RESUMO
OBJECTIVE: To determine the prevalence of postoperative urinary extravasation (POUE) following anterior urethroplasty, to analyze factors associated with its occurrence, and to study the impact of POUE on surgical success. MATERIALS AND METHODS: Retrospective cohort study including all male patients who have undergone a urethroplasty at our center between 2011 and 2018. Subjects with posterior location stricture, those who did not undergo routine radiographic follow-up, or patients with inadequate follow-up were excluded. Urinary extravasation was defined as presence of evident contrast extravasation on the postoperative voiding cystourethrogram (VCUG). Impact was determined as "need-for-reoperation". Uni- and multivariate analysis were performed to determine clinical and demographic variables associated with occurrence of extravasation and postoperative stricture. RESULTS: A total of 783 men underwent a urethroplasty and 630 fulfilled inclusion criteria. Urinary extravasation prevalence was 12.2%, and there was a "need-for-reoperation" in 1.1% of cases. On uni- and multivariate analysis, greatest stricture length (HR: 1.07 (1-1.2), p = 0.05) and penile urethral location (HR: 2.29 (1.1-4.6), p = 0.021) showed to be POUE predictors. POUE did not show to be a risk factor for postoperative stricture (HR: 1.57, 95% CI (0.8-3), p = 0.173). However, reoperation group showed to be a risk factor (HR: 6.6, 95% CI 1.4-31, p = 0.019). CONCLUSIONS: Prevalence of POUE was 12.2%. Stricture length and penile urethral strictures were POUE predictors. POUE occurrence with successful conservative management did not appear to have impact on urethroplasty outcomes as it did not predict re-stricture. POUE was reoperation cause in 1.1% of total cases.
Assuntos
Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Uretra/cirurgia , Estreitamento Uretral/cirurgia , Urina , Estudos de Coortes , Humanos , América Latina/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Cirúrgicos Urológicos Masculinos/métodosRESUMO
OBJECTIVE: The objective of this study was to identify the incidence of infiltration and extravasation in newborns using peripheral venous catheter, and affecting factors. METHOD: This observational study examined catheters inserted into newborns who received inpatient care in the neonatal intensive care unit of a state hospital located in the west of Turkey. A total of 452 peripheral venous catheters inserted into 152 newborns were observed. The forms were completed by the researchers based on their observations at each shift. RESULTS: The infiltration/extravasation occurred in 45.6% of peripheral venous catheters inserted into newborns; 19.7% were stage I and 11.7% were stage IV. A statistically significant relationship was found between the gestation week as well as the birth weight of newborns and the occurrence of infiltration/extravasation complication. In addition, there were statistically significant relationships between the administration of single or multiple antibiotics, total parenteral nutrition and the incidence of infiltration/extravasation complication. CONCLUSION: It is recommended to use an appropriate scale for the assessment of infiltration/extravasation as well as to implement measures for preventing the occurrence of infiltration/extravasation.
Assuntos
Cateterismo Periférico/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Unidades de Terapia Intensiva Neonatal , Antibacterianos/administração & dosagem , Peso ao Nascer , Cateterismo Periférico/métodos , Feminino , Idade Gestacional , Humanos , Incidência , Recém-Nascido , Masculino , Nutrição Parenteral Total/métodos , Estudos Prospectivos , Fatores de Risco , TurquiaRESUMO
OBJECTIVE: to determine the incidence rate and risk factors for the nursing-sensitive indicators phlebitis and infiltration in patients with peripheral venous catheters (PVCs). METHOD: cohort study with 110 patients. Scales were used to assess and document phlebitis and infiltration. Socio-demographic variables, clinical variables related to the PVC, medication and hospitalization variables were collected. Descriptive and inferential analysis and multivariate logistic models were used. RESULTS: the incidence rate of phlebitis and infiltration was respectively 43.2 and 59.7 per 1000 catheter-days. Most PVCs with these vascular traumas were removed in the first 24 hours. Risk factors for phlebitis were: length of hospital stay (p=0.042) and number of catheters inserted (p<0.001); risk factors for infiltration were: piperacillin/tazobactan (p=0.024) and the number of catheters inserted (p<0.001). CONCLUSION: the investigation documented the incidence of nursing-sensitive indicators (phlebitis and infiltration) and revealed new risk factors related to infiltration. It also allowed a reflection on the nursing care necessary to prevent these vascular traumas and on the indications and contraindications of the PVC, supporting the implementation of the PICC as an alternative to PVC.
