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Abstract(s)
Problemática: A obtenção de um acesso vascular afigura-se como um dos avanços mais notáveis da saúde contemporânea. Na maioria dos contextos internacionais, entre as opções de acesso conhecidas, nenhuma é mais recorrente que a cateterização venosa periférica, sendo os enfermeiros responsáveis pelos cuidados prestados à pessoa neste âmbito. Porém, sabe-se que um número significativo de cateterizações falha prematuramente, decorrente, por vezes, de práticas não devidamente informadas por evidência científica recente, com risco para a saúde e bem-estar das pessoas. Esta realidade é particularmente desafiante para a pessoa com doença oncológica, a qual experiencia risco acrescido de depleção da rede venosa periférica. Na literatura, ainda que incipiente, alguns autores assinalam o potencial das intervenções multimodais na promoção de cuidados de enfermagem eficientes, seguros e sustentáveis à pessoa com necessidade de cateterização venosa periférica. Objetivo: Avaliar o impacte de uma intervenção multimodal (IM) nas práticas de enfermagem no âmbito da cateterização venosa periférica de pessoas com doença oncológica. Material e métodos: Trata-se de um estudo de investigação-ação, desenvolvido em colaboração com uma equipa de enfermagem de um serviço cirúrgico de um hospital de oncologia em Portugal. O estudo foi desenvolvido com base em seis atividades principais: i) estudo observacional prospetivo no contexto de estudo, de modo a avaliar o impacte das práticas e tecnologias em uso pelos enfermeiros nos resultados sensíveis aos seus cuidados; ii) tradução, adaptação e validação de duas escalas de avaliação da rede venosa periférica para a população adulta portuguesa; iii) desenvolvimento de um pack de cateterização venosa periférica; iv) desenvolvimento de um bundle clínico informado por evidência científica recente e opinião de peritos internacionais em acessos vasculares; v) condução de painéis de discussão de práticas com a equipa de enfermagem; e vi) estudo observacional prospetivo, de modo a avaliar o impacte da IM a nível da uniformização e alinhamento das práticas da equipa de enfermagem no que respeita à cateterização venosa periférica, assim como na prevenção de complicações associadas. Resultados: Findo a primeira atividade, constatámos que as práticas de cateterização venosa periférica não eram uniformes entre a equipa, divergindo pontualmente das recomendações existentes em guidelines internacionais, o que poderá explicar a taxa de sucesso à primeira tentativa (67%), o número elevado de tentativas consecutivas de punção (M = 1,6; DP = 1,1, 1-8) e a taxa observada de falha prematura da cateterização venosa periférica (26%) observados. A implementação da IM resultou na prestação de cuidados de enfermagem à pessoa com necessidade de cateterização venosa periférica informados por evidência científica recente, especialmente no que respeita ao envolvimento e avaliação da rede venosa periférica da pessoa, preservação da técnica assética no-touch, fixação segura do cateter venoso periférico, ensinos à pessoa após a cateterização e vigilância de complicações por parte da equipa. As mudanças observadas resultaram em indicadores superiores de qualidade dos cuidados de enfermagem neste âmbito, verificando-se o aumento da taxa de sucesso à primeira tentativa (86%; χ2(1) = 10,04; p = 0,002), diminuição do número de tentativas consecutivas de punção (t(154) = 7,6, p = 0,007, d = 0,39) e da taxa observada de falha prematura da cateterização venosa periférica (10%; χ2(1) = 8,7; p < 0,003) observados. Conclusão: A IM (co)desenvolvida com a equipa de enfermagem afigura-se como uma resposta estruturada, sensível a desafios estruturais e processuais, que potenciou a prestação de cuidados de enfermagem à pessoa com necessidade de cateterização venosa periférica informados por evidência, com resultados significativos no que respeita à sua qualidade e experiência de cuidados.
