Trauma vascular periférico em urgência: impacto após implantação de bundle

Abstract

Quantitative research aimed to create and apply in clinical practice a 'bundle of peripheral vascular trauma prevention "approach to the process of peripheral vascular puncture in urgent and emergency situations in the service in which the vessel was used for infusion volumes and intravascular drugs and analyze their effectiveness in clinical practice by comparing the incidence of vascular trauma before and after educational intervention. The setting of the research was an emergency service and emergency participation of people of both genders, sexes and over 18 years of a mining town. Multimethod and techniques were used to identify the occurrence of manifestations of peripheral vascular injuries from punctures (semiotic techniques, measurements and photographic records) from the construction of two cohorts interspersed with educational intervention. Data analyzed using descriptive, inferential and correlational statistics. Met all legal and ethical requirements for research involving humans. Evaluated 244 and 191 sites of punctures observed in the emergency care industry with the routine of the institution and after modification, respectively. In the first stage were observed in 143 cases (58.6%) of peripheral vascular trauma distributed as follows: pain (49.6%); the change of skin color (17.6%) types, ecchymosis (8.6%), hematoma (1.2%) and erythema (13.5%); decreased functional capacity of limb or punctured it (7%), the change of skin integrity types of edema (23%); induration (15.2%); visualization of interruption (12.7%); viewing secretion at the site of catheter insertion (0.8%) and the change in local temperature (10.2%). The bundle of "prevention of peripheral vascular trauma" was created based on scientific and adaptable to people who had their punctured vessels comprising the steps of fixing, maintenance and removal of the catheter into the blood vessel profile evidence. He was presented to the nursing staff through educational process whose approach included: initial motivation from the indices of incidence of peripheral vascular trauma, strategies to prevent them, and actions to reduce iatrogenic complications. The bundle was subsequently incorporated into the routine of institutional sectors investigated and evaluated 191 sites of punctures in which it was used. 60 cases (31.4%) of peripheral vascular trauma using the bundle were observed: pain (21.5%); changing the color of the skin (7.3%) types, ecchymosis (1.6%), hematoma (2.1%) and erythema (6.3%); decreased functional capacity of limb or punctured it (0.5%), the change of skin integrity types of edema (4.7%); induration (6.8%); visualization of a discontinuity (3.7%); viewing secretion at the site of catheter insertion (1%) and the change in local temperature (1%). The creation and implementation of a "bundle of peripheral vascular trauma prevention" approach to the punching process in peripheral vascular and emergency rescue service was efficient to the point of reducing the incidence of vascular trauma when compared with the period before (58, 6%) and after educational intervention bundle content (31.4%). The types of manifestations of trauma identified in two moments portrayed nursing problems present in clinical nursing practice for which the present investigation has as its contribution identification and ducts whose effectiveness has been proven through the standardization of simple pipelines, low operating cost and which achieved results that qualify the nursing care to the extent that they are capable of being dealt with nursing behaviors.