Assuntos
Cateterismo Periférico/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Flebite/epidemiologia , Flebite/etiologia , Veias/lesões , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto JovemRESUMO
ABSTRACT Objective: to determine the incidence rate and risk factors for the nursing-sensitive indicators phlebitis and infiltration in patients with peripheral venous catheters (PVCs). Method: cohort study with 110 patients. Scales were used to assess and document phlebitis and infiltration. Socio-demographic variables, clinical variables related to the PVC, medication and hospitalization variables were collected. Descriptive and inferential analysis and multivariate logistic models were used. Results: the incidence rate of phlebitis and infiltration was respectively 43.2 and 59.7 per 1000 catheter-days. Most PVCs with these vascular traumas were removed in the first 24 hours. Risk factors for phlebitis were: length of hospital stay (p=0.042) and number of catheters inserted (p<0.001); risk factors for infiltration were: piperacillin/tazobactan (p=0.024) and the number of catheters inserted (p<0.001). Conclusion: the investigation documented the incidence of nursing-sensitive indicators (phlebitis and infiltration) and revealed new risk factors related to infiltration. It also allowed a reflection on the nursing care necessary to prevent these vascular traumas and on the indications and contraindications of the PVC, supporting the implementation of the PICC as an alternative to PVC.
RESUMO Objetivo: determinar a taxa de incidência e os fatores de risco para os indicadores sensíveis aos cuidados de Enfermagem, flebite e infiltração, em pacientes portadores de cateteres venosos periféricos (CVPs). Método: estudo de coorte com 110 pacientes. Utilizou-se escalas para avaliar e documentar flebite e infiltração. Recolheram-se variáveis sociodemográficas, clínicas, relativas ao CVP, à medicação e à internação, bem como efetuou-se análise descritiva e inferencial, e modelação logística multivariada. Resultados: a taxa de incidência de flebite e infiltração foi de 43,2 e 59,7 por mil cateteres-dia, respectivamente. A maioria dos CVPs foi removida nas primeiras 24h devido a esses traumas vasculares. Foram fatores de risco para flebite o tempo de internação (p=0,042) e o número de cateteres inseridos (p<0,001), sendo para infiltração a piperacilina/tazobactan (p=0,024) e o número de cateteres inseridos (p<0,001). Conclusão: a investigação documentou a incidência de indicadores sensíveis aos cuidados de Enfermagem (flebite e infiltração) e evidenciou novos fatores de risco relacionados à infiltração. Possibilitou, também, uma reflexão sobre os cuidados de Enfermagem para prevenir esses traumas vasculares, as indicações e as contraindicações do CVP, tendo subsidiada a implementação do PICC nas práticas de Enfermagem como alternativa ao CVP.
