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Complicações associadas ao cateter venoso central : um ensaio clínico numa unidade de cuidados intensivos pediátricos
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Introdução: A colocação de um cateter venoso central (CVC) é um procedimento útil e muitas vezes necessário em cuidados intensivos, sendo relevante investigar as complicações associadas. Os objetivos deste estudo são: i) analisar a incidência de complicações imediatas e tardias associadas à colocação de um CVC na Unidade de Cuidados Intensivos Pediátricos (UCIPed), ii) avaliar a relação entre a ocorrência de complicações e o local de inserção do CVC, e iii) identificar fatores que condicionem a ocorrência destas complicações.
Métodos: Realizou-se um estudo clínico retrospetivo na UCIPed do Hospital de Santa Maria, relativo ao ano de 2022. Este foi realizado através da revisão dos processos clínicos, e foram incluídos todos os doentes com um CVC colocado que estavam internados na unidade. Foram registados dados demográficos e relativos ao CVC, e a ocorrência de complicações do mesmo.
Resultados: Num total de 144 CVC, analisaram-se os 126 CVC não tunelizados de curta duração. Os locais de inserção mais frequentes foram a veia femoral (57,9%) e a veia jugular interna (36,5%). Nos 61 CVC colocados durante o internamento na UCIPed, ocorreram as seguintes complicações imediatas: hemorragia minor (6,6%), hematoma (1,6%), hemotórax (1,6%) e arritmia (1,6%). Nos 126 CVC, as complicações tardias incluíram: infeção do local de entrada do CVC (ILECVC) provável (1,6%), dificuldade no retorno venoso (1,6%), disfunção do CVC (11,9%) e trombose venosa profunda (TVP) (3,2%). A taxa de infeção da corrente sanguínea associada ao CVC (ICSACVC) foi de 0 por 1000 dias de CVC. Não se estabeleceu uma relação estatisticamente significativa entre o local de inserção (veia jugular interna ou veia femoral) e a ocorrência de hemorragia minor, disfunção de CVC e TVP. A hemodiafiltração venovenosa contínua (HDFVVC) e a extra corporeal membrane oxygenation (ECMO) estiveram significativamente associadas à disfunção do CVC (p = 0,036), ambas com risco relativo de 4,25 (IC 95%: 1,55 - 11,67, p = 0,005). O mesmo se verificou em relação ao número de dias de CVC (p = 0,008), com um risco relativo de 6,36 (IC 95%: 2,43 - 16,68, p = 0,0002) entre os CVC de duração curta (0-7 dias) e duração longa (>15 dias).
Conclusões: A frequência de complicações imediatas e tardias associadas ao CVC foi reduzida, sendo comparável ou até inferior à documentada na literatura. Nas variáveis analisadas, não se estabeleceu uma relação significativa entre o local de inserção do CVC e a ocorrência de complicações. Identificou-se que o número de dias de permanência do CVC, bem como a realização de HDFVVC e ECMO, estão associados a uma maior incidência de disfunção do CVC.