Background: Obtaining vascular access emerges as one of the most notable advances in modern healthcare. Across international settings, among the established vascular access techniques, none is more recurrent than peripheral intravenous catheterizations, with nurses being responsible for care delivery. However, a significant number of catheterizations fail prematurely, resulting from practices not properly informed by recent scientific evidence, posing a risk to people’s health and well-being. This reality is particularly challenging for people with cancer, who experience an increased risk of peripheral venous system depletion. In the literature, although incipient, some authors emphasize the potential of multimodal interventions in promoting efficient, safe, and sustainable nursing care for the person in need of peripheral intravenous catheterization. Aim: To assess the impact of a multimodal intervention (MI) on nurses’ peripheral intravenous catheterization practices in people with cancer. Material and methods: This is an action research study, developed in collaboration with a nursing team from a surgical service of an oncology hospital in Portugal. The study was developed based on six main activities: i) prospective observational study in the study setting, to assess the impact of nursing practices and technologies used on care-sensitive outcomes; ii) translation, adaptation, and validation for the Portuguese adult population of two peripheral intravenous system assessment scales; iii) development of a peripheral intravenous catheterization pack; iv) development of a clinical bundle informed by recent scientific evidence and the opinion of international experts in vascular access; v) conduction of discussion panels with the nursing team; and vi) prospective observational study, to assess the impact of the MI in the standardization and alignment of nurses’ peripheral intravenous catheterization practices, as well as in the prevention of associated complications. Results: Concluded the first activity, we found that peripheral intravenous catheterization practices were not consistent among the nursing team, occasionally differing from the existing recommendations in international guidelines, which may explain the low first- attempt success rates (67%), the high number of consecutive punctures attempts (M = 1.6; SD = 1.1, 1-8), and the significant premature failure rates (26%) observed. The implementation of the MI resulted in the delivery of nursing care to the person in need of peripheral intravenous catheterization informed by recent scientific evidence, especially when focusing on the involvement and assessment of the person's peripheral venous system, preservation of the aseptic no-touch technique, secure fixation of the peripheral venous catheter, post-insertion person education and surveillance by the team. The observed changes resulted in superior nursing care quality indicators in this field, with an increase in first-attempt success rates (86%; χ2(1) = 10.04; p = 0.002), a decrease in the number of consecutive puncture attempts (t(154) = 7.6, p = 0.007, d = 0.39) and in the premature failure rates observed (10%; χ2(1) = 8.7; p < 0.003). Conclusions: The MI (co)developed with the nursing team emerges as a structured response, sensitive to structural and process challenges, which enhanced the delivery of evidence-informed nursing care to the person in need of peripheral intravenous catheterization, with a significant impact in its quality and the person’s care experience.
Background: Obtaining vascular access emerges as one of the most notable advances in modern healthcare. Across international settings, among the established vascular access techniques, none is more recurrent than peripheral intravenous catheterizations, with nurses being responsible for care delivery. However, a significant number of catheterizations fail prematurely, resulting from practices not properly informed by recent scientific evidence, posing a risk to people’s health and well-being. This reality is particularly challenging for people with cancer, who experience an increased risk of peripheral venous system depletion. In the literature, although incipient, some authors emphasize the potential of multimodal interventions in promoting efficient, safe, and sustainable nursing care for the person in need of peripheral intravenous catheterization. Aim: To assess the impact of a multimodal intervention (MI) on nurses’ peripheral intravenous catheterization practices in people with cancer. Material and methods: This is an action research study, developed in collaboration with a nursing team from a surgical service of an oncology hospital in Portugal. The study was developed based on six main activities: i) prospective observational study in the study setting, to assess the impact of nursing practices and technologies used on care-sensitive outcomes; ii) translation, adaptation, and validation for the Portuguese adult population of two peripheral intravenous system assessment scales; iii) development of a peripheral intravenous catheterization pack; iv) development of a clinical bundle informed by recent scientific evidence and the opinion of international experts in vascular access; v) conduction of discussion panels with the nursing team; and vi) prospective observational study, to assess the impact of the MI in the standardization and alignment of nurses’ peripheral intravenous catheterization practices, as well as in the prevention of associated complications. Results: Concluded the first activity, we found that peripheral intravenous catheterization practices were not consistent among the nursing team, occasionally differing from the existing recommendations in international guidelines, which may explain the low first- attempt success rates (67%), the high number of consecutive punctures attempts (M = 1.6; SD = 1.1, 1-8), and the significant premature failure rates (26%) observed. The implementation of the MI resulted in the delivery of nursing care to the person in need of peripheral intravenous catheterization informed by recent scientific evidence, especially when focusing on the involvement and assessment of the person's peripheral venous system, preservation of the aseptic no-touch technique, secure fixation of the peripheral venous catheter, post-insertion person education and surveillance by the team. The observed changes resulted in superior nursing care quality indicators in this field, with an increase in first-attempt success rates (86%; χ2(1) = 10.04; p = 0.002), a decrease in the number of consecutive puncture attempts (t(154) = 7.6, p = 0.007, d = 0.39) and in the premature failure rates observed (10%; χ2(1) = 8.7; p < 0.003). Conclusions: The MI (co)developed with the nursing team emerges as a structured response, sensitive to structural and process challenges, which enhanced the delivery of evidence-informed nursing care to the person in need of peripheral intravenous catheterization, with a significant impact in its quality and the person’s care experience.
Description
Keywords
Cateterização venosa periférica Pessoa com doença oncológica Enfermagem Práticas profissionais Qualidade em saúde Peripheral intravenous catheterization Person with cancer Nursing Professional practices Quality in healthcare