EDUCATIONAL GUIDE FOR CARING FOR CRITICALLY ILL ADULTS WITH A PERIPHERALLY INSERTED CENTRAL CATHETERABSTRACT
Objective: To develop and validate an educational guide for the nursing care of critically ill adult patients using a Peripherally Inserted Central Catheter
Method: This is a descriptive methodological study aimed at developing an educational guide based on collected variables, evidence described in the literature, and validation by evaluators. These professionals were recruited through non-probabilistic sampling. The stages of the material development process followed Echer's framework. During the validation, the experts responded to a concordance scale developed by the researchers, based on the Suitability Assessment of Materials (SAM) framework. After organizing the data, a thorough analysis of the experts’ suggestions was conducted, and the Content Validation Index was calculated to measure the experts' agreement on the representativeness of each item. A minimum Content Validation Index of 0.80 per item was considered acceptable. This study was conducted at a Federal Public University located in the São Paulo hinterland, Brazil, with data collection taking place from May 2022 to January 2023.
Results: The educational guide developed and validated by specialists consists of 36 pages, with 12 items achieving the maximum adequacy in the Content Validation Index, and only 1 item reaching a value of 0.85 according to the experts’ evaluation.
Conclusion: This study allowed for the development and validation of a free, easily understandable digital educational guide containing evidence-based information for nursing care of critically ill adult patients using a Peripherally Inserted Central Catheter.
DESCRIPTORS:
Nursing; Nursing care; Adult health; Central venous catheterization; Clinical practice guideline; Evidence-based nursing
RESUMO
Objetivo: construir e validar um guia educativo para os cuidados de enfermagem com pacientes adultos críticos em uso do Cateter Central de Inserção Periférica.
Método: estudo metodológico de caráter descritivo, para construção de guia educativo a partir das variáveis coletadas, evidências descritas na literatura e validação através de juízes. O recrutamento desses profissionais se deu por amostragem não-probabilística. As etapas do processo de construção do material seguiram o referencial de Echer. Na validação, os experts responderam a uma escala de concordância desenvolvida pelos pesquisadores, embasada no referencial Suitability Assessment of Materials. Após a organização dos dados, foi realizada análise criteriosa das sugestões dos experts e o cálculo do Índice de Validação de Conteúdo para aferir a concordância dos juízes quanto à representatividade de cada item. Foi considerado aceitável o Índice de Validação de Conteúdo mínimo de 0,80 para cada item. Esse estudo foi realizado em uma Universidade Pública Federal localizada no interior de São Paulo, Brasil, com coleta de dados de maio de 2022 a janeiro de 2023.
Resultados: o guia educativo construído e validado por especialistas constitui-se de 36 páginas, sendo que 12 itens atingiram o máximo de adequação no Índice de Validação de Conteúdo e somente 1 item atingiu o valor de 0,85 segundo avaliação dos experts.
Conclusão: este estudo permitiu a construção e validação de um guia educativo digital, gratuito, de fácil compreensão e contendo informações baseadas em evidências científicas, para os cuidados de enfermagem com o Cateter Central de Inserção Periférica no paciente adulto crítico.
DESCRITORES:
Enfermagem; Cuidados de enfermagem; Saúde do adulto; Cateterismo venoso central; Guia de prática clínica; Enfermagem baseada em evidências
RESUMEN
Objetivo: construir y validar una guía educativa para el cuidado de enfermería de pacientes adultos críticos con catéter central de inserción periférica.
Método: estudio metodológico de carácter descriptivo, para construir una guía educativa a partir de las variables recolectadas, evidencia descripta en la literatura y validación a través de jueces. El reclutamiento de los profesionales se realizó por muestreo no probabilístico. Las etapas del proceso de construcción del material siguieron el marco de Echer. En la validación, los expertos respondieron a una escala de concordancia desarrollada por los investigadores, basada en el marco del Suitability Assessment of Materials. Después de la organización de datos, se llevó a cabo un análisis cuidadoso de las sugerencias de los expertos y se calculó el Índice de Validación de Contenido para evaluar el acuerdo de los jueces sobre la representatividad de cada ítem. Se consideró aceptable un Índice de Validación de Contenido mínimo de 0,80 para cada ítem. Este estudio se realizó en una Universidad Pública Federal ubicada en el interior de São Paulo, Brasil, con recolección de datos de mayo de 2022 a enero de 2023.