Introduction: The placement of a central venous catheter (CVC) is a useful and often necessary procedure in intensive care, making it relevant to investigate the associated complications. The objectives of this study are: i) to analyse the incidence of immediate and late complications associated with the placement of a CVC in the UCIPed, ii) to evaluate the relationship between the occurrence of complications and the site of CVC insertion, and iii) to identify factors that influence the occurrence of these complications. Methods: A retrospective clinical study was conducted in the UCIPed of the Hospital de Santa Maria, covering the year of 2022. This was carried out through the review of clinical records, including all patients with a CVC in place during their stay in the unit. Demographic data, data related to the CVC and its associated complications were recorded. Results: Out of a total of 144 CVCs, 126 non-tunneled short-term CVCs were analysed. The most frequent insertion sites were the femoral vein (57.9%) and the internal jugular vein (36.5%). Among the 61 CVCs placed during the UCIPed stay, the immediate complications recorded were: minor hemorrhage (6.6%), hematoma (1.6%), hemothorax (1.6%), and arrhythmia (1.6%). Among the 126 CVCs, the late complications included: probable infection at the CVC insertion site (1.6%), difficulty in venous flow (1.6%), CVC dysfunction (11.9%), and deep vein thrombosis (DVT) (3.2%). The rate of catheter-related bloodstream infections was 0 per 1000 CVC days. No statistically significant relationship was established between the insertion site (internal jugular vein or femoral vein) and the occurrence of minor hemorrhage, CVC dysfunction, and DVT. Continuous venovenous hemodiafiltration (CVVHDF) and extracorporeal membrane oxygenation (ECMO) were significantly associated with CVC dysfunction (p = 0.036), both with a relative risk of 4.25 (95% CI: 1.55 - 11.67, p = 0.005). The same was observed regarding the number of CVC days (p = 0.008), with a relative risk of 6.36 (95% CI: 2.43 - 16.68, p = 0.0002) between short-term (0-7 days) and long-term (>15 days) CVCs. Conclusions: The frequency of immediate and late complications associated with CVC use was low, being comparable to or even lower than that documented in the literature. Among the analysed variables, no significant relationship was established between the CVC insertion site and the occurrence of complications. It was identified that the duration of CVC placement, as well as CVVHDF and ECMO, are associated with a higher incidence of CVC dysfunction.
Introduction: The placement of a central venous catheter (CVC) is a useful and often necessary procedure in intensive care, making it relevant to investigate the associated complications. The objectives of this study are: i) to analyse the incidence of immediate and late complications associated with the placement of a CVC in the UCIPed, ii) to evaluate the relationship between the occurrence of complications and the site of CVC insertion, and iii) to identify factors that influence the occurrence of these complications. Methods: A retrospective clinical study was conducted in the UCIPed of the Hospital de Santa Maria, covering the year of 2022. This was carried out through the review of clinical records, including all patients with a CVC in place during their stay in the unit. Demographic data, data related to the CVC and its associated complications were recorded. Results: Out of a total of 144 CVCs, 126 non-tunneled short-term CVCs were analysed. The most frequent insertion sites were the femoral vein (57.9%) and the internal jugular vein (36.5%). Among the 61 CVCs placed during the UCIPed stay, the immediate complications recorded were: minor hemorrhage (6.6%), hematoma (1.6%), hemothorax (1.6%), and arrhythmia (1.6%). Among the 126 CVCs, the late complications included: probable infection at the CVC insertion site (1.6%), difficulty in venous flow (1.6%), CVC dysfunction (11.9%), and deep vein thrombosis (DVT) (3.2%). The rate of catheter-related bloodstream infections was 0 per 1000 CVC days. No statistically significant relationship was established between the insertion site (internal jugular vein or femoral vein) and the occurrence of minor hemorrhage, CVC dysfunction, and DVT. Continuous venovenous hemodiafiltration (CVVHDF) and extracorporeal membrane oxygenation (ECMO) were significantly associated with CVC dysfunction (p = 0.036), both with a relative risk of 4.25 (95% CI: 1.55 - 11.67, p = 0.005). The same was observed regarding the number of CVC days (p = 0.008), with a relative risk of 6.36 (95% CI: 2.43 - 16.68, p = 0.0002) between short-term (0-7 days) and long-term (>15 days) CVCs. Conclusions: The frequency of immediate and late complications associated with CVC use was low, being comparable to or even lower than that documented in the literature. Among the analysed variables, no significant relationship was established between the CVC insertion site and the occurrence of complications. It was identified that the duration of CVC placement, as well as CVVHDF and ECMO, are associated with a higher incidence of CVC dysfunction.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Cateteres venosos centrais Complicações associadas a cateteres venosos centrais Unidade de cuidados intensivos pediátricos Pediatria