Gerência do cuidado de enfermagem na manutenção do cateter venoso central para o paciente em transplante de células-tronco hematopoiéticas

Abstract

Introduction: the Hematopoietic Stem Cell Transplantation is a complex treatment, which restores, under certain circumstances, the immunologic and hematopoietic systems in patients who show malignant and non-malignant illnesses. In order for the procedure to be possible, the implantation of a central venous catheter is necessary, which could be related to a series of adverse events, such as infectious, thrombotic or mechanic complications. The nurse is responsible for managing the care for the central venous catheter, preventing complications and adverse events related to its use. Objective: To discuss the actions of nursing care management, aiming at evidence-based best practices in the CVC maintenance process in patients undergoing HSCT. Method: exploratory field research with a qualitative approach. The research scenario is the Bone Marrow Transplant Unit of a private hospital in the city of Zona da Mata Mineira, with ten nursing professionals participating in the research. The data collection began after approval by the Research Ethics Committee, under Consolidated Ruling 3.205.698 and CAAE number 06396818.0.0000.5147. The data was obtained through individual, semi-structured interviews, in the months of April and May 2019. Bardin’s content analysis was used, as was the Iramuteq software to help in the process of coding and categorizing the data from the interviews. Results: Six classes emerged, compiled into three categories. The main results were: the importance of the catheter in transplantation, the role of the nurse in the catheter maintenance process, the view of the nursing team and the importance of the permeability of the central venous catheter. Final Considerations: The study highlighted the management actions in the nursing care in keeping the CVC, among these, the effective communication, the development of educational practices and implementation of evidence-based practices and the need for nursing professionals to be aligned with the best practices in order to secure the safety of the patient and mitigate the risk of bloodstream infection around the catheter. The participants reiterated the use of heparin solution to maintain the permeability of the CVC. However, when faced with the risks related to the use of this solution in onco-hematological patients, a reevaluation is suggested on which solution to use in the transplant unit.