RESUMEN Objetivos: determinar la tasa de incidencia y los factores de riesgo para los indicadores sensibles a los cuidados de Enfermería, flebitis e infiltración, en pacientes portadores de catéteres venosos periféricos (CVPs). Método: se trata de un estudio de cohorte entre 110 pacientes. Se utilizaron escalas para evaluar y documentar la flebitis y la infiltración. Se recogieron variables sociodemográficas y clínicas, relativas al CVP, a la medicación y a la internación. Se realizó un análisis descriptivo e inferencial, y modelación logística multivariada. Resultados: la tasa de incidencia de flebitis e infiltración fue de 43,2 y 59,7 por mil catéteres-día, respectivamente. Se removió la mayoría de los CVPs en las primeras 24 horas debido a dichos traumas vasculares. Los factores de riesgo para la flebitis fueron: el tiempo de internación (p=0,042) y el número de catéteres insertados (p<0,001); para la infiltración: la piperacilina/tazobactan (p=0,024) y el número de catéteres insertados (p<0,001). Conclusión: la investigación documentó la incidencia de indicadores sensibles a los cuidados de Enfermería (flebitis e infiltración) y evidenció nuevos factores de riesgo relacionados con la infiltración. Posibilitó, también, una reflexión sobre los cuidados de Enfermería para prevenir los traumas vasculares y sobre las indicaciones y contraindicaciones del CVP, con la implantación del PICC auxiliando en las prácticas de Enfermería como alternativa del CVP.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Flebite/etiologia , Flebite/epidemiologia , Cateterismo Periférico/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Fatores de Risco , Estudos de CoortesRESUMO
The accidental release of intravenous contrast media (ICM) from the intravascular compartment to the adjacent soft tissues is one of the most frequent complications of the injection procedure in multi-slice CT (MSCT). Its incidence is low, occurring in between 0.1 and 0.9 percent of patients undergoing these studies. Affected areas usually present mild lesions characterized by swelling and local erythema and that tend to resolve spontaneously without sequelae. However, serious lesions may also occur, such as compartment syndrome. For these reasons it is essential to know patients at risk, precautionary measures, specific technical factors, early diagnosis and appropriate management of this complication. These elements constitute basic skills that every radiologist must possess.
La salida accidental de medio de contraste intravenoso (MCI) desde el compartimento intravascular hacia los tejidos de partes blandas adyacentes es una de las complicaciones más frecuentes del procedimiento de inyección en tomografía computada multicorte (TCMC). Su incidencia es baja, ocurre entre el 0,1 y el 0,9 porciento de los pacientes que se someten a estos estudios. Las zonas afectadas generalmente presentan lesiones leves caracterizadas por aumento de volumen y eritema local que tienden a remitir espontáneamente sin secuelas. Sin embargo, también pueden ocurrir lesiones graves, como un síndrome compartimental. Por estas razones es fundamental conocer los pacientes en riesgo, las medidas de precaución, los factores técnicos específicos, el diagnóstico precoz y el manejo oportuno de esta complicación. Estos elementos constituyen competencias básicas que todo radiólogo debe poseer.
Assuntos
Humanos , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Extravasamento de Materiais Terapêuticos e Diagnósticos , Meios de Contraste/efeitos adversos , Tomografia Computadorizada por Raios X/efeitos adversos , Controle de Qualidade , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Extravasamento de Materiais Terapêuticos e Diagnósticos/terapia , Fatores de Risco , RadiologiaRESUMO
Una de las complicaciones más graves de la administración intravenosa de citostáticos es su extravasación. En este trabajo se define cómo puede ocurrir la salida no intencionada de un fármaco citostático al espacio perivascular o subcutáneo durante su administración, lo que puede deberse a diversos factores. Su incidencia es entre el 0,1 y el 6 por ciento, según diferentes reportes. Existen disímiles protocolos para su tratamiento y todos coinciden en que lo más importante es aplicar lo antes posible las medidas físicas y farmacológicas que requiera cada caso
Extravasation is one of the most serious complications during intravenous administration of cytostatics. In this paper we describe how an unintentional output of a cytostatic drug to the perivascular or subcutaneous space can occur during its administration, resulting from diverse factors. Its incidence is 0,1 to 6 percent , according to different reports. There are dissimilar protocols for treatment and all agree that applying physical and pharmacological measures is the most important, as soon as each case require
Assuntos
Humanos , Masculino , Feminino , Citostáticos/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/complicações , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Extravasamento de Materiais Terapêuticos e Diagnósticos/prevenção & controleRESUMO
AIMS: The aims were to compare characteristics of children with peripheral intravenous catheters who developed infiltration and those who did not and to identify risk factors for developing this complication. METHOD: A retrospective cohort study carried out at a university hospital, with 338 children with peripheral intravenous catheters. Variables related to the children and therapies were investigated. RESULTS: Researchers identified infiltration in 54 children (16%). Characteristics statistically different in those who developed infiltration were the following: intravenous therapy for more than 5 days, presence of predisposing factors to peripheral venipuncture failure, history of previous infiltration, catheter readjustment to vein insertion, use of infusion pump, intermittent administrations, and shorter dwell time. CONCLUSION: Only intravenous therapy variables showed a significant relation with the occurrence of infiltration and represented risk factors for its occurrence.
