Neonatal intensive
care unit nursing care
Cuidados de enfermería en unidad de cuidados intensivos neonatales
Adisnay Rodríguez-Plasencia
adisnayrp@gmail.com
Universidad Regional Autónoma de Los Andes. UNIANDES, Ambato – Ecuador.
https://orcid.org/0000-0002-5293-2817
ABSTRACT
The
objective of this study was to analyze the nursing care associated with the epicutaneous catheter in the neonatal intensive care unit.
We worked from the critical rationalism approach by means of a descriptive
documentary research with bibliographic design, the population consisted of 15
scientific articles that met the inclusion criteria. It is important that the
nursing staff has a high level of knowledge in the placement, preparation and
conservation of the peripherally inserted central catheter, the care is
established in the application of a protocol based on scientific evidence.
Regarding the benefits of the epicutaneous catheter
in neonatal patients, its main objective is the insertion and maintenance of
the central line, it is placed through a peripheral vein until it reaches the
superior vena cava, this catheter is used to maintain infusions in larger quantities,
and other drugs.
Descriptors: pediatrics; nursing; health
services. (Source: UNESCO Thesaurus).
RESUMEN
Se
tiene por objetivo analizar los cuidados de enfermería asociados al catéter
epicutáneo en la unidad de cuidados intensivos neonatales. Se trabajó desde el
enfoque racionalismo critico mediante un tipo de investigación descriptiva
documental con diseño bibliográfico, la población consistió en 15 articulos
científicos que cumplieron con los criterios de inclusión. Es importante que la
personal de enfermería tenga un alto conocimiento, en colocación, preparación,
conservación del catéter central de inserción periférica, los cuidados están
establecidos en la aplicación de un protocolo basados en una evidencia
científica. Sobre los beneficios del catéter epicutáneo en los pacientes
neonatos, su principal objetivo es la inserción y mantenimiento de la vía
central, es colocado a través de una vena periférica hasta llegar a la vena
cava superior, este catéter se utiliza para mantener infusiones en cantidades
mayores, y otras drogas.
Descriptores: pediatría;
servicio de enfermería; servicio de salud. (Fuente: Tesauro UNESCO).
Research articles section
INTRODUCTION
Newborns who are admitted to
the neonatal intensive care unit is one of the important challenges for the
health team that is providing care to the newborn, this epicutaneous
catheter is an important, safe and prolonged access, and it is also less
painful for the newborn, its treatment with this catheter is to receive
parenteral nutrition due to the high osmolarity index, drugs such as sedatives,
tranquilizers and hypnotics, infusion of continuous liquids and larger amounts,
antibiotic therapy where each of these drugs contain large chemical properties
that irritate the vein especially its inner layer (Perales et al. 2018).
The use of this peripherally
inserted central catheter can present various complications such as bleeding,
obstruction, limb edema, phlebitis, vessel perforation, catheter rupture,
hydrothorax, pleural effusion, fluid extravasation, cardiac tamponade, catheter
occlusion. To prevent the occurrence of other infectious processes, health
units especially the critical area of neonatology raise new preventive
measures, such as the use of 2% chlorhexidine and immediately remove the
devices, thus avoiding sepsis as complications (Higareda-Almaraz et al. 2018).
Complications of percutaneous
central venous catheters (PCVC) include catheter-related bloodstream infection
(CRBSI), occlusion, leakage, and phlebitis, which can lead to sepsis or
prolonged hospitalization (Li-Ting, et al. 2021). While in the neonatology unit
the nursing professional plays an important role in the care and management of
percutaneous lines, which receive prolonged treatments for their various
pathologies; Despite the care and application of biosafety measures provided to
neonates, complications related to the prolonged use of the catheter appear.
Among these complications, sepsis, phlebitis, occlusion of the catheter and
extravasation have been shown to occur more frequently, affecting the neonate's
recovery and extending the days of hospitalization (Peñaloza-Zabala &
Analuisa-Jiménez, 2021).
Based on the above, the
objective is to analyze the nursing care associated with the epicutaneous catheter in the neonatal intensive care unit.
METHOD
We
worked from the critical rationalism approach by means of a descriptive
documentary research with bibliographic design, the population consisted of 15
scientific articles that met the inclusion criteria.
Inclusion
criteria
Research
articles related to nursing care of epicutaneous
catheters in the neonatal intensive care unit, located in databases: Scielo,
PubMed, Redalyc, between the years 2017 to 2021.
Exclusion
criteria
Will
be excluded from the review process, gray literature, graduate theses,
non-scientific journals, non-recommended websites, topics not related to the
subject of epicutaneous catheters.
ANALYSIS OF RESULTS
The care carried out by the nursing professional in
the neonatal intensive care unit should be constantly strengthened through
training so that the quality of care provided is increasingly much better than
the previous one; giving better results in patients, as well as in the
professional both for the quality and warmth in their daily work. It is
important that the nursing staff has a high level of knowledge in placement,
preparation and conservation of the peripherally inserted central catheter, the
care is established in the application of a protocol based on scientific
evidence (Gholamreza et al. 2021).
