Flebites: caracterização e protocolo de práticas seguras para prevenção

Abstract

The use of Peripheral Intravenous Catheters is essential in daily nursing practices, especially in the hospital environment. Phlebitis is one of the frequent complications of its use. This study aimed to characterize phlebitis and to develop, in a participatory manner, a protocol that provides support for the prevention of phlebitis in hospitalized patients with peripheral intravenous catheters and for good professional practices in the hospital context. This is an action research, developed in three sequential stages, from June to December 2023, in a public teaching hospital in the central-west region of the state of Rio Grande do Sul. The first phase was a prospective longitudinal study (three evaluations) with 96 patients hospitalized in the Emergency Room and Medical Clinic. In the second phase, a field observation was carried out with the nursing team at the time of venipuncture, preparation and administration of medications and, in the third phase, four seminars with the nursing team. The population consisted of patients, nurses and nursing technicians from the units studied. To assess the occurrence and degree of phlebitis, as well as good care practices, instruments with variables related to the patient, catheter, phlebitis and the procedures adopted in the insertion and handling of catheters were used. For the seminars, the Ishikawa Diagram was used to encourage discussions and construction of the protocol. Descriptive statistics were used for data analysis according to the type of variable. As results, regarding the frequency and degree of phlebitis, in the first evaluation (n=96), 16.7% presented phlebitis and 43.8% with grade I. In the second evaluation (n=24), 8.3% presented phlebitis with grades II and III. In the third evaluation (n=10), one presented phlebitis in grade 3. Phlebitis occurred mainly in the Emergency Room and in male patients. Regarding the catheter insertion site, the cephalic vein was predominant, with the use of a welladhered transparent dressing and no visualization of the insertion site. The root causes identified were related to the lack of material; selection, stabilization and coverage of the catheter; hand hygiene assistance points; identification and replacement of the catheter coverage, in addition to the deficit in care of the insertion site and removal of the catheter. The collective construction of the protocol allowed the review of effective strategies for the prevention of the occurrence of new cases of phlebitis by the nursing team and has the potential to reduce it, positively impacting the quality of care provided. Knowledge of the causes and reasons related to the occurrence of phlebitis can support decision-making, management and care processes, regarding investments in preventive or risk mitigation strategies in the context studied.