Resultados: La guía educativa construida y validada por expertos consta de 36 páginas, donde 12 ítems alcanzan la máxima adecuación en el Índice de Validación de Contenido y sólo 1 ítem alcanza el valor de 0,85 según la valoración de los expertos.
Conclusión: este estudio permitió la construcción y validación de una guía educativa digital, gratuita y de fácil comprensión, que contiene información basada en evidencia científica, para el cuidado de enfermería con el Catéter Central de Inserción Periférica en pacientes adultos críticos.
DESCRIPTORES:
Enfermería; Cuidados de enfermería; Salud del adulto; Catéter venoso central; Guía de práctica clínica; Enfermería basada en la evidencia
INTRODUCTION
Educational technologies offer numerous potential benefits, such as contributing to the acquisition of knowledge and skills essential to care. Among these, educational materials are defined as a hybrid technology capable of supporting clinical decision-making and guiding practices through the structuring of knowledge, norms, and protocols1.
Nurses working in critical care units require qualifications to adapt to the evolving specialized equipment and devices in order to reduce uncertainty and enhance performance and quality of care. However, due to new technologies and the complexity of patients' clinical conditions, these sectors face even more obstacles in implementing educational practices2.
The Peripherally Inserted Central Catheter (PICC) is a catheter inserted through peripheral veins, allowing direct access to larger veins near the cardiac area, thereby minimizing direct contact between medication and the vascular network3. This reduces the potential for irritation of blood vessels and the risk of bodily harm associated with repeated vein punctures, in addition to presenting relative ease of insertion and greater patient tolerance compared to other central catheters, significantly increasing clinical efficiency4-5.
In addition to providing durable vascular access, the PICC is associated with a low risk of bloodstream infections, which can contribute to its prolonged use6.
In hospital settings, it is commonly used in adult patients, mainly in the treatment of critically ill patients, allowing the administration of various medications such as antibiotics, chemotherapeutic agents, and parenteral nutrition4-7. Moreover, even professionals from institutions that do not perform PICC placements-such as primary health care providers-need to be familiar with the specifics of maintenance care. This is because many patients are now at home with a PICC for treatment, especially those receiving long-term therapies6.
Although it has been implemented in health institutions in Brazil for over 25 years, there is still a lack of knowledge among professionals about the advantages of its use7. Evidence indicates low competencies in knowledge and practical skills regarding the insertion and care of patients with PICC. This is an important limiting factor for the use of this technology, despite its benefits for the quality of care of patients requiring intravenous therapy8.
Given that organizational processes and human resources are susceptible to failures, it is necessary to implement interventions that promote favorable outcomes with a focus on patient safety. In light of the above, it is imperative that health institutions at the primary, secondary, and tertiary levels promote accessible educational strategies, fostering patient safety and quality of care due to the specificities of the PICC9. Thus, developing an educational guide based on the best available evidence, written in simplified language and accessible to health care professionals, can serve as a tool to guide safe and high-quality care in the maintenance of the PICC.
Accordingly, the present study aims to develop and validate an educational guide for nursing care of critically ill adult patients using a Peripherally Inserted Central Catheter.
METHOD
This is a descriptive methodological study focused on the construction and validation of an educational guide based on the best evidence regarding the use, maintenance, and management of complications related to the Peripherally Inserted Central Catheter (PICC) in critically ill adult patients. The principles of the 'Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0)' guide, available on the Equator Network website, were used to guide the writing of the article10.
To initiate the study, a Survey11was conducted to identify the main weaknesses in nurses' knowledge about the device. A self-administered questionnaire titled 'Knowledge Test on Indication, Insertion, Maintenance, and Management of PICC Complications12-14 was developed by the researchers, containing 11 statements in which professionals were to identify whether they were true or false. The questionnaire was sent via Google Forms®, along with the Informed Consent Form (ICF) and a biographical and professional characterization questionnaire. This questionnaire included the following information: initials of the name, date of birth, gender, academic degree, postgraduate studies, length of professional experience, current professional area of practice, care experience with PICC, experience in the development and evaluation of educational materials aimed at nurses, and publication of scientific research on the validation of educational materials and/or peripherally inserted central catheters in adult patients. Thus, this participatory approach allowed for the identification of the target audience's needs, enabling the adjustment of the educational material's content to meet the professionals' demands and expectations. The stages of the material construction process followed a framework15 that addresses didactic materials for health care.
