Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.202300701
Jornal Vascular Brasileiro
Original Article

Complicações de acessos venosos centrais em um serviço de cirurgia vascular de um hospital de ensino: uma coorte prospectiva

Complications of central venous catheterization at a vascular surgery service in a teaching hospital: a prospective cohort study

Leonardo Jatczak; Renan Camargo Puton; Alencar Junior Lopes Proença; Leonardo Colussi Rubin; Luiza Brum Borges; Jaber Nashat Saleh; Mateus Picada Corrêa

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Resumo

Contexto: Os acessos venosos centrais são essenciais no manejo de pacientes hospitalizados; contudo, a sua inserção está sujeita a complicações que podem dificultar seu uso e causar morbidade aos pacientes. No Brasil, dados acerca da incidência dessas complicações e das variáveis associadas com esse desfecho são escassos.

Objetivos: Determinar a incidência de complicações mecânicas e de falhas de acessos venosos centrais de curta permanência realizados no serviço de Cirurgia Vascular de um hospital de ensino, além de identificar as variáveis associadas com a sua ocorrência.

Métodos: Tratou-se de uma coorte prospectiva com 73 tentativas de acesso venoso central realizadas em pacientes assistidos pelo serviço de Cirurgia Vascular de um hospital de ensino entre julho e outubro de 2022.

Resultados: Complicações mecânicas ocorreram em 12 tentativas de acessos (16,44%), e falhas, em 10 tentativas (13,70%). Os fatores associados às complicações mecânicas foram menor experiência do operador (p < 0,001), menor grau de especialização do operador (p = 0,014), falha na tentativa de acesso precedente à solicitação de auxílio ao serviço de Cirurgia Vascular (p = 0,008) e presença de pelo menos dois critérios de dificuldade (p = 0,007).

Conclusões: A incidência local de complicações mecânicas e de falhas dos acessos venosos centrais foi semelhante à descrita na literatura internacional, mas foi superior à descrita em trabalhos brasileiros. Os resultados sugerem que o grau de experiência do executor do acesso, a história de falha em tentativa precedente e a presença de pelo menos dois critérios de dificuldade verificados antes do procedimento estão associados com piores desfechos.

Palavras-chave

dispositivos de acesso vascular, cateteres, complicações pós-operatórias

Abstract

Background: Central venous catheters are essential for management of hospitalized patients, but their insertion is subject to complications that can make them unusable and/or cause patient morbidity. There are few data on the incidence of these complications and the variables associated with these outcomes in Brazil.

Objectives: To determine the incidence of mechanical complications and failures of short stay central venous catheters fitted by the vascular surgery service at a teaching hospital and identify variables associated with their occurrence.

Methods: This was a prospective cohort of 73 attempts to fit patients with a central venous catheter performed by the vascular surgery service at a teaching hospital from July to October of 2022.

Results: Mechanical complications occurred in 12 cannulation attempts (16.44%) and there were 10 failures (13.70%). The factors associated with mechanical complications wereless experienced operators (p < 0.001), less specialized operators (p = 0.014), a failed attempt prior to requesting help from the vascular surgery service (p = 0.008), and presence of at least two criteria for difficulty (p = 0.007).

Conclusions: The local incidence of mechanical complications and central venous cannulation failures was similar to rates described in the international literature, but higher than rates in other Brazilian studies. The results suggest that the degree of experience of the person fitting the catheter, history of a failed prior attempt, and presence of at least two criteria for difficulty identified before the procedure were associated with worse outcomes.

Keywords

vascular access devices; catheters; postoperative complications

References

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Submitted date:
04/23/2023

Accepted date:
06/12/2023

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
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