Assuntos
Cateterismo Periférico/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Infusões Intravenosas/efeitos adversos , Adolescente , Braço , Brasil/epidemiologia , Cateterismo Periférico/enfermagem , Criança , Criança Hospitalizada , Pré-Escolar , Estudos de Coortes , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Extravasamento de Materiais Terapêuticos e Diagnósticos/prevenção & controle , Feminino , Mãos , Humanos , Lactente , Recém-Nascido , Infusões Intravenosas/enfermagem , Masculino , Flebite/epidemiologia , Flebite/etiologia , Flebite/prevenção & controle , Estudos Retrospectivos , Fatores de RiscoRESUMO
AIMS AND OBJECTIVES: To verify the incidence of extravasation of cytostatic drugs in patients treated on an outpatient basis at a university hospital in the city of São Paulo, Brazil, during the period from 1998 to 2002, and to assess the quality of care provided by the nursing team using a protocol adopted for the treatment of this adverse event as a parameter. BACKGROUND: The movement for quality in healthcare services has been a recent event in Brazil, mainly as the result of the Brazilian Program of Hospital Accreditation instituted in 1998. Considering the emphasis on risk management, it is important to mention the monitoring of the occurrence of extravasations of cytostatic drugs in order to improve the quality of nursing care provided to cancer patients. DESIGN AND METHODS: An evaluative study with a descriptive, prospective and longitudinal design was conducted, based on the documentary analysis of the notification of 216 extravasations of vesicant and irritant drugs that occurred between 1998 and 2002 and the corresponding prescriptions of cold or hot compresses. RESULTS: The mean incidence of extravasations ranged from 0.2 to 1.4% over the five years of the study. Incorrect prescription of the type of compress was observed for three patients. Undesired effects were ulcers caused by the extravasation of vinblastine and dacarbazine in two cases. CONCLUSIONS: The low incidence of both extravasation and tissue damage demonstrates the adequate quality of nursing care provided to cancer patients at the outpatient clinic studied. However, the identification of the lack of 12 records of thermal treatment and of three erroneous prescriptions requires the implementation of educational measures to prevent these types of incident. RELEVANCE TO CLINICAL PRACTICE: The relevance of this study to clinical practice is to increase the awareness and involvement of the nursing team in the maintenance of a continuous surveillance system of the process and results of chemotherapy administration in order to increase the quality of care and the safety of the patient.
Assuntos
Antineoplásicos/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Neoplasias/tratamento farmacológico , Enfermagem Oncológica/normas , Qualidade da Assistência à Saúde , Gestão de Riscos , Adulto , Antineoplásicos/administração & dosagem , Brasil , Hospitais Universitários/normas , Humanos , Incidência , Sistemas de Medicação no Hospital , Neoplasias/enfermagem , Ambulatório Hospitalar/normasRESUMO
O meio de contraste iodado é a droga mais comumente utilizada pelo radiologista. Seus efeitos adversos säo as reaçöes alérgicas e, menos frequentemente, o extravasamento para a pele. Pelo fato de näo haver, na literatura, consenso quanto ao tratamento do extravasamento, realizamos revisäo para estabelecer o protocolo de tratamento de tais acidentes, para que os pacientes recebam condutas padronizadas e adaptadas para a nossa realidade