Avaliação da prática de punção venosa central guiada por ultrassom em Manaus/AM

Abstract

BACKGROUND: The central vein puncture for catheter installation is now considered a common procedure in hospitals and emergency rooms. Catheters in central veins have several functions that are related to the clinical management of severe patients. Despite the benefits, the central venous puncture procedure for catheter installation presents significant risks such as: failure to establish venous access; catheter malposition; arterial puncture; subcutaneous hematoma; pneumothorax; hemothorax and even, rarely, sudden cardiac arrest. Ultrasonography has emerged in recent decades as an option to guide central venous puncture and central venous catheters, but despite the scientific evidence in favor of using this technology, mainly in reducing complications and increasing success rates, this resource is not yet being used systematically in many parts of the world. OBJECTIVE: The objective of this work is to study the use of ultrasound as a guide for central venous punctures in the city of Manaus / AM. METHOD: We designed a cross - sectional descriptive study conducted through an electronic questionnaire, applied to physicians who puncture central venous accesses in their work routine. The questionnaires were applied to physicians from 4 important tertiary hospitals in the city of Manaus, 3 of them being from the public network and 1 from the private network. Data analysis was done descriptively and using chi-square and Fisher statistical tests when comparative analyzes were required. RESULTS: We verified in this study that the ultrasound use rate to guide venous punctures in the hospitals evaluated was 44% and the most reported reasons for not using ultrasound were the unavailability of the device and the lack of training in the use; there was no statistical difference between the answers given by resident physicians and specialists; the factors that most encourage physicians to use ultrasound are anatomical difficulties, obesity, and coagulation disorders. CONCLUSIONS: This work shows that, despite its benefits, ultrasonography is still not used systematically in our hospital. Awareness of physicians, proper training, broader availability, and ease of use of ultrasound devices appear to be ways to improve this scenario.