private hospital in the city of São Paulo, during the period from August 31, 2010 to July 1, 2011, which evaluated 254 PICC insertions. The adoption of analgesic or sedative strategies occurred in 88 (34.6%) catheter placements and was not related to the number of venipunctures, duration of procedure or catheter tip position. Intravenous administration of midazolam, in 47 (18.5%), and fentanyl, in 19 (7.3%), catheter insertions were the most frequent strategies. Wider adoption of analgesic strategies is recommended before, during and after the procedure.

Measuring pain in neonates during placement of central line catheter via peripheral insertion

OBJETIVO: Medir la intensidad del dolor durante la instalacion del cateter central de insercion periferica, comparando el momento de la puncion venosa con la progresion del cateter. METODOS: Estudio descriptivo exploratorio con recoleccion prospectiva de los datos realizado en la unidad neonatal de un hospital-escuela de gran porte de la ciudad de Sao Paulo. Se evaluo la respuesta dolorosa al procedimiento de insercion del cateter en 28 neonatos, utilizandose la escala Premature Infant Pain Profile (PIPP) en las etapas de pre-puncion (15 segundos), puncion venosa (30 segundos) y progresion del cateter (30 segundos). RESULTADOS: El puntaje PIPP mayor o igual a siete, indicativo de dolor moderado a intenso ocurrio en 13 RN (59,1%) en la primera puncion venosa y 10 RN (45,5%) en la progresion del cateter del grupo que no recibio analgesico o sedativo. CONCLUSION: Los resultados apuntan que es necesario adoptar medidas analgesicas, ya que los neonatos internados en la unidad de terapia intensiva neonatal son frecuentemente sometidos a procedimientos invasores y dolorosos.

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.

Analgesia e sedação durante a instalação do cateter central de inserção periférica em neonatos

This study aimed to characterize the analgesia and sedation strategies in neonates having a peripherally inserted central catheter (PICC) placed, and to relate it to the number of venipunctures, duration of procedure and catheter tip position. This was a cross-sectional study with prospective data collection, conducted in a neonatal intensive care unit of a private hospital in the city of Sao Paulo, during the period from August 31, 2010 to July 1, 2011, which evaluated 254 PICC insertions. The adoption of analgesic or sedative strategies occurred in 88 (34.6%) catheter placements and was not related to the number of venipunctures, duration of procedure or catheter tip position. Intravenous administration of midazolam, in 47 (18.5%), and fentanyl, in 19 (7.3%), catheter insertions were the most frequent strategies. Wider adoption of analgesic strategies is recommended before, during and after the procedure.This study aimed to characterize the analgesia and sedation strategies in neonates having a peripherally inserted central catheter (PICC) placed, and to relate it to the number of venipunctures, duration of procedure and catheter tip position. This was a cross-sectional study with prospective data collection, conducted in a neonatal intensive care unit of a private hospital in the city of São Paulo, during the period from August 31, 2010 to July 1, 2011, which evaluated 254 PICC insertions. The adoption of analgesic or sedative strategies occurred in 88 (34.6%) catheter placements and was not related to the number of venipunctures, duration of procedure or catheter tip position. Intravenous administration of midazolam, in 47 (18.5%), and fentanyl, in 19 (7.3%), catheter insertions were the most frequent strategies. Wider adoption of analgesic strategies is recommended before, during and after the procedure.

Analgesia y sedación durante la instalación del catéter venoso central de inserción periférica en neonatos

This study aimed to characterize the analgesia and sedation strategies in neonates having a peripherally inserted central catheter (PICC) placed, and to relate it to the number of venipunctures, duration of procedure and catheter tip position. This was a cross-sectional study with prospective data collection, conducted in a neonatal intensive care unit of a private hospital in the city of Sao Paulo, during the period from August 31, 2010 to July 1, 2011, which evaluated 254 PICC insertions. The adoption of analgesic or sedative strategies occurred in 88 (34.6%) catheter placements and was not related to the number of venipunctures, duration of procedure or catheter tip position. Intravenous administration of midazolam, in 47 (18.5%), and fentanyl, in 19 (7.3%), catheter insertions were the most frequent strategies. Wider adoption of analgesic strategies is recommended before, during and after the procedure.This study aimed to characterize the analgesia and sedation strategies in neonates having a peripherally inserted central catheter (PICC) placed, and to relate it to the number of venipunctures, duration of procedure and catheter tip position. This was a cross-sectional study with prospective data collection, conducted in a neonatal intensive care unit of a private hospital in the city of São Paulo, during the period from August 31, 2010 to July 1, 2011, which evaluated 254 PICC insertions. The adoption of analgesic or sedative strategies occurred in 88 (34.6%) catheter placements and was not related to the number of venipunctures, duration of procedure or catheter tip position. Intravenous administration of midazolam, in 47 (18.5%), and fentanyl, in 19 (7.3%), catheter insertions were the most frequent strategies. Wider adoption of analgesic strategies is recommended before, during and after the procedure.