Análisis de las complicaciones asociadas a los catéteres centrales de inserción periférica. Estudio observacional prospectivo

Marta Ferraz-Torres; Ana Diez-Revilla; Ruth Plaza-Unzue; Maria Inés Corcuera-Martinez

doi:10.15649/cuidarte.3352

Autores/as

Marta Ferraz-Torres PhD, MMCE, RN, University Hospital of Navarra, Navarra, Spain. Associate professor, Department of Health Sciences, Public University of Navarre. Researcher, IdiSNA, Navarra Institute for Health Research. https://orcid.org/0000-0002-7740-2572
Ana Diez-Revilla RN, University Hospital of Navarra, Navarra, Spain. https://orcid.org/0000-0002-2350-1954
Ruth Plaza-Unzue RN, University Hospital of Navarra, Navarra, Spain.
Maria Inés Corcuera-Martinez RN, Hospital University Hospital of Navarra, Navarra, Spain.

DOI:

https://doi.org/10.15649/cuidarte.3352

Palabras clave:

Acceso Vascular, Equipo de Enfermería, Oncología, Hematología, Tratamiento

Resumen

Introducción: Los equipos de acceso vascular suelen utilizar guías o algoritmos para determinar el dispositivo de acceso vascular más adecuado según el paciente y la sustancia que se va a administrar. Se supone que las guías permiten al personal identificar a la persona más calificada para insertar el catéter, pero pocos estudios recogen información sobre el desempeño de estas unidades. Objetivo: Este estudio busca identificar la evolución y la tasa de complicaciones de los catéteres centrales de inserción periférica (PICC) en pacientes que requieren acceso vascular. Materiales y Métodos: Estudio observacional prospectivo de tres años de duración. Las variables continuas con distribución normal se compararon mediante la prueba t de Student. Las variables distribuidas con distribución no paramétrica se analizaron con la prueba U de Mann-Whitney. Para las variables categóricas se utilizó la prueba chi cuadrado de dos colas o la prueba exacta de Fisher. Se realizó análisis de regresión para la variable dependiente “complicaciones”. Resultados: El 61,99% (566) de los PICC fueron insertados en pacientes con tratamiento oncológico y una duración media de 136±127,51 días. Los PICC usados en pacientes hematológicos tuvieron una duración media de 144±141,3 días (p=0,438). Las complicaciones más frecuentes fueron la remoción accidental (3,50%, 32, OR 0,581), trombosis (3%, 27, OR 0,752) bacteriemia asociada al catéter venoso central (2,10%, 19, OR, 0,113). Discusión: Las complicaciones relacionadas con los PICC fueron poco frecuentes, siendo la principal la trombosis. Las remociones accidentales fueron frecuentes, una complicación que no ha sido suficientemente analizada en otros estudios. Conclusiones: La inserción y manejo de los PICC por un equipo de acceso vascular permite a las unidades lograr una baja tasa de complicaciones en pacientes oncohematológicos.

Como citar este artículo: Ferraz-Torres Marta, Diez-Revilla Ana, Plaza-Unzue Ruth, Corcuera-Martinez Maria Inés. Analysis of complications associated with peripherally inserted central venous catheters. Prospective observational study. Revista Cuidarte. 2024;15(3):e3352. https://doi.org/10.15649/cuidarte.3352

Biografía del autor/a

Marta Ferraz-Torres, PhD, MMCE, RN, University Hospital of Navarra, Navarra, Spain. Associate professor, Department of Health Sciences, Public University of Navarre. Researcher, IdiSNA, Navarra Institute for Health Research.

PhD, MMCE, RN, University Hospital of Navarra, Navarra, Spain. Associate professor, Department of Health Sciences, Public University of Navarre. Researcher, IdiSNA, Navarra Institute for Health Research.

Ana Diez-Revilla, RN, University Hospital of Navarra, Navarra, Spain.

RN, University Hospital of Navarra, Navarra, Spain.

Ruth Plaza-Unzue, RN, University Hospital of Navarra, Navarra, Spain.

RN, University Hospital of Navarra, Navarra, Spain.

Maria Inés Corcuera-Martinez, RN, Hospital University Hospital of Navarra, Navarra, Spain.

RN, Hospital University Hospital of Navarra, Navarra, Spain.

Referencias

Cotogni P, Barbero C, Garrino C, Degiorgis C, Mussa B, De Francesco A, et al. Peripherally inserted central catheters in non-hospitalized cancer patients: 5-year results of a prospective study. Support Care Cancer. 2015;23:403–409. https://doi.org/10.1007/s00520-014-2387-9

Alexandrou E, Ray-Barruel G, Carr PJ, Frost SA, Inwood S, Higgins N, et al. OMG Study Group. Use of short peripheral intravenous catheters: characteristics, management, and outcomes worldwide. J Hosp Med. 2018;13(5):e1-e7. https://doi.org/10.12788/jhm.3039

Schults JA, Kleidon T, Petsky HL, Stone R, Schoutrop J, Ullman AJ. Peripherally inserted central catheter design and material for reducing catheter failure and complications. Cochrane Database Syst 2019. 3; 2019 (7):CD013366 https://doi.org/10.1002/14651858.CD013366

Marsh N, Webster J, Larsen E, Genzel J, Cooke M, Mihala G, et al. Expert versus generalist inserters for peripheral intravenous catheter insertion: a pilot randomize controlled trial. Trials. 2018;19(1):564. https://doi.org/10.1186/s13063-018-2946-3

Ferraz-Torres M, Mañeru-Oria A, Corcuera-Martinez MI, Diez-Revilla A, Aldonza-Torres M, Escobedo-Romero RL et al. Implantación de una unidad de terapia intravenosa. Una realidad en marcha. Rol enfermería. 2018;41(9):568-576. https://pesquisa.bvsalud.org/portal/resource/pt/ibc-179697

Carr PJ, Moureau NL. Specialized Vascular Access Teams. In: Moureau, N. (eds) Vessel Health and Preservation: The Right Approach for Vascular Access. Springer, Cham. 2019.