The selection of participants considered the following inclusion criteria: being a nurse with current or previous professional experience in intensive care units, and current or previous experience in direct care of adult patients using a PICC. The recruitment of these professionals was carried out through non-probabilistic snowball sampling, in which a faculty member of the department at the Federal Public University where the study took place was selected to be the key informant and initial trigger of the invitation to participate16.
In this way, the construction of the educational guide was developed through three stages. The first stage consisted of a literature review aimed at identifying national and international recommendations on maintenance care and management of PICC complications in adult patients, as well as the process of production and validation of educational materials. The second stage involved the textual development (scripts) of the educational guide, creation of photographs in a simulated clinical setting, and layout of the content.
The third and final stage consisted of the validation of the material by specialists. An adapted framework17 was used for the characterization of the experts. Thus, the professional, besides being a nurse, should be involved in clinical care with at least one year of experience and possess at least one of the following: specialization in the study's area of interest, a master's degree with a dissertation in the study's area of interest, a doctoral thesis in the study area, publication of relevant research in the area of interest, or publication of an article on the topic in a reference journal.
The specialists were also recruited through non-probabilistic sampling using the snowball technique16,18. Invitations were sent by email, explaining the research objective to each participant.
During the validation process, the experts were presented with the educational guide and the agreement scale19 developed by the researchers, containing information about the appearance and content of the material. Aspects related to the organization, writing style, appearance, and motivation of the material were analyzed. In this validation phase, the Delphi Technique was used, aiming to obtain the maximum agreement among a group of specialists on a particular topic20. For each of the descriptive contributions suggested by the experts, new searches for scientific evidence were conducted, and if consistent with the literature, the suggestions were accepted.
After organizing the data, the Content Validity Index (CVI) was calculated to assess the evaluators' agreement regarding the representativeness of each item. For the calculation of the CVI, 'agreement' was considered when there was no alteration or suggestion, and 'disagreement' for any alteration or suggestion made by the experts For this study, a minimum acceptable CVI of 0.80 for each item was considered21.
Despite the lack of consensus in the literature on the ideal number of experts for validating educational material, a guideline22 recommending 6 to 20 expert evaluators was adopted. Finally, the constructed and validated educational guide was sent to all nurses participating in the study.
This study was conducted at a Federal Public University located in the São Paulo hinterland, with online data collection and no geographical restrictions. All the described stages occurred between May 2022 and January 2023, after ethical authorization.
RESULTS
The main objective in developing this educational guide was to provide nurses with easy access to relevant information based on scientific evidence, necessary for the daily maintenance and management of PICC complications in critically ill adult patients. Therefore, in general, the information was synthesized using easily understandable language and illustrated with photos in a simulated setting to detail the described care procedures
Thus, all procedures presented in the Educational Guide are accompanied by photographs that detail the sequence of actions for the proper execution of the technique. This approach was chosen to bring the reader closer to the content through clinical simulation and the use of visual language. Furthermore, according to authors17, the presence of images enhances active reading engagement, clearly emphasizing the objective
For the creation of the photographs, a simulated hospital room was used, along with a medium-fidelity simulator, a PICC, and moulage. Additionally, other essential supplies were included to represent the procedures, such as medication ampoules, gauze, microporous tape, and sterile transparent dressings for central venous catheters The photo session was conducted in a single day, lasting five hours. A pre-established script outlining the necessary sequence to illustrate the procedures was used. It also detailed environmental preparations and the step-by-step clinical interventions to be photographed.
The photographs are placed close to the text they represent to facilitate understanding. Therefore, in the images, only the main subject is focused and prioritized, avoiding walls, windows, and other backgrounds that might cause distraction
The educational guide presents text with descriptive language and active voice. Regarding the design, the cover consists of an image of a hand inserting the device, manipulating the guidewire with sterile technique. It was decided to highlight the PICC from the first page, intending to draw attention to this instrument. According to authors17, font sizes need to be larger than 12 or 14 points to ensure legibility. It is also recommended that titles be ‘'2 points' larger than the text size17, a criterion adopted in preparing this educational material.
