Motivo de retirada do cateter de Hickman em pacientes submetidos ao transplante de células-tronco hematopoéticas

Dressings for the central venous catheter to prevent infection in patients undergoing hematopoietic stem cell transplantation: a systematic review and meta-analysis

PURPOSE

To identify the most effective dressing for covering long-term central venous catheter exit site to prevent catheter-related infections and skin irritation in patients undergoing hematopoietic stem cell transplantation.

METHODS

Systematic Review. The search was performed in the following electronic databases: CINAHL, Cochrane Library CENTRAL, EMBASE, LILACS, PubMed, Scopus, and Web of Science. Google Scholar was used for the gray literature search.

RESULTS

Seven studies were included which tested different arrangements of dressings: sterilized gauze and adhesive tape with a transparent polyurethane film (n = 2), transparent polyurethane film with a different replacement interval frequency (n = 2), transparent polyurethane film with and without chlorhexidine released continuously by the dressing at the site of intravascular catheter insertion (n = 2), and dressings vs. no dressings (n = 1). The meta-analysis for catheter-related infection prevention showed no difference between type of dressing (RR 1.76, [95% CI 0.82; 3.75], I₂ 0%) and for the replacement frequency at different intervals (RR 1.04, [95% CI 0.67; 1.61], I₂ 0%). The meta-analysis for skin irritation evaluated the transparent polyurethane film replacement frequency and indicated that a longer dressing replacement interval (10 to 15 days) reduces the risk of developing this outcome (RR 0.71, 0.52; 0.96, 95% CI, I₂ 24%).

CONCLUSIONS

Regarding the type of the dressing, there is no evidence indicating the best dressing. Although there is no evidence available for the ideal replacement frequency, the risk to develop skin irritation is reduced in longer dressing replacements intervals.

Nursing care in a hematopoietic stem cells transplantation unit

In hematopoietic stem cell transplantation units, nursing care is different from other services. The objective in this descriptive study with a qualitative approach was to identify the care activities of nurses at a transplantation unit, classified according to the framework of nurses' functions. The data were collected through systematic observation and treated through content analysis. Three functions were identified for nurses: clinical nurse, management nurse and visit nurse, the first having a wider range of care activities. The maintenance of life care is focused on patient and environmental hygiene; the general techniques involve basic techniques like instrument/drug handling and patient assessment; and the specialized care includes specific activities, such as bone marrow collection and infusion, central catheter care and care for blood transfusion and chemotherapy. It was concluded that the care is integral, specialized and based on knowledge gained through additional training and expertise.