{"id":1932,"date":"2023-09-11T13:36:34","date_gmt":"2023-09-11T16:36:34","guid":{"rendered":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/?p=1932"},"modified":"2023-09-11T13:36:34","modified_gmt":"2023-09-11T16:36:34","slug":"infeccao-cateter-nutricao-parenteral","status":"publish","type":"post","link":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/infeccao-cateter-nutricao-parenteral\/","title":{"rendered":"O que pode ser feito para reduzir o risco de infec\u00e7\u00e3o associada ao cateter na nutri\u00e7\u00e3o parenteral?"},"content":{"rendered":"

Durante a administra\u00e7\u00e3o de terapia nutricional por via parenteral, quadros de sepse s\u00e3o uma das principais complica\u00e7\u00f5es. <\/strong>Esse problema est\u00e1 relacionado \u00e0 eleva\u00e7\u00e3o da morbimortalidade e aumento dos custos m\u00e9dico-hospitalares1<\/sup>. Por isso, saber como evitar infec\u00e7\u00e3o associada ao cateter na nutri\u00e7\u00e3o parenteral \u00e9 indispens\u00e1vel para preservar a condi\u00e7\u00e3o cl\u00ednica do paciente submetido a essa interven\u00e7\u00e3o.<\/strong><\/p>\n

Os cuidados para prevenir tal problema passam pela escolha do tipo de cateter de acordo com o ambiente em que a nutri\u00e7\u00e3o parenteral \u00e9 administrada, pela assepsia correta durante toda a manipula\u00e7\u00e3o e pela conserva\u00e7\u00e3o do acesso e dos curativos em boas condi\u00e7\u00f5es.<\/p>\n

 <\/p>\n

Escolha dos tipos de cateteres<\/h2>\n

A escolha do tipo de cateter a ser utilizado para a administra\u00e7\u00e3o da nutri\u00e7\u00e3o parenteral<\/a> depende de fatores associados ao quadro de cada paciente. Assim, \u00e9 preciso levar em conta o local em que ser\u00e1 realizada a terapia (se em casa ou no hospital), o tempo de perman\u00eancia, a previs\u00e3o de uso da nutri\u00e7\u00e3o parenteral e o tipo de f\u00f3rmula empregada, al\u00e9m da experi\u00eancia do profissional respons\u00e1vel pela coloca\u00e7\u00e3o do cateter2<\/sup>.<\/strong><\/p>\n

Dessa forma, a nutri\u00e7\u00e3o parenteral em pacientes hospitalizados pode ser infundida por meio de cateter venoso central n\u00e3o tunelizado, com um, dois ou mais l\u00famens ou ainda um cateter PICC (cateter venoso central de inser\u00e7\u00e3o perif\u00e9rica)2<\/sup>.<\/p>\n

Nos casos em que o tempo de infus\u00e3o for curto e a osmolaridade da f\u00f3rmula for menor que 900 mOsm\/L, os cateteres venosos perif\u00e9ricos podem ser usados3,4<\/sup>. De qualquer maneira, as evid\u00eancias dispon\u00edveis apontam que n\u00e3o h\u00e1 maior risco de infec\u00e7\u00e3o ou tromboflebite \u00e0 medida que o tempo do cateterismo aumenta5<\/sup>.<\/p>\n

A troca do cateter n\u00e3o deve ocorrer em per\u00edodos inferiores a 96 horas.<\/strong> Por outro lado, se houver sinais de inflama\u00e7\u00e3o no local da inser\u00e7\u00e3o, o cateter deve ser removido logo que os primeiros indicativos do problema forem percebidos6-9<\/sup>.<\/p>\n

Em ambiente domiciliar, embora haja dificuldade de constru\u00e7\u00e3o de consenso com base em evid\u00eancias de qualidade10<\/sup>, o uso do PICC costuma ser o recomendado<\/strong>2<\/sup>. Tal indica\u00e7\u00e3o se d\u00e1 sobretudo quando a recomenda\u00e7\u00e3o for para per\u00edodos menores de at\u00e9 3 ou 4 meses2<\/sup><\/strong>. Caso o tempo exceda isso, os cateteres tunelizados e os totalmente implantados s\u00e3o a principal indica\u00e7\u00e3o2<\/sup>. Gra\u00e7as a determinadas caracter\u00edsticas, cateteres tunelizados tipo Broviac ou Hickman oferecem menor risco de infec\u00e7\u00e3o2<\/sup>.<\/p>\n