Montserrat was chosen as the font due to its simplicity and legibility. The titles use the Bebas Neue font and, to highlight them, are positioned at the top of the pages in bold, with a font size larger than the body text. The pilot version of the educational guide totaled 34 pages, sequentially numbered in the upper right margin, text arranged horizontally, justified or centered, A4 size (21 cm × 29.7 cm) in portrait orientation.
After completing photo editing and textual revisions, graphic elements were added to the material to make it more informal and appealing to the audience, thus illustrating what was represented on each page. An effort was made to maintain the predefined color scheme and avoid visually cluttering the material by distributing the content across the pages. In this way, the material presents logical and uniform layout and design, with standardized illustrations.
To organize the educational material didactically, 12 items were separated: 1. Description of the device; 2. Indications of the PICC catheter and selection criteria; 3. Nursing care for patients using PICC; 4. Dressing; 5. Saline and Heparin Flushing of the Catheter; 6. Adverse events in patients with PICC: 6.1 Infection; 6.2 Catheter obstruction (thrombotic or mechanical); 6.3 Extravasation and infiltration; 6.4 Phlebitis (mechanical, chemical, or infectious); General Notes and References To this end, the performance of professionals who responded to the authors' questionnaire titled 'Knowledge Test on Indication, Insertion, Maintenance, and Management of PICC Complications' was considered.
The educational guide presents this content sequence intending first to familiarize the reader with the device through its description and a listing of its main characteristics. Next, it presents nursing care practices and the importance of adequate assistance to raise awareness about evidence-based practice Finally, the material presents the management of possible complications with the PICC. Figure 1 provides illustrative pages from the educational guide.
The pilot version of the material was sent to 70 experts. Of these, only 11 responded to the biographical and professional characterization questionnaire, signed the Informed Consent Form (ICF), and completed the content evaluation instrument17.
Table 1 presents the biographical characterization of the experts, including gender, age range, professional qualifications, length of professional experience, length of experience in intensive care, and experience with the PICC.
Of the 13 items indicated for the first evaluation, 4 fully met the objective, reaching consensus as adequate by 100% of the experts. "Additionally, 5 items achieved an adequacy of 90.9%, and 3 items achieved 81.8% adequacy. Finally, only the item 'The information presented in the educational guide is correct' fell below the CVI threshold for material validation during the first analysis, achieving 63.6% adequacy according to the reviewers.
During the second submission, with the modified material and the highlighted changes, 12 items achieved the maximum CVI of 1.0 for adequacy, and only the item 'Length of sentences' reached a CVI of 0.85 according to the experts' evaluation. Thus, the final version of the material consists of 36 pages, with all parameters reaching the stipulated numbers for validation, as shown in Table 2.
Moreover, 19 comments were made by the reviewers in the open-ended question 'additional suggestions,' but only 2 suggestions were not accepted due to a lack of scientific evidence supporting the proposals. The results of the present study are available free of charge and digitally, as presented in Figure 2.
QR code for access to the educational guide validated by experts. São Carlos, SP, Brazil, 2023.
DISCUSSION
By comparing the CVI of the pilot version of the educational guide with the second version-which took into account the adjustments pointed out by the reviewers during the first Delphi round-it is observed that the evaluators significantly contributed to the improvement of the information contained in the material. Clinical experience was a factor that underscored the relevance of the suggestions, given that some content weaknesses may go unnoticed when only the theoretical basis is considered without taking practical applicability into account-points that were highlighted by the nurses.
Among the suggestions not accepted in the educational guide was the addition of the locking technique for preventing catheter-related infections, especially in adults. This technique is aimed at preventing biofilm formation in long-term catheters by applying concentrated substances, such as heparin and antimicrobials, to create a lumen lock12,23. According to evidence12, this measure is indicated for specific groups of patients undergoing hemodialysis, receiving chemotherapy, or using parenteral nutrition. The risk of antimicrobial resistance and solution incompatibility with the device material were identified as barriers to generalizing the use of this lumen lock technique. Studies report that there is still insufficient evidence on the efficacy of locking, which remains under investigation12,23-24. Similarly, another reviewer mentioned the specificity of the Groshong catheter, which is valved and made of silicone; however, no studies were found to support infusing large volumes under pressure, as claimed by the reviewer.
