NURSING IN THE PREVENTION OF INFECTION CATHETER CENTRAL: systematic literature review.

Abstract

INTRODUCTION: The adult client in a situation of high complexity in use of central venous catheterization (CVC) is totally dependent on intensive care. In this context Is that the nurse must be alert to use all senses to Their Develop a holistic look and systematically observe the intent to Promote the best and safest care to humans. In this sense the Evidence-Based Practice (EBP) proposes that the problems that arise in clinical care practice, are organized using the PICO strategy, which is an acronym for Patient, Intervention, Comparison and "Outcomes" (outcome). These four components are the key elements of the research question and the construction of clinical question for bibliographic search of evidence. Thus, considering that the customer adult / senior high in complexity with the use of central venous catheterization (CVC) has risk of catheter-related infection, emerged the following clinical question: In adult client of high complexity, where the effectiveness of dressing with antiseptic chlorhexidine in preventing the potential for infection of central venous catheterization?

BACKGROUND: The interest in studying this subject appeared in Evidence-Based Practice in Career Training Specialist (TPE), while postgraduate Nursing. Noting that the dressings in central venous catheter were not made with 2% chlorhexidine, due to lack of standardization during the shifts for the team. So my indignation was identified in the literature on the best antiseptic dressing central venous catheter.

OBJECTIVE: The aim of this study was to identify the nursing research, using the PICO strategy to determine the best available evidence for the curative care in the client / senior, submitted to the central venous catheter.

METHODOLOGY: This is a computerized literature search of the kind review of the literature, the literature was through searches of PubMed journals indexed in productions and Nursing Journals Portal using publications in Portuguese and English, predominantly the years 2007 to 2012, with the target population adults / seniors high complexity undergoing central venous catheter. After selecting search terms and use of Boolean operators (delimiters) represented by the terms connectors AND (restrictive combination) were used for each of the 4 components of the PICO strategy, represented in the table below:

Acronyms Definition Description
Problem P Customer adult / elderly in high complexity submitted to central venous catheter at risk for infection.
I spoke Prepare dressing in a standard central venous catheter.
Control C or
Identify compared the effectiveness of 2% chlorhexidine dressing.
The profit potential for infection Prevention of central venous catheterization in adult client / idodo high complexity.
Table 1 - Explanatory Table on the PICO strategy, used in literature.

Based on the foregoing clinical study question emerged selections classified as controlled descriptors relating to each of the peak components were extracted from databases MeSH (PubMed) and DeCS (BIREME). So those extracted from MeSH were: X (Intensive Care), Y (Catheter-related infections) Z (Catheterization, Central Venous) and were extracted from DeCS: A (Intensive Care). B (catheter-related infections), C (Central Venous Catheterization). The search for articles was conducted from June to October 2012. Therefore we selected 06 articles in the English language and 04 articles in Portuguese language that apply to the target population in question referenced the study clinic.

SUMMARY OF SCIENTIFIC EVIDENCE: Nursing should participate with the medical professional in choosing the best access to the central venous catheter, the antiseptic to be used, the strict requirement of maximum protection barrier and the concept of client / family ². Nursing plays a key role in the strategy of continuing education, ie, with updated information on the subject, should create a checklist to follow a standard procedure in, where the only goal is to offer treatment free of infection with safety, comfort and resolution of the clinical problem of high complexity of the client as well as the reduction of hospital expenses regarding prolonged hospitalization due to infection of the central venous catheter. Based on this context that the entire team must be able to recognize the risks and complications of the device but also must be trained to handle and especially the practice of intravenous therapy.

DISCUSSION OF RESULTS ON SCIENTIFIC EVIDENCE: Nursing provides customer support of high complexity, according to the Law of Professional Nursing, n. 7498 of June 25, 1986, in the article (Art.11). So we know that there are still assistants and technicians providing direct care to clients in critical situations of high complexity. This sense that the nurse should be aware of the assistance of his staff to the client, and should prepare training where every team can achieve the same goal in favor of the client / family.Given the assumption that the nurse conducts training for all its staff in order to avoid complications from improper manipulation of the catheter. A nurse prepares the client for the procedure, with the medical professional chooses the appropriate device and vein, prepares documentation and evaluates the daily local venous access, performs the dressing, prescribes and directs nursing care. As should also guide family members about the importance of hand washing before and after touching the client, not clarifies the manipulation of the devices at the bedside. The family welcomed and informed about the tour conducted by the team and the risks of infection by unnecessary handling, the family will certainly be an ally to client care.

ANSWER TO QUESTION THE SCIENTIFIC EVIDENCE BASED CLINIC:
This study shows that the performance of aseptic technique, choosing the ideal antiseptic care and acquisition in the use of central venous catheterization healing, to promote satisfaction and zero risk of infection Customer ². The nurse has the knowledge as a means to obtain competence in professional practice and thus be a support for the daily care. In daily practice, a nurse who works with the the institution offers, but she has the autonomy to choose the ideal antiseptic, this should provide broad spectrum, fast acting, presence of residual effect, low toxicity, low inactivation in the presence of matter organic, stability, non corrosiveness, odor pleasant, good user acceptance and market availability. From the data presented in this study the effectiveness of the dressing with antiseptic chlorhexidine gluconate 2% in preventing the potential for infection of central venous catheterization, on account of high complexity is the best product for the quality of care thereby decreasing infection by handling the dressing in catheter. The advantages of the antiseptic chlorhexidine gluconate 2% are: low toxicity, low absorption, low irritability and activity is not affected in the presence of matter orgânica2-3

CONCLUSIONS: Given the assumption should the nurse had developed strategies for getting all the work shifts smoothly, actions should be taken continuing education as essential in professional practice, encouraging the technical improvement and development of knowledge and skills ethical and legal, with purpose of providing specialized care to the client using CVC. Thus there is a need to create a primer and / or Standard Operating Procedure (SOP) for the client to receive qualified care standard in preventing infection CVC. Nurse is a professional who works managing and coordinating the whole process of customer service and all that is involved in the context of the institution. And it is in this sense that during hours of duty can arise many questions that have no answers at first, but through the PICO strategy that assists in definitions, guides the construction of clinical question and literature search, enables a rapid response scientific Nurse. In this sense, the present study shows the efficacy of antiseptic dressing with 2% chlorhexidine gluconate in preventing the potential for infection catheter being the product of choice for the dressing for providing bactericidal longer in the skin.