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Administração de medicação por via de cateter venoso periférico: prática clínica em uso e a perspetiva dos enfermeiros
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Abstract(s)
O cateter venoso periférico é um dos dispositivos invasivos mais utilizado pelos enfermeiros, possibilitando a administração de medicação intravenosa. A evidência aponta práticas clínicas díspares e pouco padronizadas, que comprometem a segurança dos procedimentos relativos ao cateter venoso periférico. Dada a escassez de estudos em Portugal neste âmbito, justifica-se uma investigação com o objetivo de conhecer a prática clínica dos enfermeiros na administração de medicação por via do cateter venoso periférico e compreender as razões que os enfermeiros apontam para explicar a prática em uso, bem como as estratégias de melhoria.
Realizou-se um estudo transversal, descritivo e correlacional, de natureza mista, em duas fases. Na fase 1 foi aplicado um questionário de autopreenchimento, via online, a 200 enfermeiros, tendo sido adaptado de um instrumento prévio. Na fase 2 foi realizada uma entrevista semiestruturada a 10 enfermeiros, partindo dos itens do questionário e dos resultados da fase 1 do estudo. Durante a investigação foram salvaguardados os princípios éticos e deontológicos.
As respostas ao questionário refletem uma adesão satisfatória às práticas seguras de administração de medicação por via do cateter venoso periférico. Os itens menos pontuados foram a desinfeção do portal de acesso ao cateter e torneira de três vias, previamente à administração de medicação; a troca da tampa prévia por uma tampa estéril na torneira de três vias e o transporte da medicação no tabuleiro após a sua preparação. No estudo da associação das variáveis os resultados foram pouco significativos. Da análise das entrevistas emergiram sete temas: i) conhecimento, ii) risco, iii) organização do trabalho, iv) recursos materiais, v) tempo de exercício profissional, vi) política institucional; vii) responsabilidade. Cada tema dividiu-se em diversas categorias, que traduzem as razões apontadas pelos enfermeiros para explicar as práticas, incluindo fatores de processo e estrutura, políticas institucionais e ainda razões que colocam em causa a responsabilidade profissional, ética e legal dos enfermeiros. Os enfermeiros identificaram diferentes estratégias que podem promover a adesão às práticas seguras.
Este estudo aponta desvios da prática clínica dos enfermeiros em relação às recomendações seguras para administração de medicação intravenosa e a necessidade de intervenção para garantir a melhoria dos cuidados de enfermagem. No futuro seria útil complementar a informação apurada com observação das práticas, para que seja possível planear uma intervenção multimodal, crucial para a qualidade e segurança dos cuidados de saúde.
The peripheral venous catheter is one of the invasive devices most used by nurses, enabling the administration of intravenous medication. The evidence points to disparate and poorly standardized clinical practices, which compromise the safety of procedures related to peripheral venous catheters. Given the scarcity of studies in Portugal in this area, an investigation is justified with the aim of understanding the clinical practice of nurses in administering medication via peripheral venous catheter and understanding the reasons that nurses give to explain the practice in use, as well as improvement strategies. A cross-sectional, descriptive and correlational study, of a mixed nature, was carried out in two phases. In phase 1, a self-completed questionnaire was administered online to 200 nurses, adapted from a previous instrument. In phase 2, a semi-structured interview was carried out with 10 nurses, based on the questionnaire items and the results of phase 1 of the study. During the investigation, ethical and deontological principles were safeguarded. Responses to the questionnaire reflect satisfactory adherence to safe practices for administering medication via peripheral venous catheter. The lowest scored items were disinfection of the catheter access portal and three-way tap, prior to medication administration; exchanging the previous cap for a sterile cap on the three-way stopcock and transporting the medication on the tray after preparation. In the study of the association of variables, the results were not very significant. From the analysis of the interviews, seven themes emerged: i) knowledge, ii) risk, iii) work organization, iv) material resources, v) professional practice time, vi) institutional policy; vii) responsibility. Each theme was divided into several categories, which reflect the reasons given by nurses to explain practices, including process and structure factors, institutional policies and reasons that call into question the professional, ethical and legal responsibility of nurses. Nurses identified different strategies that can promote adherence to safe practices. This study highlights deviations in nurses' clinical practice in relation to safe recommendations for intravenous medication administration and the need for intervention to ensure the improvement of nursing care. In the future, it would be useful to complement the information gathered with observation of practices, so that it is possible to plan a multimodal intervention, crucial for the quality and safety of healthcare.
The peripheral venous catheter is one of the invasive devices most used by nurses, enabling the administration of intravenous medication. The evidence points to disparate and poorly standardized clinical practices, which compromise the safety of procedures related to peripheral venous catheters. Given the scarcity of studies in Portugal in this area, an investigation is justified with the aim of understanding the clinical practice of nurses in administering medication via peripheral venous catheter and understanding the reasons that nurses give to explain the practice in use, as well as improvement strategies. A cross-sectional, descriptive and correlational study, of a mixed nature, was carried out in two phases. In phase 1, a self-completed questionnaire was administered online to 200 nurses, adapted from a previous instrument. In phase 2, a semi-structured interview was carried out with 10 nurses, based on the questionnaire items and the results of phase 1 of the study. During the investigation, ethical and deontological principles were safeguarded. Responses to the questionnaire reflect satisfactory adherence to safe practices for administering medication via peripheral venous catheter. The lowest scored items were disinfection of the catheter access portal and three-way tap, prior to medication administration; exchanging the previous cap for a sterile cap on the three-way stopcock and transporting the medication on the tray after preparation. In the study of the association of variables, the results were not very significant. From the analysis of the interviews, seven themes emerged: i) knowledge, ii) risk, iii) work organization, iv) material resources, v) professional practice time, vi) institutional policy; vii) responsibility. Each theme was divided into several categories, which reflect the reasons given by nurses to explain practices, including process and structure factors, institutional policies and reasons that call into question the professional, ethical and legal responsibility of nurses. Nurses identified different strategies that can promote adherence to safe practices. This study highlights deviations in nurses' clinical practice in relation to safe recommendations for intravenous medication administration and the need for intervention to ensure the improvement of nursing care. In the future, it would be useful to complement the information gathered with observation of practices, so that it is possible to plan a multimodal intervention, crucial for the quality and safety of healthcare.
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Keywords
Controle de Infecção Administração Intravenosa Cateterismo Periférico Enfermagem