\u00a0<\/em><\/strong><\/p>\n

Veja tamb\u00e9m: <\/em><\/strong>O que voc\u00ea precisa saber sobre as indica\u00e7\u00f5es da nutri\u00e7\u00e3o parenteral?<\/em><\/strong><\/a><\/p>\n

\u00a0<\/em><\/strong><\/p>\n

Cuidados de assepsia para evitar a infec\u00e7\u00e3o associada ao cateter na nutri\u00e7\u00e3o parenteral<\/h2>\n

A orienta\u00e7\u00e3o da Ag\u00eancia Nacional de Vigil\u00e2ncia Sanit\u00e1ria (ANVISA) para reduzir o risco de infec\u00e7\u00e3o associada ao cateter \u00e9 o emprego para limpeza da pele com solu\u00e7\u00e3o alco\u00f3lica com gluconato de clorexidina, sempre com concentra\u00e7\u00e3o a 0,5%2<\/sup>.<\/strong><\/p>\n

A European Society for Clinical Nutrition and Metabolism (ESPEN)<\/em><\/a>, por sua vez, recomenda que a solu\u00e7\u00e3o de clorexidina tenha concentra\u00e7\u00e3o de, ao menos, 2%. Al\u00e9m disso, a entidade indica a necessidade de desinfec\u00e7\u00e3o dos adaptadores, drenos e conectores 3<\/sup><\/strong>No mais, os conjuntos de administra\u00e7\u00e3o devem ser trocados periodicamente.<\/p>\n

A desinfec\u00e7\u00e3o das conex\u00f5es, dos conectores valvulados e ports de adi\u00e7\u00e3o de medicamentos deve ser feita com solu\u00e7\u00e3o antiss\u00e9ptica \u00e0 base de \u00e1lcool. Para garantir a efic\u00e1cia do procedimento, ele deve ser feito com movimentos capazes de gerar fric\u00e7\u00e3o mec\u00e2nica, por intervalos de entre 5 e 15 segundos 3,11<\/sup>.<\/strong><\/p>\n

As evid\u00eancias a respeito do tempo de desinfec\u00e7\u00e3o t\u00eam n\u00edvel moderado de certeza. Assim, cada estabelecimento de sa\u00fade deve acompanhar a presen\u00e7a de quadros de infec\u00e7\u00e3o para avaliar o desempenho do procedimento11<\/sup>. A falta do movimento de fric\u00e7\u00e3o no momento da desinfec\u00e7\u00e3o e as diferen\u00e7as entre os modelos de conectores podem reduzir a efic\u00e1cia.<\/strong><\/p>\n

Ademais, \u00e9 importante fazer a desinfec\u00e7\u00e3o dos conectores antes de cada acesso ou manipula\u00e7\u00e3o. Entretanto, eles devem ser trocados em caso de desconex\u00e3o do cateter, presen\u00e7a de sangue ou outro sinal de sujeira11<\/sup>.<\/p>\n

\"\"<\/p>\n

 <\/p>\n

Recomenda\u00e7\u00f5es de manuten\u00e7\u00e3o de curativos e cateteres<\/h2>\n

Curativos transparentes, gazes ou fitas adesivas esterilizadas s\u00e3o os componentes mais utilizados para a elabora\u00e7\u00e3o dos curativos2<\/sup>. Para reduzir o risco de problemas, as gazes devem ser trocadas a cada 48 horas e os curativos transparentes a cada 7 dias2<\/sup>.<\/strong> Todavia, a troca deve ser feita de forma imediata sempre que for percebido que h\u00e1 umidade, sujeira ou problemas de fixa\u00e7\u00e3o do material1<\/sup>.<\/p>\n

Durante a troca do curativo, o local pode ser limpo com solu\u00e7\u00e3o fisiol\u00f3gica (NaCl a 0,9%).<\/strong> Nesse momento, o respons\u00e1vel pode avaliar as condi\u00e7\u00f5es da pele e do cateter e aplicar uma solu\u00e7\u00e3o antiss\u00e9ptica se n\u00e3o forem notadas anormalidades1<\/sup>.<\/p>\n

