The strategic role of the nurse in the selection of IV devices
ABSTRACT Use of vascular devices represents one of the most common procedures used as a complementary measure in the treatment of patients. An indication algorithm was established to serve as a guideline for nurses in choosing the best intravenous device, considering the main variables of drug therapy. A protocol approved by the Institute of Orthopedics and Traumatology of Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP), where the authors work, was subsequently established and the nurse carried out the evaluation for the indication of both the peripheral device and the central device, whether a peripherally inserted central catheter (PICC) or other device inserted by the physician. As a result, there was a decrease in the incidence of phlebitis from 0.77% in 2010 to 0.17% in 2011, with an annual curve of negative tendency. The nursing team also appeared more satisfied, diminishing stress related to puncture failure.
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ABSTRACT: The use of peripherally inserted central catheters (PICCs) in hospitalized patients is already well established by studies and guidelines, and PICCs are widely used at our institution. However, few studies have been published examining patients using the device in day hospital systems; specifically, if the device brings about early dehospitalization, if it facilitates quick return to coexistence in society and to work, and how to plan medication administration through this system. Our general objective was to evaluate the advantages and disadvantages of the use of PICCs in patients undergoing prolonged intravenous treatment. We selected patients using PICCs in the day hospital at the Institute of Orthopedics and Traumatology at Clinics Hospital of the School of Medicine of the University of São Paulo, conducted a semistructured interview, and did an analysis of medical records. The most frequent diagnoses that led to use of a PICC were postoperative infection (53.84%) and osteomyelitis (23.07%). Teicoplanin was the most common drug prescribed, followed by vancomycin. Regarding the puncture site, the basilic vein prevailed with 69.23%. Most of the catheters (61.54%) remained in place from 60 to 150 days. The end of the drug therapy was the reason for removal in 66.4% of cases. Regarding pain assessment, 88.47% of patients declared they did not feel any pain or felt moderate pain during the PICC insertion procedure. Based on the data collected, it can be concluded that PICCs are reliable devices for a wide variety of intravenous infusions used in patients treated at our day hospital.Journal of the Association for Vascular Access 09/2014; 19(3):180–187. DOI:10.1016/j.java.2014.06.001