Internal Medicine Service, Hospital de Clinicas de Porto Alegre (HCPA), Rua Ramiro Barcelos 2350, Sala 700, Porto Alegre, Rio Grande do Sul, CEP 90035-903, Brazil.
Intensive Care Service, HCPA, Porto Alegre, RS, Brazil.
Sci Rep. 2020 Oct 16;10(1):17530. doi: 10.1038/s41598-020-74395-0.
Central venous catheters (CVCs) are frequently used, but the rate of complications is high. This study evaluates the effects of a short training program for CVC insertion in a university-based teaching hospital. A sample of adults with CVCs inserted outside the intensive care unit was selected from two academic years: 2015, year without structured training, and 2016, year with structured training. Clinical and laboratory information, as well as the procedure's characteristics and complications (mechanical and infectious) were collected. The incidence of complications before and after the training was compared. A total of 1502 punctures were evaluated. Comparing the pre- and post-training period, there was an increase in the choice for jugular veins and the use of ultrasound. A numerical reduction in the rate of complications was identified (RR 0.732; 95% CI 0.48-1.12; P = 0.166). This difference was driven by a statistically significant lower rate of catheter-related infections (RR 0.78; 95% CI 0.64-0.95; P = 0.047). In the multivariate analysis, aspects regarding technique (ultrasound use, multiple punctures) and year of training were associated with outcomes. Structured training reduces the rate of complications related to CVC insertion, especially regarding infections.
中心静脉导管（CVC）经常被使用，但并发症发生率较高。本研究评估了在一所大学教学医院进行 CVC 置管短期培训计划的效果。从两个学年（2015 年无结构化培训年和 2016 年有结构化培训年）中选择了在重症监护室外接受 CVC 置管的成年患者样本。收集了临床和实验室信息，以及程序的特征和并发症（机械性和感染性）。比较了培训前后并发症的发生率。共评估了 1502 次穿刺。与培训前相比，培训后选择颈静脉和使用超声的比例增加。发现并发症发生率呈数值下降（RR 0.732；95%CI 0.48-1.12；P=0.166）。这一差异是由导管相关感染率显著降低（RR 0.78；95%CI 0.64-0.95；P=0.047）驱动的。在多变量分析中，与技术相关的方面（超声使用、多次穿刺）和培训年份与结果相关。结构化培训可降低 CVC 置管相关并发症的发生率，特别是感染。
