Cateter venoso central de inserção periférica (PICC): práticas da equipe de enfermagem na atenção intensiva neonatal

Abstract

The Peripherally Inserted Central Catheter's (PICC) is an intravenous device inserted through a peripheral punch that with the assistance of an introducer needle, with progresses in the direction of blood flow until the central location. The aim of this study was to describe the practice of using the PICC in care reality of neonatal.This is a qualitative and quantitative study conducted intensive care in a Neonatal Intensive Care Unit (NICU) of a university hospital, located in the South the Brazil.The data were collected from January to August 2015 by systematic observation of the insertion of PICC 47, and semi-structured interviews with nine nurses enabled insertion of PICC and working in the NICU. The analysis of quantitative data occurred by descriptive statistics and a analysis qualitative were analyzed for Directed Content Analysis.Os results showed that most babies were premature (72.7%), males (52.0 %) and less than 2500 grams (72.7%) were classified as appropriate for gestational age (79.0%). The most prevalent diagnosis was prematurity (75.8%) and the main indication for the use of the device was parenteral nutrition (57.4%). Most of the devices have been installed in the first three days of life (59.6%) with an average of 3.7 punches and the left upper limb (44, 2%) was more acessado.Almost half of intracardiac devices have start location (48.8%), and were not removed electively (48.8%) of complications. The analysis of qualitative data allowed the identification of two thematic categories: Benefits of using PICC for the baby, staff and service, PICC: obstacles and challenges encountered in reality assistential.Os participants showed in their testimonies that the use of PICC provided optimization time for nursing staff, improved service and enhancement of nurse. Also work decreased pain, suffering and the manipulation of the newborn caused by multiple punctures venosas.Em contrast, participants stressed that face challenges for the insertion and maintenance PICC, as the difficulty in the clinical trial to know the best time for device insertion, medical option for non umbilical catheterization of the newborn, need to try to insert the PICC with worn venous network, and problems with the conservation culminating in retreat not programmed. It is recommended that the team establish a very PICC installation routine based on clinical conditions, gestational age, and the presence or absence of umbilical venous catheterization, in order to ensure venous access secure and compliant with the prescribed therapy, and with less damage baby. There is the need to seek new technologies for insertion of PICC and conducting trainings for maintenance of this device.