Cuidado del paciente crítico en la realización del examen de imagen en la cama: revisión integrativa

Soares, Débora Thais Siqueira; Hermann, Ana Paula; Lacerda, Maria Ribeiro; Méier, Marineli Joaquim; Caceres, Nayla Tamara de Godoi; Lima, Juliana Zimmermann

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Revista Brasileira de Enfermagem

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REVIEW • Rev. Bras. Enferm. 73 (6) • 2020 • https://doi.org/10.1590/0034-7167-2018-0948 copiar

Cuidado del paciente crítico en la realización del examen de imagen en la cama: revisión integrativa

Autoría SCIMAGO INSTITUTIONS RANKINGS

RESUMEN

Objetivo:

identificar em la evidencia la atención que se debe aplicar al realizar pruebas de imágen esen cama en pacientes críticos.

Método:

revisión integradora. Se consultaron las bases de datos: Pubmed, Biblioteca Virtual em Salud, Joanna Briggs Institute, The British Institute of Radiology, Radiología Brasileña y académico de Google. Utilizando la estrategia de investigación PICO, se seleccionaron artículos publicados a partir de 2013, que presentaban información sobre laatención al realizar pruebas de imagenen cama.

Resultados:

las diferentes intervenciones resultantes del análisis de los 23 artículos seleccionados permitieron la agrupación temática de la atención relacionada com la seguridade en la comunicación, la identificación del paciente, la atención con dispositivos y la prevención y el control de infecciones, que pueden utilizarse para realizar pruebas de imagen em la cama.

Consideraciones finales:

la atención descrita em la evidencia proporciono apoyo para lavalidación de un protocolo de atención segura para pacientes críticos sometidos a imágenes de cama.

Descriptores:
Cuidados Críticos; Atención de Enfermería; Grupo de Atención al Paciente; Pruebas em el Punto de Atención; Seguridad del Paciente

