RESUMO
Objetivo: estimar parámetros de calidad y de costos en el procedimiento de inserción de Catéter Venoso Central y el Catéter Venoso Central de inserción periférica. Metodología: Se evaluaron las historias de niños (edad 31 días -15 años ), que ingresaron al Hospital Universitario del Valle, entre enero de 2011 y diciembre de 2014, que requirieron canalización de una vena central. Se evaluaron variables demográficas, de calidad y se estimaron costos de ambos procedimientos. Resultados: Se evaluaron 100 procedimientos de inserción Central y 100 de inserción periférica, los últimos tuvieron menor tiempo de espera, se realizaron en la habitación, no requirieron ayuno, ni traslado al quirófano, a un menor costo, lo cual impactó la oportunidad de administración de tratamiento farmacológico, la evolución y la estancia hospitalaria. Conclusiones: Se recomienda que el procedimiento de inserción periférica sea la primera elección en niños que requieran tratamientos endovenosos mayores a cinco días, para esto es necesario conformar un grupo que supervise el funcionamiento de los catéteres y brinde educación continua al personal de salud de los servicios de hospitalización y a familiares, contar con una sala de procedimiento para la inserción del PICC que brinde seguridad y adecuado manejo del dolor.
Aim: to estimate quality and cost parameters of central venous catheter insertion peripheral and central venous catheter procedures. Methods: we reviewed records of 200 children (31 days - years old), hospitalised at a University Hospital between January 2011 and December 2014 who required central vein access. We assessed demographic, quality variables and cost of both procedures. Results: we reviewed records of 100 central insertion and 100 peripheral insertion procedures. Peripheral insertions had less waiting time, were conducted next to the child's bed, without need for fasting or transfering to the operating room, at a lower cost, all of these ensured timely administration of medicaments and nutrition, which resulted in lower stance time. The peripheral insertion also freed surgeon and operating room time to perform other interventions. Conclusions: We recommend that peripheral insertion procedure should be the first choice in children requiring intravenous treatments longer than five days. In order to establish a periferal insertion procedure in a hospital, a team is required to follow-up the patients and provide continuing education to health personnel in services and to family members, there is also a need for an appropiate space for insertion procedures and pain management.
Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Custos de Cuidados de Saúde , Colômbia , Hospital Dia/economia , Catéteres , Catéteres/estatística & dados numéricos , Cateteres Venosos CentraisRESUMO
OBJECTIVE: To measure the average direct cost of peripherally inserted central catheterization performed by nurses in a pediatric and neonatal intensive care unit. METHOD: A quantitative, exploratory-descriptive, single-case study, whose sample consisted of the non-participant observation of 101 peripherally inserted central catheter procedures. The cost was calculated by multiplying the execution time (timed using a chronometer) spent by nursing professionals, participants in the procedure, by the unit cost of direct labor, added to the cost of materials, drugs, and solutions. RESULTS: The average direct cost of the procedure was US$ 326.95 (standard deviation = US$ 84.47), ranging from US$ 99.03 to US$ 530.71, with a median of US$ 326.17. It was impacted by material costs and the direct labor of the nurses. CONCLUSION: The measurement of the average direct cost of the peripherally inserted central catheter procedure shed light on the financials of consumed resources, indicating possibilities of intervention aiming to increase efficiency in allocating these resources.
Assuntos
Cateterismo Periférico/economia , Catéteres/economia , Enfermeiras e Enfermeiros/economia , Cateterismo Periférico/estatística & dados numéricos , Catéteres/estatística & dados numéricos , Criança , Pré-Escolar , Custos e Análise de Custo , Feminino , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Enfermeiras e Enfermeiros/estatística & dados numéricosRESUMO
ABSTRACT Objective: To measure the average direct cost of peripherally inserted central catheterization performed by nurses in a pediatric and neonatal intensive care unit. Method: A quantitative, exploratory-descriptive, single-case study, whose sample consisted of the non-participant observation of 101 peripherally inserted central catheter procedures. The cost was calculated by multiplying the execution time (timed using a chronometer) spent by nursing professionals, participants in the procedure, by the unit cost of direct labor, added to the cost of materials, drugs, and solutions. Results: The average direct cost of the procedure was US$ 326.95 (standard deviation = US$ 84.47), ranging from US$ 99.03 to US$ 530.71, with a median of US$ 326.17. It was impacted by material costs and the direct labor of the nurses. Conclusion: The measurement of the average direct cost of the peripherally inserted central catheter procedure shed light on the financials of consumed resources, indicating possibilities of intervention aiming to increase efficiency in allocating these resources.
