Talita Elci de Castro

Práticas de manejo do cateter central de inserção periférica em uma unidade neonatal

El estudio tuvo como objetivo describir el manejo de los Cateteres Centrales de Insercion Periferica instalados en los recien nacidos internados en una unidad neonatal de cuidados intensivos de un hospital privado, despues de la adopcion del protocolo institucional. Fue realizado un estudio cuantitativo, descriptivo y exploratorio con recolecta de datos prospectiva. Fueron analizados datos de 45 cateteres instalados. El retiro electivo ocurrio en el 63,8% de los cateteres instalados y complicaciones ocurrieron en 30,8% de los cateteres. Las complicaciones mas frecuentes fueron rotura (15,4%), oclusion (11%) y traccion accidental (4,4%). En 33% de los cateteres instalados no hubo registro de los curativos. Concluyese que las complicaciones estuvieron relacionadas con el cuidado del cateter, siendo necesaria la capacitacion de los profesionales, asi como nuevos instrumentos para registrar la asistencia clinica de enfermeria relacionada al manejo del cateter.The study aimed to describe the management of Peripherally Inserted Central Catheters insertion in neonates admitted at a neonatal intensive care unit of a private hospital, after implementation of the institutional protocol. An exploratory, quantitative descriptive study with prospective data collection was carried out. Data of 45 catheters insertion were analyzed. The rate of catheters with elective removal was 63.8%, and catheters complications rate was 30.8%. The most frequently complications were rupture (15.4%), occlusion (11%) and accidental dislodgement (4.4%). No records about the catheter dressings were observed in 33% of catheters insertion. One conclude that the complications were related to care practices of the catheter, requiring professional training and new tools to record the care provided in relation to the catheters management.

Prevalence and reasons for non-elective removal of peripherally inserted central catheter in neonates

This is a cross sectional study conducted with 67 newborns admitted at the neonatal intensive care unit of a private hospital in São Paulo, between July and December 2010, who underwent 84 Peripherally Inserted Central Catheter (PICC line) placement procedures. The aim was to describe the prevalence and reasons of non-elective removal of the catheter. Data was collected from medical records and institutional forms related to PICC placement. The mean of corrected gestational age of the neonates was 32.8 weeks, weight 1671.6 g and postnatal age 9.4 days. The non-elective removal was observed in 33 (39.3%) catheters, 18.1% due to occlusion, 9.5% rupture, 7.1% extremity edema, 6.0% suspected infection, 1.2% accidental dislodgement 1.2% poor extremity perfusion and 1.2% due to extravasation. The prevalence and the reasons of non-elective removal indicated that strategies to prevent avoidable complications related to PICC are necessary.Estudo transversal, realizado com 67 recem-nascidos internados em uma Unidade de Terapia Intensiva Neonatal de um hospital privado de Sao Paulo, entre julho e dezembro de 2010, submetidos a 84 insercoes de Cateteres Centrais de Insercao Periferica (CCIP). Os objetivos foram descrever a prevalencia de remocao nao eletiva do cateter e seus motivos. Os dados foram coletados de prontuarios medicos e do formulario de registro de informacoes sobre o cateter. A media de idade gestacional corrigida dos neonatos foi 32,8 semanas, peso 1.671,6 g e idade pos-natal 9,4 dias. A remocao nao eletiva ocorreu em 33 (39,3%) cateteres, 13,1% por obstrucao, 9,5% ruptura, 7,1% edema do membro, 6% suspeita de infeccao, 1,2% tracao acidental, 1,2% ma perfusao e 1,2% extravasamento. A prevalencia e os motivos de remocao nao eletiva indicaram a necessidade de estrategias para a prevencao de complicacoes evitaveis relacionadas ao CCIP.

Polyomavirus BK and JC in individuals with chronic kidney failure, kidney transplantation, and healthy controls

BACKGROUND New clinical approaches to diagnose and monitor individuals with systemic diseases have been employed through the use of oral fluids. Polyomavirus BK (BKPyV) and JC (JCPyV) infect asymptomatically around 80% of general population worldwide remaining latent in the body. In case of immunosuppression, a replication can occur, leading to diseases. OBJECTIVE The aim of this study was to detect and quantify BKPyV and JCPyV in oral fluids of individuals with chronic kidney failure (CKF), kidney transplantation (KT) and controls compared with their detection in blood and urine, traditionally used for this test. STUDY DESIGN Forty six subjects were included and distributed into 3 groups: 14 with CKF (Group 1), 12 with KT (Group 2) and 20 healthy individuals (Group 3). In a total, 315 samples were collected and analyzed through RT-PCR, being 151 of gingival crevicular fluid, 46 of saliva, 46 of mouthwash, 43 of blood and 29 of urine. RESULTS All subjects from group 1 were positive for BKPyV in at least one collected samples and 14% were positive for JCPyV. In Group 2, 91.7% were positive for BKPyV and 51.7% for JCPyV. Among subjects of Group 3, 80% were positive for BKPyV and 45% for JCPyV. CONCLUSIONS Oral fluids exhibited high prevalence of BKPyV and JCPyV and were equally efficient compared to urine and blood. The use of oral fluids to detect these polyomaviruses enhances positivity in screening, even in cases of absence of viremia and especially in individuals who are not able to urinate.

Salivary parameters and oral health in the Moebius syndrome.