Article / journal/year	Tipyofstudy / sample	Objective	Mainresults
A1⁽¹⁴14 Afonso TR, Daminello E, Guimarães LA, Mônaco CG, Vieira MLC, Cordovil A, et al. Influência do Posicionamento do Paciente sobre a qualidade das imagens ecocardiográficas em exames realizados no Leito. Arq Bras Cardiol: ImagemCardiovas [Internet]. 2016 [cited 2018 Oct 27];29(4):112-7. Available from: http://departamentos.cardiol.br/dic/publicacoes/revistadic/revista/2016/portugues/Revista04/08_artigo_original_164_port.pdf http://departamentos.cardiol.br/dic/publ... ⁾ Arq Bras Cardiol: Imagem Cardiovasc. 2016.	Observation and evaluation of image quality in regarding to the decubitus position. Total of 67 patients.	To assess whether changing the patient's position during the exam could have an influence on the technical quality of the images and whether additional factors could limit collecting adequate images in the bed.	Patient's positioning on the bed is extremely important for obtaining good quality images. About 90% of the images were considered good/excellent when the patients were placed in the Left Lateral Decubitus.
A2⁽¹⁵15 Machado RC, Gironés P, Souza AR, Moreira RSL, Von Jakitsch CB, Branco JNR. Protocolo de cuidados de enfermagem a pacientes com dispositivo de assistência ventricular. Rev Bras Enferm [Internet]. 2017 [cited 2018 Oct 27];70(2):353-9. Available from: http://www.scielo.br/pdf/reben/v70n2/pt_0034-7167-reben-70-02-0335.pdf http://www.scielo.br/pdf/reben/v70n2/pt_... ⁾ Revista Brasileira de Enfermagem. 2017	Descriptive study, with a quantitative approach of methodological validation of an instrument.	To develop and validate a nursing care protocol for patients with Ventricular Assist Device (VAD).	Protocol composed of 10 actions: the appropriate nutritional support, the assessment of the patient's pain, the correct analgesia and the prevention of infectious processes are highlighted.
A3⁽¹⁶16 Morais ACC, Lemos MM, Marques VD, Bandeira COP. Institutional protocol to standardize the chest drainage system management, from surgery to nursing care, at a regional hospital in northern Paraná. Acta Sci Health Sci [Internet]. 2016 [cited 2018 Oct 27];38(2):173-7. Available from: http://periodicos.uem.br/ojs/index.php/ActaSciHealthSci/article/view/26972 http://periodicos.uem.br/ojs/index.php/A... ⁾ Acta Scientiarum. Health Sciences. 2016.	Prospective observational study. Adult patients undergoing thoracic drainage with a water seal.	To evaluate the management of closed chest drainage systems through the analysis of adult patients, as well as standardize the care protocol for chest drainage and minimize its complications.	Protocol composed of 12 actions. Therapeutic success is evidenced and it is directly related to the qualification and continuous training of the patient's caregivers undergoing chest drainage.
A4⁽¹⁷17 Rocha AEF, Rocha FAA, Mourão Neto JJ, Gomes FMA, Cisne MSV. Cuidado de enfermagem ao paciente ventilado artificialmente: uma revisão integrativa. Essentia [Internet]. 2017 [cited 2018 Oct 27];18(1):41-53. Available from: http://www.uvanet.br/essentia/index.php/revistaessentia/article/view/35 http://www.uvanet.br/essentia/index.php/... ⁾ Essentia. 2017	Integrative Review. A total of 12 articles were selected.	To identify the scientific evidence about the nursing care provided to patients undergoing mechanical ventilation in the ICU.	Nursing care for artificially ventilated patients requires nurses to have prior knowledge and skills so that patients' care needs are met.
A5⁽¹⁸18 Souza LM, Ramos MF, Becker ESS, Meirelles LCS, Monteiro SAO. Adesão dos profissionais de terapia intensiva aos cinco momentos da higienização das mãos. Rev Gaúcha Enferm [Internet]. 2015 [cited 2018 Oct 27];36(4):21-8. Available from: https://seer.ufrgs.br/RevistaGauchadeEnfermagem/article/view/49090 https://seer.ufrgs.br/RevistaGauchadeEnf... ⁾ Revista Gaúcha de Enfermagem. 2015	Cross-sectional, analytical study with a quantitative approach. A total of 793 observations were made.	To identify the adherence of health professionals in an Intensive Care Unit regarding the five moments of hand-washing (HW) recommended by WHO.	In 446 (56.2%) observations, there was no HW. HW with soap and water was more frequent (32%) compared to rubbing with alcohol (11.8%). The HW adherence rate was 43.7%.