All nursing staff must have a procedural guide on
the care and maintenance of the device to ensure excellence in nursing care,
reducing the efforts that have the possibility of manifesting, defend the
permanence, patency and duration of the catheter in a sterile manner, unite the
various points of view of neonatal nursing professionals. When placing a peripheral central insertion
catheter, the neonate will have less pain at the time of its placement, better
cost-benefit, and it will also have a low rate of complications compared to
other types of catheters (Konstantinidi, et al. 2019),
The most commonly used approach routes for the
placement of epicutaneous catheters are the upper
extremities (basilic and cephalic veins), although the picaneal,
temporal and axillary veins can also be used. The veins of the lower
extremities are only used if the previous ones fail, because of the higher risk
of contamination, due to their proximity to the genitoanal area, this procedure
should be performed in a sterile manner, to avoid possible complications (Habas
et al. 2018).
To avoid these complications the nursing staff must
have a high scientific knowledge about its placement, if it is placed wrongly it aggravates the health status of the neonate,
within the complications related to the catheter, including malposition,
leakage, early migration or fracture, events related to the procedure such as
bleeding, trauma to tissues underlying the placement site and pneumothorax.
Late complications also include migration, fracture, infection, rupture,
pericardial and pleural effusion, venous thrombosis, and catheter dysfunction
(Wei et al. 2019).
The increase in bacteremias
caused by Candida species has become the most frequent pathogen in
catheter-associated bacteremias (Yamin et al. 2021).
Catheter control begins at the time of catheter placement, and adequate asepsis
is necessary. The most commonly used antiseptics for skin disinfection are povidone
iodine, alcohol and 2% chlorhexidine. compared to gauze in invasive catheters
and the use of antibiotic-coated catheters to decrease the incidence of
systemic phlebitis (SRC) (Webster et al. 2019).
Care is a diversity of actions that are aimed at preserving
the life of the neonate, nursing focuses its care on the body and spirit of the
person, being a primary basis for strengthening health. Nurses in neonatal
intensive care supply the role of the mother providing tranquility, through
comfort, comfort with their multiple skills and empathy, they look for signs in
neonates that produce irritability, discomfort as the next step prioritizes and
provides the necessary care favoring a comfortable rest and sleep of the
neonate (Tubbs-Cooley et al. 2019).
The act of caring assist, save, conserve by
considering that the care of the patient with a peripherally inserted central
catheter presupposes peculiar aspects for the maintenance of the device, in
order to ensure its permanence and the decrease of complications. Once the
circuits are connected to the patient, the continuous infusion with the
indicated solution must be maintained, it cannot be stopped because there is
blood return which can clog the line, verify the permeability by means of the
continuous flow through the infusion pump, evaluate the skin if there is no
presence of phlebitis, send blood cultures, as well as cultivate the catheter
tips, every time the line is manipulated it must be done in a sterile way
(Estrada-Orozco et al. 2020).
The neonate is totally dependent on the health team,
details the main care as, before performing the invasive procedure maintain
thermal, respiratory and hemodynamic stability, it is important to know any
hematological compromise that may cause bleeding, assess the patient's
condition and record in the nursing records, finished the procedure is
suggested to perform a radiographic control to confirm its location of the
catheter fix, and place the three-way keys, install an infusion with minimal
drip to avoid coagulation (Almadhoob & Ohlsson,
2020).
The antiseptic of first choice for neonates with
sufficient safety, is the use of chlorhexidine in neonatal intensive care units
has increased significantly in the last decade, mainly because of its impact on
catheter-related infections. Hand hygiene has shown a significantly high
decrease in infection rates, daily monitoring of the insertion site, keeping a
record or check link where they verify how the procedure was when placing the
catheter, dates of cures, labeling of catheter placement, nursing records,
catheter management, washing of lumens (Westling et al. 2020).
Regarding the use of percutaneous catheters is a
mechanical and basic activity in neonatal intensive care, especially in the
care of premature neonates; because catheter insertion is related to embolism,
sepsis, thrombosis or fluid accumulation, the main care is healing and dressing
change every 7 days using an aseptic technique, changes of systems, extensions,
circuits, connectors, 3-way key at least every 72 hours, if contamination is
suspected it should be changed immediately (Ray-Barruel
et al. 2019).
The nursing professional aims to provide
comprehensive care to the human being in their different stages of life,
especially in the most vulnerable such as the neonate, patients admitted to the
NICU area require priority and individualized care to improve their adaptation
and survival. All nurses providing care to neonatal patients should be trained
in the asepsis of the central venous catheter insertion site for peripheral
insertion, thus ensuring safety and quality of care, avoiding complications and
at the same time reducing the days of stay and costs in the unit (Wang et al.
2022).
CONCLUSION
About the benefits of the epicutaneous
catheter in neonatal patients, its main objective is the insertion and
maintenance of the central line, it is placed through a peripheral vein until
it reaches the superior vena cava, this catheter is used to maintain infusions
in larger quantities, and other drugs. It should be changed daily in case the
dressing is stained with hematic liquid, because the daily change has a high
risk of laceration of the neonate's skin, also in case of emergency should
place another catheter, see the number of lumens, anatomical location of
insertion, the technique should be aseptic, the type of disinfectant most
commonly used are chlorhexidine dressings.
FINANCING
Non-monetary
CONFLICT OF INTEREST
There is no conflict of interest with persons or
institutions related to the research.
ACKNOWLEDGMENTS
To the Universidad Regional Autónoma de Los
Andes. UNIANDES, Ambato - Ecuador.
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