Predição de sucesso na introdução do catéter central de inserção periférica em recém-nascidos

• Ano de defesa: 2022
• Autor(a) principal: Rocha, Aurora Tatiana Soares da
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal do Rio Grande do Norte; Brasil; UFRN; PROGRAMA DE PÓS-GRADUAÇÃO EM CIÊNCIAS APLICADAS À SAÚDE DA MULHER
• Palavras-chave em Português: Recém-nascidos; Valor preditivo; Cateterismo periférico; Cateterismo venoso central; Unidade de terapia intensiva neonatal; CNPQ::CIENCIAS DA SAUDE
• Link de acesso: https://repositorio.ufrn.br/handle/123456789/51273

Introduction: Newborns hospitalized in Neonatal Intensive Care Units often require prolonged intravenous therapy to recover their health and the peripherally inserted central catheter (PICC) is the most indicated for the safe infusion of these solutions. However, placing this catheter in newborns can be difficult, which becomes a challenge for the nursing team, which predisposes the baby to multiple peripheral punctures, stress and pain. A particularly important aspect for this population is the lack of data on prediction equations for successful PICC insertion. Thus, this study aims to develop a prediction equation for the success of PICC insertion in newborns. Methods: This is an observational, retrospective study conducted with all medical records of newborns admitted to the neonatal intensive care unit who used the PICC between August 2018 and July 2021. Duplicate or incompletely and/or incorrectly filled data on newborns were excluded. It was considered successful in the insertion of PICC when the catheter tip was threaded into the superior vena cava from an upper extremity and into the inferior vena cava from a lower extremity site. Binary association and logistic regression tests were applied. Variables with p<0.05 remained in the final regression model. Results: A total of 359 newborns with a gestational age between 23 a 41 weeks with a median of 31 weeks and 4 days, 284 were on mechanical ventilation (invasive or non-invasive) and 70 evolved for successful PICC insertion. Being extremely premature, very premature and premature reduces the probability of PICC success by 31,2% (IC95%: 25,5 a 38,1%), 21,4% (IC95%: 17,8 a 25,7%) e 16,7% (IC95%: 14,0 a 19,8%) respectively. As well as being on invasive ventilation and non invasive reduces reduces the probability of PICC success by 82,4% (IC95%: 72,3 a 93,9%) e 85,3% (IC95%: 75,0 a 97,1%) respectively. While a newborn's weight > 1500 grams and insertion of the catheter in the upper region increase the chance of PICC success by 2.5 and 2.93 times, respectively. Weight classification, gestational age, insertion site and use of mechanical ventilation were variables that were kept in the final equation to calculate the number of chances of success for PICC insertion. The predictive equation for PICC success found was: OR success PICC = 0,178 x (GA.classif) x (region) x (vent.sup) x (weight.classif) Conclusion: Gestational age classification and use of mechanical ventilation reduce the probability of success introduction of PICC. While a weight > 1500 grams and catheter insertion in the upper region increase the chance of PICC success. The predictive equation found is a practical and reproducible tool that can reduce the risk and complications related to failure in catheter insertion.