A6⁽¹⁹19 Toso BRGO, Viera CS, Valter JM, Delatore S, Barreto GMS. Validação de protocolo de posicionamento de recém-nascido em Unidade de Terapia Intensiva. Rev Bras Enferm. 2015;68(6):835-41. doi: 10.1590/0034-7167.2015680621i https://doi.org/10.1590/0034-7167.201568... ⁾ Revista Brasileira de Enfermagem. 2015.	Methodological study. Participation of five specialists.	Check the positioning recommendations of newborns (NB) and build a standard operating procedure protocol (SOP) for positioning NBs in the Neonatal Intensive Care Unit (NICU).	Correct positioning of the premature baby: head of the bed raised to 30°. Positions: a) flat or supine position: maximum flexion and support of the scapular zone; b) Lateral decubitus: Slight flexion of the trunk and head in the midline and flexion of the arms; c) prone position or pronation: flexion of the spine, slight pelvic elevation, correct feet angle and nesting.
A7⁽²⁰20 Gan KLJ, Tan M. Evidence-based management of patients with chest tube drainage system to reduce complications in cardiothoracic vascular surgery wards. Int J Evid Based Healthc [Internet]. 2015 [cited 2018 Oct 27];13(2):58-65. Available from: https://journals.lww.com/ijebh/Abstract/2015/06000/Evidence_based_management_of_patients_with_chest.4.aspx https://journals.lww.com/ijebh/Abstract/... ⁾ International Journal of Evidence-Based Healthcare.2015	A convenience sample, selected 33 nurses.	To identify the best available evidence and develop an evidence-based clinical audit project to use as a guide to assess current nursing, practice and implement a change strategy to increase compliance with best practice standards for nursing in patients with chest tubes.	A total of 94% of participants agreed that the use of the checklist improved patient care and 90% agreed that it was useful for performing physical examinations on patients. Regarding workload: 35% of nurses did not notice an increase in workload.
A8⁽²¹21 Miyague AH, Mauad FM, Martins WP, Benedetti ACG, Ferreira AEGM, Mauad-Filho F. O exame ultrassonográfico como potencial fonte de infecção cruzada e nosocomial: uma revisão da literatura. Radiol Bras [Internet]. 2015 [cited 2018 Oct 27];48(5):319-23. Available from: http://www.scielo.br/pdf/rb/v48n5/pt_0100-3984-rb-48-05-0319.pdf http://www.scielo.br/pdf/rb/v48n5/pt_010... ⁾ Radiologia Brasileira. 2015.	Literature review, without description of the method used.	To review the main concepts related to the topic addressed in order to better understand them, thus making it possible to establish strategies for safe practice without compromising the quality of the exam and the operator's productivity.	The use of gloves is recommended during all tests and should be used to remove the used preservative and to wash the transducer. Hand asepsis is essential for starting a new exam. Cleaning/ disinfecting the probes should be systematic and routinely.
A9⁽³3 Pereira LMV, Almeida LF, Franco AS, Marins ALC, Ribeiro GSR, Macedo M. Retirada não planejada de dispositivos invasivos e suas implicações para a segurança do paciente crítico. Rev Pesqui: Cuid Fundam [Internet]. 2018 [cited 2018 May 17];10(2):490-5. Available from: http://www.seer.unirio.br/index.php/cuidadofundamental/article/view/6106 http://www.seer.unirio.br/index.php/cuid... ⁾ Revista Online de Pesquisa: Cuidado é Fundamental. 2018.	Descriptive, retrospective, documentary research with a quantitative approach. A total of 360 printouts were analyzed.	To analyze the unplanned removal of invasive devices in an intensive care unit.	The enteric catheter for food stood out among those devices removed in an unplanned manner (42%). The reasons for which the removal was done were: removed by the patient (33%), obstruction (30%) and accidental loss (21%).