Pacientes com cateteres de longa perman\u00eancia podem se beneficiar com a aplica\u00e7\u00e3o de pequenas doses de anticoagulantes, principalmente para prevenir tromboembolismo venoso em pacientes pedi\u00e1tricos1,12<\/sup>. Por fim, algumas evid\u00eancias corroboram a relev\u00e2ncia da aplica\u00e7\u00e3o de antimicrobianos em cateteres venosos de curta dura\u00e7\u00e3o, reduzindo as complica\u00e7\u00f5es infecciosas3<\/sup>. <\/strong><\/p>\n

 <\/p>\n

Para ampliar a seguran\u00e7a, veja alguns cuidados para manuseio e administra\u00e7\u00e3o da nutri\u00e7\u00e3o parenteral.<\/a><\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

 <\/p>\n

Refer\u00eancias:<\/p>\n

    \n
  1. Ciosak, S. I., Matsuba, C. S. T., Silva, M. L. T., Serpa, L. F., & Poltronieri, M. J. (2011). Acessos para terapia de nutri\u00e7\u00e3o parenteral e enteral. Projeto Diretrizes<\/em>, 9<\/em>. Dispon\u00edvel em: https:\/\/amb.org.br\/files\/_BibliotecaAntiga\/acessos_para_terapia_de_nutricao_parenteral_e_enteral.pdf<\/a> Acesso em 06 abr 2023.<\/li>\n
  2. Gon\u00e7alves, R. C., de Matos, L. B. N., Cunha, H. F. R., Totti, F., Kawagoe, J. Y., Martin, L. G. R., … & Correia15, M. I. T. D. Manual BRASPEN de Compet\u00eancias Relacionadas \u00e0 Dispensa\u00e7\u00e3o e \u00e0 Administra\u00e7\u00e3o de Nutri\u00e7\u00e3o Parenteral. Braspen J<\/em>, 3<\/em>, 217-232. Dispon\u00edvel em: http:\/\/arquivos.braspen.org\/journal\/jul-ago-set-2019\/artigos\/1-SeparataManualGrafica.pdf<\/a> Acesso em 06 abr 2023<\/li>\n
  3. Pittiruti M, Hamilton H, Biffi R, MacFie J, Pertkiewicz M; ESPEN. ESPEN Guidelines on Parenteral Nutrition: central venous catheters (access, care, diagnosis and therapy of complications). Clin Nutr. 2009;28(4):365-77. Dispon\u00edvel em: https:\/\/www.clinicalnutritionjournal.com\/article\/S0261-5614(09)00078-8\/fulltext<\/a> Acesso em 06 abr 2023<\/li>\n
  4. Starker P, Wretlind A, Kinney JM. Parenteral nutrition. CRC Handbook of Nutritional Supplements: Volume I: Human Use. 2018;47:317-30.<\/li>\n
  5. Cicolini G, Bonghi AP, Di Labio L, Di Mascio R. Position of peripheral venous cannulae and the incidence of thrombophlebitis: an observational study. J Adv Nurs. 2009;65(6). Dispon\u00edvel em: https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/j.1365-2648.2009.04980.x<\/a> Acesso em 9 de mar\u00e7o de 2023<\/li>\n
  6. Guenter P, Worthington P, Ayers P, Boullata JI, Gura KM, Marshall N, et al.; Parenteral Nutrition Safety Committee, American Society for Parenteral and Enteral Nutrition. Standardized competencies for parenteral nutrition administration: the ASPEN Model. Nutr Clin Pract. 2018;33(2):295-304 Dispon\u00edvel em: https:\/\/aspenjournals.onlinelibrary.wiley.com\/doi\/10.1002\/ncp.10055<\/a>\u00a0 Acesso em 06 abr 2023<\/li>\n
  7. Turpin RS, Canada T, Rosenthal V, Nitzki-George D, Liu FX, Mercaldi CJ, et al.; IMPROVE Study Group. Bloodstream infections associated with parenteral nutrition preparation methods in the United States: a retrospective, large database analysis. JPEN J Parenter Enteral Nutr. 2012;36(2):169-76. Dispon\u00edvel em: https:\/\/aspenjournals.onlinelibrary.wiley.com\/doi\/abs\/10.1177\/0148607111414714<\/a> Acesso em 9 de mar\u00e7o de 2023<\/li>\n
  8. Timsit JF, Mimoz O, Mourvillier B, Souweine B, GarrousteOrgeas M, Alfandari S, et al. Randomized controlled trial of chlorhexidine dressing and highly adhesive dressing for preventing catheter-related infections in critically ill adults. Am J Respir Crit Care Med. 2012;186(12):1272-8. Dispon\u00edvel em: https:\/\/www.atsjournals.org\/doi\/10.1164\/rccm.201206-1038OC?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed<\/a> Acesso em 9 de mar\u00e7o de 2023<\/li>\n
