Central Venous Catheters: A Survey of ICU Practices

Aim. This paper describes the current infection control practices for CVC care and compares these to evidence-based practice guidelines. Background. Intensive care patients with central venous catheters (CVCs) are at risk of catheter-related infection, which increases morbidity, mortality and health care costs. Infection control practices, including care of intravenous administration sets and catheter sites, are undertaken by nurses in an attempt to avoid infection. Although practice guidelines are available, infection control practices may vary between practitioners and institutions; however, current practice has not been formally surveyed. Method. A prospective, cross-sectional descriptive survey was carried out. Intensive care units (n = 14) in Australia were surveyed about their infection control policies for CVC care. Results were tabulated and compared with evidence-based practice guidelines. Results. A wide variety of responses was received about duration of administration set use for standard, parenteral nutrition and propofol (lipid-based anaesthetic) infusions; ad hoc administration set connection technique; dressing frequency, materials and solutions; and barrier precautions used during procedures. There was inconsistent adherence to the guidelines. Conclusion. There is variation in the infection control approach to CVC care. Greater adherence to existing Centers for Disease Control Guidelines would assist in the standardization of best practice and facilitate evidence-based care. What is already known about this topic Patients with central venous catheters are at risk of catheter-related infection, which increases morbidity, mortality and health care costs. Many nursing practices attempt to minimize infective risk, although not all are supported by evidence. The Centers for Disease Control provide evidence-based practice guidelines for the prevention of infection and care of central venous catheters. What this paper adds The state of current nursing practice with regards to infection control with central venous catheters. The level of adherence by nurses to the Centers for Disease Control practice guidelines. Recommendations for nursing practice, education and future research

Perfil dos pacientes internados em serviços de pediatria no município do Rio de Janeiro: mudamos? Profile of pediatric services inpatients in the city of Rio de Janeiro: have we changed?

Apesar das alterações observadas nos últimos anos no adoecimento e na mortalidade na infância com marcada redução das internações por doenças infecto-contagiosas, existem poucos estudos que apresentem o perfil clínico e demográfico das internações pediátricas em nosso meio. O estudo teve como objetivo identificar as características e os procedimentos diagnósticos e terapêuticos das internações pediátricas em hospitais do sistema público de saúde no município do Rio de Janeiro. Quanto ao método, foi realizado estudo retrospectivo desenvolvido em quatro hospitais públicos no Rio de Janeiro, em amostra constituída de 170 internações ocorridas nas enfermarias de pediatria no período de janeiro a dezembro de 2008. As informações obtidas evidenciaram elevada frequência de crianças portadoras de doenças crônicas (47.6%) no conjunto das internações estudadas. Os serviços também apresentaram elevado percentual de pacientes com histórico de reinternação (35.3%). A análise por unidade mostrou que, entre os quatro serviços estudados, apenas um apresentou menor proporção de crianças portadoras de doenças crônicas e menor frequência de reinternações. Nas outras três unidades hospitalares, em mais da metade do grupo estudado, as causas de internações encontradas estavam ligadas às doenças crônicas. Os resultados confirmam a necessidade de organização dos serviços pediátricos no sentido de estarem preparados, com estrutura e processos de cuidado adequados, para o manejo, tratamento e acompanhamento do paciente portador de doença crônica.<br>Despite the changes observed in recent years in illness and mortality in childhood with a marked reduction in hospitalizations for infectious diseases, few studies exist that show the clinical and demographic profile of pediatric admissions in our midst. The study aimed to identify the characteristics and diagnostic and therapeutic procedures of pediatric admissions in hospitals in the public health system in the municipality of Rio de Janeiro. As to the method, a retrospective study conducted in four public hospitals in Rio de Janeiro, in a sample consisting of 170 hospital admissions in pediatric wards from January to December 2008. The information obtained showed the high frequency of children with chronic diseases (47.6%) in all studied hospitals. The services also showed a high percentage of patients with a history of re-hospitalization (35.3%). The analysis unit showed that among the four services studied, only one showed a lower proportion of children with chronic diseases and lower frequency of readmissions. In the other three hospitals, more than half of the group studied, the causes of hospitalization were found linked to chronic diseases. The results confirm the need for organization of pediatric services in order to be prepared, with appropriate structure and processes of care, for the management, treatment and monitoring of patients with chronic diseases