A10 ⁽²²22 Ding S, Meystre NR, Campeanu C, Gullo G. Contrast media extravasations in patients undergoing computerized tomography scanning: a systematic review and meta-analysis of risk factors and interventions. JBI Database System Rev Implement Rep [Internet]. 2018 [cited 2018 Oct 27];16(1): 87-116. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29324560 https://www.ncbi.nlm.nih.gov/pubmed/2932... ⁾ JBI Database of Systematic Reviews and Implementation Reports. 2018	Systematic review. It included patients who underwent a CT scan with contrast.	To identify risk factors and interventions that prevent or reduce the extravasation of the contrast medium in patients undergoing computerized tomography examination.	The amount of extravasated fluid, the venous access and the catheter's permanence time and the patient's characteristics can be a risk factor for extravasation, recent hospitalization.
A11⁽²³23 Vital JACP, Cruz ICF. Diretrizes para a prática baseada em evidências sobre a intervenção de enfermagem cuidado com o local de incisão cirúrgica no pós operatório de cirurgia cardíaca em UTI- Revisão Sistematizada de Literatura. J Special Nurs Care.[Internet]. 2016 [cited 2018 Oct 27];10(1): 258-70. Available from: http://www.jsncare.uff.br/index.php/jsncare/article/view/2994/763 http://www.jsncare.uff.br/index.php/jsnc... ⁾ Journal of Specialized Nursing Care. 2018	Descriptive research carried out through systematic bibliographic review. A total of 10 articles were selected.	To review the evidence-based guidelines that will assist the intensive care nurse in the identification and prevention of Surgical Site Infections (SSI) in the postoperative period of cardiac surgery, in the Intensive Care Unit.	Proper assessment of the surgical site is important. The nurse has a central role in the maintenance of the surgical dressing and in the evaluation of the surgical wound, in order to detect early complications of infection.
A12⁽²⁴24 Almeida TPM, Cruz ICF. Diretrizes para a prática de cuidados de enfermagem com cateter vesical em pacientes de alta complexidade: Revisão sistematizada de literatura. J Special Nurs Care[Internet]. 2018 [cited 2018 Oct 27];10(1):1983-4152. Available from: http://www.jsncare.uff.br/index.php/jsncare/article/view/3013/769 http://www.jsncare.uff.br/index.php/jsnc... ⁾ Journal of Specialized Nursing Care. 2018	Integrative bibliographic research. A total of 12 articles were selected.	To analyze the scientific evidence available for the prevention of infection associated with bladder catheterization, with emphasis on the Intensive Care Unit, through nursing interventions.	Nurse qualification guarantees the quality of the care provided to the patient, and it must follow protocols and guidelines as a way to avoid damage to the health of the patient who is already hospitalized in ICUs.
A13⁽²⁵25 Silva EA, Cruz ICF. Diretrizes para a prática baseada em evidência para o controle de intervenção de enfermagem na prevenção de infecção relacionada a cateter venoso central, um desafio na prática assistência em UTI - Revisão Sistematizada da Literatura. J Special Nurs Care [Internet]. 2018 [cited 2018 May 23];10(1):1983-4152. Available from: http://www.jsncare.uff.br/index.php/jsncare/article/view/2984/757 http://www.jsncare.uff.br/index.php/jsnc... ⁾ Journal of Specialized Nursing Care. 2018	Integrative literature review. A total of 10 articles were selected.	To review evidence-based guidelines that will assist the intensive care nurse in identifying and treating nursing care conduct related to infection control related to the Central Venous Access device.	Through good practices in the insertion, handling and removal of the central venous catheter, nurses can develop mechanisms to prevent infections related to the use ofCVC.
A14⁽²⁶26 Sousa FC, Pereira JC, Rezende DA, Laura C. Avaliação dos cuidados de enfermagem com o cateter venoso central em uma unidade de terapia intensiva adulto e pediátrica. Rev AdmSaúde [Internet]. 2018 [cited 2018 Oct 27];18(70).Available from: http://www.cqh.org.br/ojs-2.4.8/index.php/ras/article/view/92 http://www.cqh.org.br/ojs-2.4.8/index.ph... ⁾ Revista de Administração em Saúde. 2018	Clinical audit study, control and system review. With a total of 15 participants.	To evaluate CVC-related nursing care in adult and pediatric Intensive Care Units to compare the conduct to the standardized protocol in the institution and analyze the results, based on the ANVISA guide entitled "Health Care-Related Infection Prevention Measures" 2017.	Regarding the use of PPE (gloves, mask, glasses and cap) while performing CVC dressings, it was noticed that 1 (6.7%) nurse did not use sterile gloves during the procedure, 4 (26.7%) did not wear a mask, 14 (93.4%) did not wear glasses, 3 did not wear a cap (20.0%).
