Fatores clínicos associados ao sucesso nas punções intravenosas periféricas de crianças e adolescentes atendidos em um hospital público

Abstract

To demonstrate positive results in the care provided to the child, to the companion and the safety of the patient, it is essential to have a scientific and practical knowledge of peripheral venous puncture (PIP). The objective of this study was to investigate the demographic and clinical factors associated with failure in peripheral intravenous punctures of children and adolescents admitted to a public hospital of reference for paediatrics in Bahia, and as specific objectives: To characterize the demographic and clinical profile of children and adolescents submitted to peripheral intravenous puncture in a public hospital; To estimate the frequency of failure in peripheral intravenous punctures in these children and adolescents. This is a crosssectional study, carried out with secondary data, with a sample of 411 children and adolescents, totaling 723 peripheral intravenous punctures, since some children have been submitted to more than one puncture. The instrument for data collection was elaborated containing information through the demographic and clinical characteristics of children and adolescents, clinical history related to IVT, variables related to IPT and complications related to IPT. For this analysis, it was considered as a dependent variable the success of the AVP, categorized in yes and no. The collected data were tabulated in electronic spreadsheets with the help of the Statistical Package for the Social Sciences (SPSS), version 15.0, and analyzed through STATA, version 13, which was prepared for a descriptive analysis, after calculating the absolute and relative frequencies and measures of central tendency (mean and median) and measures of dispersion (standard deviation). To verify the association between outcome and exposure, a bivariate analysis was performed from the Pearson Chi-Square Test and Fisher's Test, considering a p-value ≤ 0.05 for a statistically significant association. For the multiple analysis, the OR was transformed into Prevalence Ratio (PR) through robust Poisson regression. For the estimation of the adjusted PR, the hierarchical stepwise regression regression model was used to insert the variables. In the final model observed, the permanence of statistical significance obtained values of descriptive levels equal to or lower than 5%. The matrix project was submitted to the Ethics Committee in Research of the State University of Feira de Santanta, being approved with opinion nº 841.612 / 2014. The findings show a frequency of 89.21% success in PIP, in relation to the multiple model. The factors independently associated with successful punctures were: for the visible vein, 3.44 times (95% CI: 2.27-5.24; p-value <0.001), the prevalence of success for those who did not have a visible vein. Regarding puncture characteristics, the number of trials was associated with success, with only one trial showing a prevalence of success 10.96 times the prevalence of success in two or more trials (95% CI: 5.35 - 22.45 ; p-value <0.001), as well as punctures performed in the upper limbs (PR = 3.59, 95% CI: 2.29-5.62, p-value <0.001), directly (PR = 2.59 , 95% CI: 1.66 - 4.04, p-value <0.001) with 22-gauge docateter use (RP = 2.29, 95% CI: 1.44-3.65, p-value <0.001). It is worth highlighting the strengthening and re-adaptation of evidence-based practices to strengthen the factors that are related to the success of the PIP and guarantee the quality and safety of the patient.