Respiratory Unit, University Hospital of the Federal University of Juiz de Fora.
Department of Surgery, Doutor João Penido Regional Hospital.
JBI Evid Implement. 2020 Dec 5;19(3):296-305. doi: 10.1097/XEB.0000000000000261.
The central venous catheter (CVC) is an indispensable device in the daily practice of modern medicine. Thus, the implementation of CVC interferes with the care of a large number of patients. This project aimed to implement the best practices in the insertion of CVC in adult hospitals in Brazil.
The project had three phases, including forming a team and conducting the baseline audit; identifying problems and developing strategies; and conducting a follow-up audit to assess the impact on compliance with best practices. A baseline audit was conducted at a public Hospital in Minas Gerais, Brazil, in June and July 2019. For data collection, direct observation of the procedure was performed and through the PACES (Practical Application of Clinical Evidence System) audit and feedback tool to check the compliance criteria established in the literature. After implementation, a second audit was conducted in August 2019.
During the baseline audit, the absence of adequate compliance with the criteria for using an ultrasound to insert the catheter and correct hand hygiene before the procedure was identified. Theoretical-practical training was carried out, including the use of ultrasound to perform the procedure, using an adapted mannequin. The follow-up audit showed an improvement in the compliance rate for the following audit criteria: physical assessment before the procedure (92-100%); evaluation of the most suitable vein for insertion of the catheter, avoiding the femoral vein (92-100%); correct hand hygiene before the procedure (58-100%); maintenance of asepsis throughout the procedure (83-91%) and use of ultrasound to guide venous catheterization (17-100%).
The current project proved that training the team can be effective in optimizing the implementation of evidence.
中心静脉导管（CVC）是现代医学日常实践中不可或缺的装置。因此，CVC 的实施会干扰大量患者的护理。本项目旨在在巴西的成人医院实施 CVC 插入的最佳实践。
该项目分为三个阶段，包括组建团队并进行基线审核；确定问题并制定策略；以及进行后续审核以评估对遵守最佳实践的影响。2019 年 6 月至 7 月，在巴西米纳斯吉拉斯州的一家公立医院进行了基线审核。为了收集数据，对该程序进行了直接观察，并通过 PACES（临床实践证据系统的实际应用）审核和反馈工具检查文献中规定的合规标准。实施后，于 2019 年 8 月进行了第二次审核。
在基线审核期间，发现导管插入时未充分遵循使用超声和术前正确洗手的标准。进行了理论实践培训，包括使用超声进行该程序，以及使用改良的模型。后续审核显示，以下审核标准的合规率有所提高：术前物理评估（92-100%）；评估最适合插入导管的静脉，避免股静脉（92-100%）；术前正确洗手（58-100%）；整个程序中保持无菌（83-91%）以及使用超声引导静脉置管（17-100%）。
当前项目证明，培训团队可以有效地优化证据的实施。