A15⁽²⁷27 Graveto JM, Santos C, Costa PS, Fernandes E, Alarico S, Osório N, et al. Gestão do procedimento higiene das mãos por enfermeiros: desafios para saúde coletiva. Rev Bras Enferm [Internet]. 2018 [cited 2018 Oct 27];71(Suppl 1):607-12. Available from: http://www.scielo.br/pdf/reben/v71s1/pt_0034-7167-reben-71-s1-0562.pdf http://www.scielo.br/pdf/reben/v71s1/pt_... ⁾ Revista Brasileira de Enfermagem. 2018	Descriptive and cross-sectional study, with 50 nurses.	To describe determining factors in the management of the hand hygiene procedure performed by a group of nurses in Internal Medicine services and to identify possible challenges for public health.	A total of 90% consider respecting the existing hand hygiene recommendations at the stipulated times. However, none of the moments of hand hygiene with water and soap were identified by all respondents.
A16⁽²⁸28 Silva OM, Ribeiro MC, Moraes VC, Xavier TC, Ascari RA, Frizon G. Biossegurança precaução padrão na Unidade de Terapia Intensiva: revisão Integrativa. Rev Uningá [Internet]. 2016 [cited 2018 Oct 27];49:71-8. Available from: http://revista.uninga.br/index.php/uninga/article/view/1302 http://revista.uninga.br/index.php/uning... ⁾ Revista Uningá. 2016	Integrative literature review, with a qualitative approach, totaling 22 selected articles.	To characterize the scientific production on biosafety and precaution in the ICU and to describe the factors that contribute to the healthy environment in the ICU and the habits of professionals, from 2003 to 2012.	Professionals neglect biosafety in their daily work routine, exposing themselves to occupational risks, a result strongly influenced by organizational issues of the health institution itself.
A17⁽²⁹29 Panno SF, Costenaro RGS, Diaz C, Zamberlan C. Uso de pulseiras na identificação do paciente: Implicações para o cuidado seguro. Disciplinarum Sci Ciênc Saúde [Internet]. 2017 [cited 2018 Oct 27];18(1):145-55. Available from: https://www.periodicos.unifra.br/index.php/disciplinarumS/article/view/2258 https://www.periodicos.unifra.br/index.p... ⁾ DisciplinarumScientia. Ciências da Saúde. 2017	Integrative literature review. A total of 8 publications were selected.	To identify scientific productions at national and international level on patient identification through the use of wristbands and their implications for safe care in the hospital context.	It was evident, the multiplicity of factors involved in such a process and the great challenge of health institutions in reaching acceptable levels of conformities regarding the identification process.
A18⁽³⁰30 Santos GRS, Campos JF, Silva RC. Comunicação no handoff na terapia intensiva: nexos com a segurança do paciente. Esc Anna Nery [Internet]. 2018 [cited 2018 Oct 27];22(2): 1-12. Available from: http://www.scielo.br/pdf/ean/v22n2/pt_1414-8145-ean-2177-9465-EAN-2017-0268.pdf http://www.scielo.br/pdf/ean/v22n2/pt_14... ⁾ Escola Anna Nery. 2018	Integrative, exploratory review study, which resulted in 15 articles.	To look for scientific evidence on the practice of handoff in the ICU regarding the safety of team members' communication about the hospitalized patient.	Missing, incomplete, or wrong information in the handoff is highlighted, due to the lack of standardization and preparation of this activity, causing a delay in procedures or that are wrong or not performed. The use of instruments reduces the amount of information neglected, casual conversations, and errors, improving team satisfaction.
A19⁽³¹31 Guimarães AA, Santos CFO, Silva FCS, Ferreira JCS; Freitas JS, Silva JS, et al. Quais as evidências da literatura científica relacionadas ao cuidado de enfermagem ao paciente acamado em UTI?. Rev Eletrônica Acervo Saúde [Internet]. 2018 [cited 2018 Oct 27];10:S984-90. Available from: https://www.acervosaude.com.br/doc/REAS94.pdf https://www.acervosaude.com.br/doc/REAS9... ⁾ Revista Eletrônica Acervo Saúde. 2018	Integrative literature review. A total of 6 articles were selected.	To analyze nursing care for bedridden patients in the ICU through a literature review.	Most studies evaluated the nurses' actions and the need for a trained and experienced intensivist to guarantee the quality of life of patients who need their care.