PURPOSE To evaluate salivary characteristics, such as flow rate, buffering capacity and amylase activity, and associate these parameters with oral health in individuals with Moebius syndrome (MS) and controls. METHODS The researchers assessed caries (ICDAS), periodontal disease (PSR), and plaque (Silness Löe) indexes in both groups. Unstimulated, stimulated, and bilateral parotid saliva were also collected. The salivary flow (milliliters/minute) and α-amylase activity were measured in all samples. The α-amylase activity was determined by maltose production. The buffering capacity was measured in stimulated saliva by titration of 0.01N HCl. RESULTS The occurrence of carious lesions, related to cut-off 2, as well as the occurrence of periodontal disease, was significantly higher (p > 0.05) in participants with MS when compared to the control group. Also, MS individuals presented decreased salivary flow, decreased buffering capacity, and amylase activity. CONCLUSIONS MS individuals present salivary alterations, which can be related to higher risk for caries.

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.

Management practices of peripherally Inserted central Catheter at a neonatal unit

El estudio tuvo como objetivo describir el manejo de los Cateteres Centrales de Insercion Periferica instalados en los recien nacidos internados en una unidad neonatal de cuidados intensivos de un hospital privado, despues de la adopcion del protocolo institucional. Fue realizado un estudio cuantitativo, descriptivo y exploratorio con recolecta de datos prospectiva. Fueron analizados datos de 45 cateteres instalados. El retiro electivo ocurrio en el 63,8% de los cateteres instalados y complicaciones ocurrieron en 30,8% de los cateteres. Las complicaciones mas frecuentes fueron rotura (15,4%), oclusion (11%) y traccion accidental (4,4%). En 33% de los cateteres instalados no hubo registro de los curativos. Concluyese que las complicaciones estuvieron relacionadas con el cuidado del cateter, siendo necesaria la capacitacion de los profesionales, asi como nuevos instrumentos para registrar la asistencia clinica de enfermeria relacionada al manejo del cateter.The study aimed to describe the management of Peripherally Inserted Central Catheters insertion in neonates admitted at a neonatal intensive care unit of a private hospital, after implementation of the institutional protocol. An exploratory, quantitative descriptive study with prospective data collection was carried out. Data of 45 catheters insertion were analyzed. The rate of catheters with elective removal was 63.8%, and catheters complications rate was 30.8%. The most frequently complications were rupture (15.4%), occlusion (11%) and accidental dislodgement (4.4%). No records about the catheter dressings were observed in 33% of catheters insertion. One conclude that the complications were related to care practices of the catheter, requiring professional training and new tools to record the care provided in relation to the catheters management.

Prevalência e motivos de remoção não eletiva do cateter central de inserção periférica em neonatos

This is a cross sectional study conducted with 67 newborns admitted at the neonatal intensive care unit of a private hospital in São Paulo, between July and December 2010, who underwent 84 Peripherally Inserted Central Catheter (PICC line) placement procedures. The aim was to describe the prevalence and reasons of non-elective removal of the catheter. Data was collected from medical records and institutional forms related to PICC placement. The mean of corrected gestational age of the neonates was 32.8 weeks, weight 1671.6 g and postnatal age 9.4 days. The non-elective removal was observed in 33 (39.3%) catheters, 18.1% due to occlusion, 9.5% rupture, 7.1% extremity edema, 6.0% suspected infection, 1.2% accidental dislodgement 1.2% poor extremity perfusion and 1.2% due to extravasation. The prevalence and the reasons of non-elective removal indicated that strategies to prevent avoidable complications related to PICC are necessary.Estudo transversal, realizado com 67 recem-nascidos internados em uma Unidade de Terapia Intensiva Neonatal de um hospital privado de Sao Paulo, entre julho e dezembro de 2010, submetidos a 84 insercoes de Cateteres Centrais de Insercao Periferica (CCIP). Os objetivos foram descrever a prevalencia de remocao nao eletiva do cateter e seus motivos. Os dados foram coletados de prontuarios medicos e do formulario de registro de informacoes sobre o cateter. A media de idade gestacional corrigida dos neonatos foi 32,8 semanas, peso 1.671,6 g e idade pos-natal 9,4 dias. A remocao nao eletiva ocorreu em 33 (39,3%) cateteres, 13,1% por obstrucao, 9,5% ruptura, 7,1% edema do membro, 6% suspeita de infeccao, 1,2% tracao acidental, 1,2% ma perfusao e 1,2% extravasamento. A prevalencia e os motivos de remocao nao eletiva indicaram a necessidade de estrategias para a prevencao de complicacoes evitaveis relacionadas ao CCIP.

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.

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.

Gingival leukemic infiltration as the first manifestation of acute myeloid leukemia: GINGIVAL LEUKEMIC INFILTRATION

Leukemic infiltration of the gingival tissue associated or not with gingival enlargement may be the first manifestation of acute leukemia, despite being rarely reported in the literature. A 10-year-old female patient presented with a 1-month history of an asymptomatic, firm, and pinkish-red generalized gingival overgrowth. There was no bone resorption. Incisional biopsy of the gingival tissue was performed, with histopathological examination revealing a diffuse and hypercellular infiltration of monocytoid cells. The patient was referred to a hematologist and underwent a bone marrow biopsy, which led to a conclusive diagnosis of acute myeloid leukemia. The patient was treated with chemotherapy and we observed regression of gingival enlargement after 4 weeks from the initial therapy.