Incidentes em sessões de hemodiálise à beira leito em unidades de terapia intensiva
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2019-03-29
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Universidade Federal de Goiás
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OBJECTIVE: Analyzing the incidents that occurred during the hemodialysis sessions at bedside in the Intensive Care Unit. INTODUCTION: the Intensive Care Unit are highly complex assistance environments that are conductive to the occurrence of incidents. A complex treatment realized in the hemodialysis service at bedside, indicated by the nephrologist to the severer patient aiming, to keep it metabolically stable. The hemodialysis at bedside is adapted to the environment of Intensive Care Unit, although the legislation is still incipient. Hemodialysis sessions can bring on incidental that compromise patient safety. These circumstances have potential to cause damage such as injuries, disabilities and even death. Therefore, it is necessary to understand the etiology, the contributing factors and the possible consequences of such incidents, with subsidies for strategies to promote patient safety, involving professionals that perform hemodialysis assistance, in the search for a continuous improvement culture. METODOLOGY: Cross-sectional, analytical and retrospective study, developed in 10 (ten) Intensive Care Units of Goiânia-GO, during hemodialysis sessions performed by a specialized outsourced clinic. The data collection was performed through the analysis of incidents reports, performed by the nursing team in the hemodialysis prescription at the bedside, from march to april of 2018, using a structured instrument elaborated for this purpose. Descriptive analysis was performed for categorical data, presented in absolute (n) and relative (%) frequencies and for continuous data in mean and standard deviation of the mean. To test the homogeneity of the groups in relation to the proportions, it was used the Two-Tale Fisher's Exact Test. The research has ethical approval, under CAEE nº61669016.2.0000.5078. RESULTS: During the data collection period, 873 hemodialysis sessions were performed and 563 incidents were recorded. Incidents were prevalent in male patients over 60 years old, who had diabetes mellitus and underwent hemodialysis in the SLED modality, using a central catheter for hemodialysis and without heparin. Among the reported incidents, 46.00% (259) were considered to be inherent to the treatment, with hypotension predominating, 28.06% (158) incidents with health technology, with a predominant report of leakage of the water treatment system (portable osmosis), 20.43% (115) care incidents, with emphasis on incompatibility of access to the prescribed flow, and 0.35% (02) incidents involving health products. In general, these incidents were identified by the nursing technician, who attended the hemodialysis session, prior to the patient's injury, although they requested vigilance, delayed the start of the session and did not obtain support from the unit's multiprofessional team at the time of the incident. In 56.12% (132) of the intimate circumstances, the professional worked for more than 12 uninterrupted hours. CONCLUSION: The most recorded were avoidable incidents that generated delay to start treatment and required patient monitoring, despite the non-predominance of damages. Visionary actions are necessary to mitigate incidents and promote safe care during bedside hemodialysis sessions.
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COSTA, N. N. Incidentes em sessões de hemodiálise à beira leito em unidades de terapia intensiva. 2019. 73 f. Dissertação (Mestrado em Enfermagem) - Universidade Federal de Goiás, Goiânia, 2019.