On the other hand, a page about the existence of vascular access therapy teams in hospitals was added in Chapter 3, 'Nursing Care for the Patient Using PICC,' pointing out the advantages and functions of the team, as requested. It has been proven that the existence of vascular access and intravenous therapy teams enhances care through protocols, bundles, and monitoring of indicators. In the case of the PICC, the advantages of this specialized team are based on the early insertion of the device, which reduces phlebitis and infection rates, decreases the number of venipunctures, and improves the feasibility of PICC placement. This fact increases client satisfaction and reduces team stress25.
Some suggestions were made regarding the figures in the guide. These included adding a caption to a photograph that was only illustrative and photographing the insertion kit with the introducer separated from the PICC catheter in the chapter 'Device Description.' Both changes were made. The 'bolus' box was updated, specifying the indication for such a procedure because, according to authors26, it is permitted as long as it is not performed under pressure or with large volumes.
An expert claimed that the statement 'do not use low-volume syringes' was difficult to understand, and therefore the phrase was replaced with 'only use syringes of 10, 15, and 20 ml.' According to guidelines12, larger volume syringes generate low pressure in the catheter lumen and can detect any type of resistance. The same occurred for the term "limb perimeter," which was changed to "limb circumference." There was ambiguity regarding the explanatory sentence about the best veins for device insertion in Chapter 1, so the sentence was reformulated.
It was also suggested to replace a QR code with the fully validated instrument concerning the evaluation of candidates for the use of valved PICC27. Initially, the researchers contacted the author of the instrument, who authorized its use. Upon contacting the author again to request the high-definition file, there was no response; therefore, it was decided to keep the QR code that directs to the aforementioned open-access article, adding the DOI number.
Regarding flushing, the recommendation to perform the push-pause technique was added, given that it is more effective in preventing device obstruction-which is one of the most common complications23-as stated by an expert. To avoid obstructions, the recommended flushing frequency was detailed based on evidence, and the risk of drug interactions was similarly emphasized26. In view of this, a prominent box was added emphasizing the importance of flushing the catheter lumen before, between, and after medication administration23.
Initially, the guide presented the original phlebitis scale proposed by the Infusion Nurses Society (INS)28, but as suggested by an expert, it was replaced with a Portuguese version that is closest to the Brazilian reality, since the aforementioned scale has not yet been translated into Portuguese. The included Portuguese phlebitis scale is an already validated translation18. Some formatting adjustments, such as applying italics to foreign words and updating the list of references, were also added to the guide.
The literature presents different recommendations on the use of heparin for intermittently used lines, with some services opting not to use the solution23. "Thus, a reviewer requested that references be added to specify the volume and concentration to be used, and based on information from references, the indication for catheter heparinization was described according to studies28.
Finally, a duplicated figure was corrected, and on the last page, an acknowledgment section was added to all those who helped in the construction of the educational material, through the provision of studies and also to those who participated in the validation process, as recommended by the expert.
In general, the educational guide received praise from the reviewers, who validated the initiative to build material about the PICC and its content, such as: "Congratulations on the guide, it is very objective and clear (LM)." "Congratulations, I found the manual very professional, concise, explanatory, and with relevant information. A great pocket guide (AO)."
The literature shows that educational guides can contribute and serve as an accessible source of references with objectivity and clarity of guidelines²29. Other studies also contributed to the construction and validation of this type of material in different educational and health care contexts; for example, a stud30 describes the process of constructing and validating a School Nursing Guide for promoting the health of young students, with a validation process by evaluators similar to that developed in this study.
The study presented some limitations, such as the number of experts and the scarce literature existing on the subject, specifically in adult patients. The final version of the educational guide was made available online and free of charge to all professionals participating in the present study.
CONCLUSION
This study enabled the construction and validation of an educational guide for nursing care with the Peripherally Inserted Central Catheter in critically ill adult patients. As it is a digital, free, and easy-to-understand material containing information based on scientific evidence, it is expected to be widely disseminated among units that use the PICC. Thus, it is expected that the guide will contribute to evidence-based practice and strengthen knowledge about the use of this device for patients undergoing prolonged intravenous therapy.
