Implante do Cateter Central de Inserção Periférica guiado por ultrassom versus punção às cegas para prevenção de trauma vascular: uma revisão sistemática

Abstract

The evolutionary history of intravenous therapy points to a development observed as a result of the advancement of studies and research derived from several other areas of knowledge. For this reason, it should not be reduced to a simple technique for carrying out therapy, given its well-structured arsenal of knowledge. Tunneled central catheters began to be used in the 1980s, however, regarding Peripherally Inserted Central Catheters (PICC), there are records of the beginning of their implementation since the 1970s. Their significant use in the care setting Critics consider the existence of conditions that increase the chance of complications related to puncture, when compared to other intravascular devices. However, the benefits of this device do not exempt it from the occurrence of adverse events, such as vascular trauma that usually occurs after its implantation. The prevention of this outcome is what configures the object of this study. Objective: To compare the effectiveness of implanting a Peripherally Inserted Central Catheter using ultrasound-guided puncture with blind puncture for preventing vascular trauma in adult patients admitted to an intensive care unit (ICU). Methodology: This is a systematic review of effectiveness. This design comprises a type of study capable of synthesizing the results of primary studies that meet the eligibility criteria to answer a research question. The recommendations of the JBI Manual for Evidence Synthesis were met; and to provide greater methodological rigor to its structure and content, the initiatives of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols 2020 statement were complied with. For data management purposes, a search and review protocol was drawn up, the registration of which on the International Prospective Register of Systematic Review platform it was registered under the following inscription: CRD42023467957. Data collection occurred through a paired search with independent reviewers in seven data sources, and the studies were selected according to the eligibility criteria adopted for the purposes of this review. Data extraction took place by completing a semi-structured instrument containing the variables of interest to the research, from which descriptive analyzes were processed as well as critical assessment of the methodological quality, risk of bias and strength of evidence of the studies that were part of the final sample. Results: After using the search strategy syntaxes, a total of 1.024 articles were retrieved to read the titles and abstracts. From this number, five studies were selected for full reading, as they met the scope of this review. All of them were randomized clinical trials, however, one of them was excluded because it was not available in full text in the database. The final sample was composed of four studies, which were subjected to a complete reading from which the form for data extraction was completed, as well as the JBI Critical Assessment Checklist for Randomized Controlled Trials was applied, in order to identify the risk of bias and the methodological quality of the studies. Both studies compared the effectiveness of two puncture methods for PICC implantation, between blind puncture and ultrasound-guided puncture. As a result, it was observed that the use of ultrasound to guide the puncture was superior to the conventional method for implanting the device, especially for the prevention of postoperative complications. Conclusion: Ultrasound-guided puncture is a safe, satisfactory and effective method for PICC implantation and prevention of vascular trauma in adult patients admitted to the ICU.