A20⁽³²32 Ferreira A, Webler JM, Silva JOM, Rozin L. Matia G. Adesão aos cinco momentos de higienização das mãos em unidades de terapia intensiva de um hospital pediátrico. Rev Saúde Pública do Paraná [Internet]. 2017 [cited 2018 Oct 27];18(2):96-104. Available from: https://www.researchgate.net/publication/323191106_Adesao_aos_cinco_momentos_de_higienizacao_das_maos_em_unidades_de_terapia_intensiva_de_um_hospital_pediatrico https://www.researchgate.net/publication... ⁾ Revista de Saúde Pública do Paraná. 2017	Exploratory-descriptive study, based on documents and quantitative approach. Direct observation of 61 beds.	To assess the adherence of health professionals in the five moments of hand hygiene in the ICUs of a pediatric hospital.	It is observed that, just before contact with the patient, there is a more significant concern for HM. The training of the multidisciplinary team must be carried out continuously to raise awareness of risks and prevent hospital infection to which patients are exposed.
A21⁽³³33 Mendes JR, Brasileiro MSE. Proposta de protocolo para descontaminação de equipamentos em unidade de Terapia Intensiva. Ver Enferm Centro-Oeste Mineiro [Internet]. 2017 [cited 2018 Oct 27];7(e2346):1-5. Available from: http://seer.ufsj.edu.br/index.php/recom/article/view/2346 http://seer.ufsj.edu.br/index.php/recom/... ⁾ Revista de Enfermagem do Centro-Oeste Mineiro. 2017	Laboratory analysis of 14 swabs was performed.	To analyze contamination of equipment in an intensive care unit before and after cleaning and disinfection and propose a protocol for decontamination.	In the pre-disinfection, the bedside table, the computer keyboard, and the telephone presented negative growth of staphylococcus coagulase. The phone remained contaminated after cleaning and disinfection. The medication preparation bench, the glucometer, the nursing scale, and the monitor did not show contamination before or aftercleaning/disinfection.
A22⁽³⁴34 Andrade VLF, Fernandes FAV. Prevenção da infecção do trato urinário associada ao cateterismo: estratégias na implementação de guidelines internacionais. Rev Latino-Am Enfermagem [Internet]. 2016 [cited 2018 Oct 27];24: e2678. Available from: http://www.scielo.br/pdf/rlae/v24/pt_0104-1169-rlae-0963-2678.pdf http://www.scielo.br/pdf/rlae/v24/pt_010... ⁾ Rev Latino-Americana de Enfermagem. 2016	Systematic literature review. A total of 13 articles were selected.	To describe the strategies that health professionals use in the implementation of the guidelines issued by the Centers for DiseaseControlandPrevention in the prevention of urinary tract infection associated with bladder catheterization.	It was identified: reminder systems to decrease the number of people submitted to urinary catheterization; audits on the practice of nursing professionals, application of bundles and removing the catheter when unnecessary, which allows reducing the rate of catheter-related urinary tract infections.
A23⁽³⁵35 Santos RA, Zago MABS, Giaretta VMA. Infecção hospitalar associada ao uso do cateter venoso central e seus cuidados. REENVAP [Internet]. 2013 [cited 2018 Oct 27];1(5):109-24. Available from: http://publicacoes.fatea.br/index.php/reenvap/article/viewArticle/1138 http://publicacoes.fatea.br/index.php/re... ⁾ Revista Eletrônica de Enfermagem do Vale do Paraíba. 2013	Descriptive exploratory cross-sectional study, with statistical data. A total of 130 patients were admitted, reaching 1107 patients/day.	To identify the number of nosocomial infections associated with the use of the central venous catheter and propose the use of the infection prevention bundles method, contributing to the quality of care provided to the client.	Among the 1107 patients/day with CVC, the majority of infections were caused by Staphylococcus aureus, which is removed with a simple hand washing to avoid, bundles appear, which are simple and effective measures.

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[1] Corresponding author: Débora Thais Siqueira Soares E-mail: dtssiqueira@gmail.com