RESUMEN Objetivo: Medir el costo directo promedio del paso de catéter central de inserción periférica por enfermeras en una unidad de cuidados intensivos pediátrica y neonatal. Método: Investigación cuantitativa, exploratoria-descriptiva, del tipo estudio de caso único, cuya muestra se constituyó de la observación no participante de 101 pasos de catéter central de inserción periférica. El costo se calculó multiplicando el tiempo (cronometrado) de los profesionales de enfermería, participantes en el procedimiento, por el costo unitario de mano de obra directa, sumándose al costo de materiales/medicamentos/soluciones. Resultados: El costo directo medio del procedimiento correspondió a US$ 326,95 (desviación estándar = US$ 84,47), variando entre US$ 99,03 y US$ 530,71, con mediana de US$ 326,17, habiendo sido impactados por los costos con material y mano de obra directa de los enfermeros ejecutantes. Conclusión: La medición del costo directo medio del paso del catéter central de inserción periférica confirió visibilidad financiera a los insumos consumidos, indicando posibilidades de intervención pretendiendo incrementar su eficiencia alocativa.
RESUMO Objetivo: Mensurar o custo direto médio da passagem de cateter central de inserção periférica, por enfermeiros, em uma unidade de terapia intensiva pediátrica e neonatal. Método: Pesquisa quantitativa, exploratório-descritiva, do tipo estudo de caso único, cuja amostra se constituiu da observação não participante de 101 passagens de cateter central de inserção periférica. O custo foi calculado multiplicando-se o tempo (cronometrado) despendido por profissionais de enfermagem, participantes do procedimento, pelo custo unitário da mão de obra direta, somando-se ao custo dos materiais/medicamentos/soluções. Resultados: O custo direto médio do procedimento correspondeu a US$326.95 (desvio-padrão = US$ 84.47), variando entre US$99.03 e US$530.71, com mediana de US$326.17; tendo sido impactado pelos custos com material e mão de obra direta dos enfermeiros executantes. Conclusão: A mensuração do custo direto médio da passagem de cateter central de inserção periférica conferiu visibilidade financeira aos insumos consumidos, indicando possibilidades de intervenção visando o incremento da sua eficiência alocativa.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Cateterismo Periférico/economia , Catéteres/economia , Enfermeiras e Enfermeiros/economia , Cateterismo Periférico/estatística & dados numéricos , Custos e Análise de Custo , Catéteres/estatística & dados numéricos , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Enfermeiras e Enfermeiros/estatística & dados numéricosRESUMO
OBJECTIVE: To compare the incidence and reasons for nonelective removal of percutaneously inserted central catheters (PICC lines) between centrally and noncentrally placed PICC lines in neonates. DESIGN: Prospective cohort study. SETTING: A 60-bed, tertiary-level neonatal intensive care unit in a private hospital in São Paulo, Brazil. PARTICIPANTS: Neonates who were born at the hospital and underwent successful insertion of 237 PICC lines. They were divided into two groups, central and noncentral, according to tip position. METHODS: Neonates were monitored daily from insertion of the PICC until its removal. Data were collected from medical records. RESULTS: Of the 237 PICCs analyzed, 207 (87.4%) had their tip in a central position and 30 (12.6%) in a noncentral position. The incidence of nonelective PICC removal was similar between the central and noncentral groups (p = .48). The reasons for nonelective removal were significantly different between the groups (p = .007), with a higher incidence of extravasation in the noncentral group. CONCLUSION: Noncentrally placed PICCs can provide vascular access in neonates requiring venous access for the administration of intravenous solutions. Many potential catheter-related complications can be prevented by careful bedside nursing. Frequent monitoring of noncentral PICCs is necessary to detect and prevent extravasation in neonates.