REFERENCES
-
1. Cassiano AN, Silva CJDA, Nogueira ILA, Elias TMN, Teixeira E, Menezes RMPD. Validação de tecnologias educacionais: estudo bibliométrico em teses e dissertações de enfermagem. Rev Enferm Cent-Oeste Min [Internet]. 2020 [cited 2023 Nov 6];10:e3900. Available from: https://doi.org/10.19175/recom.v10i0.3900.
» https://doi.org/10.19175/recom.v10i0.3900. -
2. Wojciechowski M, Marcondes L, Terassi M. Gerenciamento da dor: educação da equipe de enfermagem da Unidade de Terapia Intensiva adulta. BrJP [Internet]. 2024 [cited 2024 Aug 6];7:e20240038. Available from: https://doi.org/10.5935/2595-0118.20240038-pt.
» https://doi.org/10.5935/2595-0118.20240038-pt. -
3. Gullo G, Qanadli SD. ECG-based techniques to optimize peripherally inserted central catheters: Rationale for tip positioning and practical use. Front Cardiovasc Med [Internet]. 2022 [cited 2024 Aug 7];9:765935. Available from: https://pubmed.ncbi.nlm.nih.gov/35600463/
» https://pubmed.ncbi.nlm.nih.gov/35600463/ -
4. Li W, Cao J, Du YL, Wen YD, Luo WX, Liu XY. Risk factors and prediction model construction for peripherally inserted central catheter-related infections. Heliyon [Internet]. 2024 [cited 2024 Aug 7];10(8):e29158. Available from: https://pubmed.ncbi.nlm.nih.gov/38644876/
» https://pubmed.ncbi.nlm.nih.gov/38644876/ -
5. Wang P, He L, Yuan Q, Lu J, Ji Q, Peng A, et al. Risk factors for peripherally inserted central catheter-related venous thrombosis in adult patients with cancer. Thromb J [Internet]. 2024 [cited 2024 Aug 7];6(5):19749-55. Available from: https://doi.org/10.1186%2Fs12959-023-00574-4
» https://doi.org/10.1186%2Fs12959-023-00574-4 -
6. Leite AC, Silva LA, Silva MPB, Silva ML, Alves RSS, Gomes BP, et al. Atuação do enfermeiro no manuseio de cateteres venosos centrais de inserção periférica em Unidades de Terapia Intensiva Neonatal. Res Soc Dev [Internet]. 2021 [cited 2023 Nov 10];10(2):e59010212974. Available from: https://doi.org/10.33448/rsd-v10i2.12974
» https://doi.org/10.33448/rsd-v10i2.12974 -
7. Park S, Moon S, Pai H, Kim B. Appropriate duration of peripherally inserted central catheter maintenance to prevent central line-associated bloodstream infection. PLoS One [Internet]. 2020 [cited 2024 Aug 7];15(6):e0234966. Available from: https://doi.org/10.1371/journal.pone.0234966
» https://doi.org/10.1371/journal.pone.0234966 -
8. Porto PS, Gonçalves FAF, Cruz KCT, Santos LF, Bezerra ALQ, Oliveira LMAC. Competência do enfermeiro para utilização de cateter central de inserção periférica em adultos. Cien Cuid Saúde [Internet]. 2020 [cited 2023 Nov 10];19:e45305. Available from: https://doi.org/10.4025/ciencuidsaude.v19i0.45305
» https://doi.org/10.4025/ciencuidsaude.v19i0.45305 -
9. Melo LD, Brandão JL, Rocha IF, Teixeira TAD, Lima SMC. Conhecimentos da Enfermagem sobre Peripherally Inserted Central Catheters: complicações, medidas preventivas e indicações de retirada. Enferm Foco [Internet]. 2023 [cited 2023 Nov 6];14:e-202339. Available from: https://doi.org/10.21675/2357-707X.2023.v14.e-202339
» https://doi.org/10.21675/2357-707X.2023.v14.e-202339 -
10. Ogrinc G, Davies L, Goodman D, Batalden P, Davidoff F, Stevens D. SQUIRE 2.0 (Standards for Quality Improvement Reporting Excellence): Revised publication guidelines from a detailed consensus process. Perm J [Internet]. 2015 [cited 2023 Nov 15];19(4):65-70. Available from: https://doi.org/10.7812/TPP/15-141
» https://doi.org/10.7812/TPP/15-141 - 11. Prodanov CC, Freitas EC. Metodologia do trabalho científico: Métodos e Técnicas da Pesquisa e do Trabalho Acadêmico. 2nd ed. Novo Hamburgo: Feevale; 2013.