  9. Simmons S, Bryson C, Porter S. “Scrub the hub”: cleaning duration and reduction in bacterial load on central venous catheters. Crit Care Nurs Q. 2011;34(1):31-5. Dispon\u00edvel em: https:\/\/journals.lww.com\/ccnq\/Abstract\/2011\/01000\/_Scrub_the_Hub___Cleaning_Duration_and_Reduction.6.aspx<\/a>\u00a0 Acesso em 9 de mar\u00e7o de 2023<\/li>\n
  10. Kovacevich DS, Corrigan M, Ross VM, McKeever L, Hall AM, Braunschweig C. American Society for Parenteral and Enteral Nutrition Guidelines for the selection and care of central venous access devices for adult home parenteral nutrition administration. J Parenter Enter Nutr. 2019;43(1):15-31 Dispon\u00edvel em: https:\/\/aspenjournals.onlinelibrary.wiley.com\/doi\/10.1002\/jpen.1455<\/a> Acesso 06 abr 2023<\/li>\n
  11. Brasil. Ag\u00eancia Nacional de Vigil\u00e2ncia Sanit\u00e1ria (ANVISA). Medidas de preven\u00e7\u00e3o de infec\u00e7\u00e3o relacionada \u00e0 assist\u00eancia \u00e0 sa\u00fade. Bras\u00edlia: Anvisa; 2017. Dispon\u00edvel em: https:\/\/www.gov.br\/anvisa\/pt-br\/centraisdeconteudo\/publicacoes\/servicosdesaude\/publicacoes\/caderno-4-medidas-de-prevencao-de-infeccao-relacionada-a-assistencia-a-saude.pdf\/view Acesso em 06 abr 2023<\/li>\n
  12. Shah PS, Kalyn A, Satodia P, Dunn MS, Parvez B, Daneman A, et al. A randomized, controlled trial of heparin versus placebo infusion to prolong the usability of peripherally placed percutaneous central venous catheters (PCVCs) in neonates: the HIP (Heparin Infusion for PCVC) study. Pediatrics 2007;119:e284-91. Dispon\u00edvel em: https:\/\/publications.aap.org\/pediatrics\/article-abstract\/119\/1\/e284\/70659\/A-Randomized-Controlled-Trial-of-Heparin-Versus?redirectedFrom=fulltext<\/a> Acesso em 9 de mar\u00e7o de 2023<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    Durante a administra\u00e7\u00e3o de terapia nutricional por via parenteral, quadros de sepse s\u00e3o uma das principais complica\u00e7\u00f5es. Esse problema est\u00e1 relacionado \u00e0 eleva\u00e7\u00e3o da morbimortalidade e aumento dos custos m\u00e9dico-hospitalares1. Por isso, saber como evitar infec\u00e7\u00e3o associada ao cateter na nutri\u00e7\u00e3o parenteral \u00e9 indispens\u00e1vel para preservar a condi\u00e7\u00e3o cl\u00ednica do paciente submetido a essa interven\u00e7\u00e3o. […]<\/p>\n","protected":false},"author":5902,"featured_media":1934,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[49],"tags":[201,120,239,67,232],"class_list":["post-1932","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-artigo-5","tag-acesso-venoso","tag-cateter","tag-infeccao","tag-nutricao-parenteral","tag-sepse"],"acf":[],"yoast_head":"\nVeja como prevenir a infec\u00e7\u00e3o associada ao cateter na nutri\u00e7\u00e3o parenteral<\/title>\n<meta name=\"description\" content=\"Sem o devido cuidado, o risco de infec\u00e7\u00e3o associada ao cateter na nutri\u00e7\u00e3o parenteral \u00e9 alto. 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A nutricional via parenteral<\/a> \u00e9 um processo complexo, sujeito a uma s\u00e9rie de problemas que podem comprometer a seguran\u00e7a do procedimento. Dessa forma, refor\u00e7ar protocolos para reduzir o risco de infec\u00e7\u00e3o associada ao cateter na nutri\u00e7\u00e3o parenteral \u00e9 fundamental, seja no ambiente hospitalar, seja no ambiente domiciliar.<\/p>\n