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Intervenciones enfermeras en las técnicas de depuración extrarrenal continuas con citrato en una unidad de cuidados intensivos

2021; Volume: 24; Linguagem: Inglês

10.35667/metasenf.2021.24.1003081729

2660-986X

Gemma Blanch mercader, Ana Guirao mayoral, Pedro Castro,

Venous Thromboembolism Diagnosis and Management

espanolObjetivo: describir la utilizacion de filtros en la terapia de hemodiafiltracion venovenosa continua (HDFVCC) durante el primer ano de uso de citrato como anticoagulante en la unidad de cuidados intensivos (UCI) del Hospital Clinic de Barcelona, asi como las intervenciones enfermeras y la generacion de alarmas asociadas a esta terapia. Metodo: se realizo un estudio descriptivo transversal de serie de casos (dic 2016- dic 2017) con un componente longitudinal -para el analisis de las intervenciones enfermeras y las alarmas-. Se incluyo a mayores de 18 anos ingresados en cuidados intensivos que precisaron HDFVVC con citrato. A traves de la historia clinica y observacion directa se recogieron variables relacionadas con el paciente, la terapia, las alarmas e intervenciones asociadas. Se realizaron indices de estadistica descriptiva y analisis bivariantes. Resultados: se incluyeron 17 pacientes que utilizaron 38 filtros en total. El tiempo mediano de duracion de la HDFVVC fue de cinco dias y el de cada filtro de 52 horas. El motivo mas habitual de cambio de filtro fue la coagulacion (34%). Se efectuaron un total de 2,9 intervenciones enfermeras por hora (el 70% especificas de la terapia). Se observo una tendencia decreciente, no significativa estadisticamente, de las intervenciones y las alarmas en los tres primeros dias. Conclusion: la anticoagulacion con citrato en la HDFVVC se asocia con frecuentes intervenciones enfermeras, asi como con un aumento de la vida media del filtro. Teniendo en cuenta ademas la reduccion del riesgo hemorragico, los beneficios del tratamiento globalmente parecen superar sus inconvenientes desde el punto de vista de intervenciones de Enfermeria. EnglishObjective: to describe the use of filters in continuous venovenous hemodiafiltration therapy (CVVHDF) during the first year of use of citrate as anticoagulant in the Intensive Care Unit (ICU) of the Hospital Clinic of Barcelona, as well as nursing interventions and generation of alarms associated to this therapy. Method: a cross-sectional descriptive study was conducted on a series of cases (December, 2016 to December, 2017), with a longitudinal component for the analysis of nursing interventions and alarms. The study included >18-year-old patients hospitalized in Intensive Care who required CVVHDF with citrate. Through clinical records and direct observation, there was a collection of patient and therapy-related variables, as well as of the alarms and the interventions associated. Descriptive statistics indexes were conducted, as well as bivariate analysis. Results: seventeen (17) patients were included, using 38 filters in total. The median time of CVVHDF duration was five days, and 52 hours for each filter. The most common reason for change of filter was coagulation (34%). In total, 2.9 nursing interventions were conducted per hour (70% were specific for the therapy). A decreasing tendency was observed, not statistically significant, for interventions and alarms during the first three days. Conclusion: anticoagulation with citrate in CVVHDF was associated with frequent nursing interventions, as well as with an increase in the half-life of the filter. Taking also into account the reduction in risk of hemorrhage, the benefits of the treatment overall seem to overcome its drawbacks from the point of view of nursing interventions.