-
12. Brasil. Agência Nacional de Vigilância Sanitária. Medidas de prevenção de infecção relacionada à assistência à saúde [Internet]. 2017 [cited 2023 Aug 8]. Available from: https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/publicacoes/caderno-4-medidas-de-prevencao-de-infeccao-relacionada-a-assistencia-a-saude.pdf.
» https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/publicacoes/caderno-4-medidas-de-prevencao-de-infeccao-relacionada-a-assistencia-a-saude.pdf. -
13. Braga LM, Salgueiro-Oliveira AS, Henriques MAP, Rodrigues MA, Rodrigues CJV, Pereira SAG, et al. Tradução e adaptação da Phlebitis Scale para a população portuguesa. Rev Enferm Referência [Internet]. 2016 [cited 2023 Nov 15];IV(11):101-9. Available from: https://doi.org/10.12707/RIV16048
» https://doi.org/10.12707/RIV16048 -
14. Mendes MTM, Jacinto AKL, Kusahara DM, Peterlini MAS, Pedreira MLG, Avelar AFM. Marcadores de hemólise em concentrado de hemácias administrados por cateter central de inserção periférica não valvulado. Acta Paul Enferm [Internet]. 2019 [cited 2023 Nov 10];32(2):139-46. Available from: https://doi.org/10.1590/1982-0194201900020
» https://doi.org/10.1590/1982-0194201900020 -
15. Echer IC. Elaboração de manuais de orientação para o cuidado em saúde. Rev Latino-Am Enfermagem [Internet]. 2005 [cited 2023 Nov 10];13(5):754-7. Available from: https://doi.org/10.1590/S0104-11692005000500022
» https://doi.org/10.1590/S0104-11692005000500022 - 16. Polit DF, Beck CT, Hunger BP. Fundamentos de pesquisa em Enfermagem: métodos, avaliação e utilização. 7th ed. Porto Alegre: Artmed; 2011.
-
17. Fehring RJ. Methods to validate nursing diagnoses. Heart Lung [Internet]. 1987 [cited 2023 Aug 6];16(6):625-9. Available from: https://pubmed.ncbi.nlm.nih.gov/3679856/
» https://pubmed.ncbi.nlm.nih.gov/3679856/ -
18. Oliveira DC. Análise de conteúdo temático-categorial: uma proposta de sistematização. Rev Enferm UERJ [Internet]. 2008 [cited 2023 Nov 10];16(4):569-76. Available from: https://pesquisa.bvsalud.org/portal/resource/pt/lil-512081
» https://pesquisa.bvsalud.org/portal/resource/pt/lil-512081 - 19. Doak CC, Doak LG, Root JH. Teaching patients with low literacy skills. 5th ed. Philadelphia: J. B. Lippincott Company Philadelphia; 1996.
-
20. Scarparo AF, Laus AM, Azevedo ALCS, Freitas MRI, Gabriel CS, Chaves LDP. Reflexões sobre o uso da Técnica Delphi em pesquisas na enfermagem. Rev Rene [Internet]. 2012 [cited 2023 Nov 14];13(1):242-51. Available from: https://www.periodicos.ufc.br/rene/article/view/3803
» https://www.periodicos.ufc.br/rene/article/view/3803 - 21. Polit DF, Beck CT. Fundamentos de pesquisa em enfermagem: avaliação de evidências para a prática da enfermagem. 7th ed. Porto Alegre, RS(BR): Editora Artmed; 2011.
- 22. Pasquali L. Instrumentação Psicológica: Fundamentos e práticas. Porto Alegre, RS(BR): Editora Artmed ; 2010. p. 165-98.
