Dimensionamento da dor durante a instalação do cateter central de inserção periférica em neonatos

Ultrasound guided central line insertion in neonates: Pain score results from a prospective study

BACKGROUND

Central lines can be placed through different techniques, either peripherally or centrally. Although they have the same aim, decision to use one of these modalities depends on the patient outcomes. The aim is to compare pain scores between ultrasound-guided central line insertion and peripherally inserted catheter in neonates in a prospective randomized single center study.

METHODS

A randomized controlled trial was conducted in neonates requiring central venous access for any of the following reasons: total parenteral nutrition (TPN), antibiotics treatment for at least 7 days and having poor or difficult venous access. The study compared pain difference, in neonates, that were randomized between peripherally and ultra-sound guided centrally placed central lines using the validated pain score N - PASS.

RESULTS

61 neonates were enrolled in the study. US-guided CICC was associated with less pain as reported by the statistically significant lower pain score difference (p-value <0.001) than the standard PICC. Additionally, the US-guided CICC had a higher rate of successful first attempt (p = 0.012), lower overall number of attempts (p < 0.001), and shorter procedure duration (p < 0.001) as compared to standard PICC.

CONCLUSION

US-guided CICC is a less painful technique than PICC line insertion associated with higher rate of successful first attempt, lower overall number of attempts and shorter procedure duration.

Translation and adaptation of the Premature Infant Pain Profile into Brazilian Portuguese

The study aimed to translate and to adapt a version of the Premature Infant Pain Profile into the Brazilian Portuguese language. This is a cross-sectional and methodological study for the validation of a translated version of a tool. The process was conducted in four stages: initial translation, synthesis, back-translation, and analysis by experts. Four independent versions of the instrument translated into Brazilian Portuguese were produced. Based on these initial translations, a synthesis version was developed. Two back-translated versions were independently produced, and none showed major differences compared to the original instrument. An expert committee reviewed the summary version and the back-translations with respect to semantic and idiomatic equivalence. The committee considered the translation into Brazilian Portuguese as appropriate. Therefore, the Perfil de Dor no Recém-Nascido Pré-termo was considered adapted to Brazilian Portuguese, for research purposes and for clinical practice. It will contribute to the internationalization of research results in Brazil.

[Management practices of peripherally inserted central catheter at a neonatal unit]

The study aimed to describe the management of Peripherally Inserted Central Catheters insertion in neonates admitted at a neonatal intensive care unit of a private hospital, after implementation of the institutional protocol. An exploratory, quantitative descriptive study with prospective data collection was carried out. Data of 45 catheters insertion were analyzed. The rate of catheter's with elective removal was 63.8%, and catheter's complications rate was 30.8%. The most frequently complications were rupture (15.4%), occlusion (11%) and accidental dislodgement (4.4%). No records about the catheter dressings were observed in 33% of catheter's insertion. One conclude that the complications were related to care practices of the catheter, requiring professional training and new tools to record the care provided in relation to the catheter's management.