Cortés Rey N, Pinelli F, van Loon FHJ, Caguioa J, Munoz Mozas G, Piriou V, et al. The state of vascular access teams: Results of a European survey. Int J Clin Pract. 2021;75(12):e14849. https://doi.org/10.1111/ijcp.14849

Carr PJ, Higgins NS, Cooke ML, Mihala G, Rickard CM. Vascular access specialist teams for device insertion and prevention of failure. Cochrane Database Syst Rev. 2018;(3):CD011429. https://doi.org/10.1002/14651858.cd011429.pub2

Corcuera Martínez MI, Aldonza Torres M, Díez Revilla AM, Maali Centeno S, Mañeru Oria A, Elizari Roncal I, et al. Impact assessment following implementation of a vascular access team. J Vasc Access. 2022;23(1):135-144. https://doi.org/10.1177/1129729820984284

Pan L, Zhao Q, Yang X. Risk factors for venous thrombosis associated with peripherally inserted central venous catheters. Int J Clin Exp Med. 2014; 7(12): 5814-5844. . https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4307559/

Chopra V, Kaatz S, Conlon A, Paje D, Grant PJ, Rogers MAM, et al. The Michigan Risk Score to predict peripherally inserted central catheter-associated thrombosis. J Thromb Haemost. 2017;15(10):1951-1962. https://doi.org/10.1111/jth.13794

Mielke D, Wittig A, Teichgräber U. Peripherally inserted central venous catheter (PICC) in outpatient and inpatient oncological treatment. Support Care Cancer. 2020; 28(10):4753-4760. https://doi.org/10.1007/s00520-019-05276-0

Scrivens N, Sabri E, Bredeson C, McDiarmid S. Comparison of complication rates and incidences associated with different peripherally inserted central catheters (PICC) in patients with hematological malignancies: a retrospective cohort study. Leuk Lymphoma. 2020;61(1):156-164. https://doi.org/10.1080/10428194.2019.1646908

Olaechea PM, Álvarez-Lerma F, Palomar M, Gimeno R, Gracia MP, Mas N,et al. ENVIN-HELICS Study Group. Characteristics and outcomes of patients admitted to Spanish ICU: A prospective observational study from the ENVIN-HELICS registry (2006-2011). Med Intensiva. 2016;40(4):216-29. https://doi.org/10.1016/j.medin.2015.07.003

Hitchcock J, Haigh DA, Martin N, Davies S. Preventing medical adhesive-related skin injury (MARSI). Br J Nurs. 2021;30(15):S48-S56. https://doi.org/10.12968/bjon.2021.30.15.s48

Wohlwend B. Regression Model Evaluation Metrics: R-Squared, Adjusted R-Squared, MSE, RMSE, and MAE. 2023.2:1-4. https://medium.com/@brandon93.w/regression-model-evaluation-metrics-r-squared-adjusted-r-squared-mse-rmse-and-mae-24dcc0e4cbd3

Ferraz-Torres M, Diez-Revilla A, Plaza-Unzue R, Corcuera-Martinez MI. “Analysis of complications associated with peripherally inserted central venous catheters. Prospective observational study”, Mendeley Data. 2024. V1. https://doi.org/10.17632/npymmmcng5.1

Pan L, Zhao Q, Yang X. Risk factors for venous thrombosis associated with peripherally inserted central venous catheters. Int J Clin Exp Med. 2014;7(12): 5814-5844. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4307559/

Tatsuno, K., Ikeda, M., Wakabayashi, Y. Clinical Features of Bloodstream Infections Associated with Peripheral Versus Central Venous Catheters. Infect Dis Ther.2019;8:343–352. https://doi.org/10.1007/s40121-019-00257-6

Chan RJ, Northfield S, Larsen E, Mihala G, Ullman A, Hancock P, et al. Central venous Access device SeCurement And Dressing Effectiveness for peripherally inserted central catheters in adult acute hospital patients (CASCADE): a pilot randomised controlled trial. Trials. 2017;18(1):458. https://doi.org/10.1186/s13063-017-2207-x

Goossens, Godelieve A., Grumiaux N., Janssens C., Jérôme M, Fieuws S, et al. "SecurAstaP trial: securement with SecurAcath versus StatLock for peripherally inserted central catheters, a randomised open trial." BMJ open. 2018;8(2):e016058. https://doi.org/10.1136/bmjopen-2017-016058

Buetti N, Ruckly S, Schwebel C, Mimoz O, Souweine B, Lucet JC, et al. Chlorhexidine-impregnated sponge versus chlorhexidine gel dressing for short-term intravascular catheters: which one is better? Crit Care. 2020;24(1):458. https://doi.org/10.1186%2Fs13054-020-03174-0

Mimoz O, Lucet JC, Kerforne T, Pascal J, Souweine B, Goudet V,et al. Skin antisepsis with chlorhexidine-alcohol versus povidone iodine-alcohol, with and without skin scrubbing, for prevention of intravascular-catheter-related infection (CLEAN): an open-label, multicentre, randomised, controlled, two-by-two factorial trial. Lancet. 2015;386(10008):2069-2077. https://doi.org/10.1016/s0140-6736(15)00244-5

Gavin NC, Webster J, Chan RJ, Rickard CM. Frequency of dressing changes for central venous access devices on catheter‐related infections. Cochrane Database of Systematic Reviews. 2016;(2). https://doi.org/10.1002/14651858.cd009213.pub2