-
23. Giacomozzi LM, Silva RPVC, Danski MTR, Carreiro JE, Silva RF, Giacomozzi CM, et al. Efetividade do ácido ascórbico e solução fisiológica no acesso venoso central pediátrico: ensaio clínico randomizado. Cogitare Enferm [Internet]. 2022 [cited 2024 Aug 6];27:e84707. Available from: https://doi.org/10.5380/ce.v27i0.84707
» https://doi.org/10.5380/ce.v27i0.84707 -
24. Beleza LO, Ribeiro LM, Vasques CI, Margatho A, Brasil G, Costa K. Atualização das recomendações da prática quanto ao cateter central de inserção periférica em recém-nascidos. Rev Enferm UERJ [Internet]. 2021 [cited 2023 Nov 30];29(1):e61291. Available from: https://www.e-publicacoes.uerj.br/enfermagemuerj/article/view/61291
» https://www.e-publicacoes.uerj.br/enfermagemuerj/article/view/61291 -
25. Rodrigues Silva WC, Araujo SN, Costa MC, Vasconcelos AA, Siqueira AL, Bizari MS. Time de acesso vascular e terapia infusional: satisfação da equipe de saúde em hospital pediátrico. Nursing [Internet]. 2021 [cited 2023 Nov 18];24(273):5267-72. Available from: https://doi.org/10.36489/nursing.2021v24i273p5267-5278
» https://doi.org/10.36489/nursing.2021v24i273p5267-5278 -
26. Ribeiro GSR, Campos JF, Parreira PMSD, Silva RC. Protótipo de tecnologia de cuidado para prática do flushing na manutenção de cateteres intravenosos. Texto Contexto Enferm [Internet]. 2023 [cited 2023 Nov 10];32:e20220302. Available from: https://doi.org/10.1590/1980-265X-TCE-2022-0302en
» https://doi.org/10.1590/1980-265X-TCE-2022-0302en -
27. Silva TS, Ribeiro NRR, Hoffmann VRK. Instrumento para avaliação do paciente candidato ao cateter venoso central de inserção periférica valvulado. Cienc Cuid Saúde [Internet]. 2016 [cited 2023 Nov 30];15(2):203-11. Available from: https://pesquisa.bvsalud.org/portal/resource/pt/biblio-974824
» https://pesquisa.bvsalud.org/portal/resource/pt/biblio-974824 - 28. Infusion Nurses Society Brasil. Diretrizes práticas para terapia infusional. 3rd ed. São Paulo; 2018.
-
29. Cardoso ASF, Muller S, Echer IC, Rabelo-Silva ER, Boni FG, Ribeiro AS. Elaboração e validação de checklist para administração de medicamentos para pacientes em protocolos de pesquisa. Rev Gaúcha Enferm [Internet]. 2019 [cited 2024 Aug 6];40(Spec):e20180311. Available from: https://doi.org/10.1590/1983-1447.2019.20180311
» https://doi.org/10.1590/1983-1447.2019.20180311 -
30. Muniz EA, Queiroz MVO, Pinheiro PNC, Silva MRF, Moreira TMM, Oliveira EN, et al. School Nursing Guide for student health promotion: Construction and validity. Rev Bras Enferm [Internet]. 2023 [cited 2024 Aug 7];76(1):e20220260. Available from: https://doi.org/10.1590/0034-7167-2022-0260
» https://doi.org/10.1590/0034-7167-2022-0260
NOTES
-
ORIGIN OF THE ARTICLE
Extracted from the - Peripherally Inserted Central Catheter (PICC) in Adult Intensive Care Patients: Construction and Validation of an Educational Guide for Nursing Care, presented to the Nursing Undergraduate Program, Department of Nursing, Universidade Federal de São Carlos, in 2023.
-
FUNDING INFORMATION
Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP). Process No. 2021/13464-1. This work was carried out with the support of the Coordination for the Improvement of Higher Education Personnel -Brazil (CAPES) -Financing Code 001.
-
APPROVAL OF ETHICS COMMITTEE IN RESEARCH
Approved by the Ethics Committee in Research of the Universidade Federal de São Carlos, opinion no. 5,241,856, Certificate of Presentation for Ethical Consideration (CAAE) 52219621.4.0000.5504.
-
TRANSLATED BY
Agência Latintrad - Leonardo Parachú
