Implicações da técnica “Broken Needle” na punção venosa periférica de neonatos prematuros

Abstract

Among the several procedures performed in the Neonatal Intensive Care Unit (NICU), there is Peripheral Venous Puncture (PVP), considered a complex practice, which represents 85% of the activities of the nursing team, and is also the most painful. The devices used in adults have been adapted for use in infants and infants because there is no specific material for pediatric care. Among these practices is the broken needle technique, which has been considered useful by professionals who use it for facilitating the collection of blood samples, although some studies look at the risk of adverse events. The general objective is to evaluate the implications of the broken needle technique on hemodynamic and behavioral parameters related to pain during peripheral venous puncture for blood collection in preterm infants and to understand their use in professional practice. Specifically, it aimed to describe the clinical characteristics of preterm infants; to evaluate the implications of the broken needle technique in PVP in premature neonates in the following parameters: pain level, behavioral and physiological; to verify the occurrence of adverse events of the use of the technique in PVP in preterm infants; to apprehend the perception of nursing and medical professionals who use the broken needle technique in PVP in preterm infants. The mixed method study was developed in two stages: the first was a quantitative, cross - sectional and descriptive study, in which the sample consisted of preterm neonates divided into two groups - treated and control, and a retrospective study was carried out. In the second stage a qualitative research was conducted with semi-structured interviews with five professionals and the data were submitted to the Bardin Content Analysis. In the characterization of the neonates there is similarity between the two groups, being mostly premature with gestational age between 32 and 35.6 weeks, with diagnoses related to respiratory causes, weighing more than 1500g. In the documentary analysis there was no record of phlogistic signs or lesions in the members in which the blood collection was performed. The professionals believe that the broken needle technique is more effective because it is faster than the other techniques, which has not been proven in the analysis of the collection time in neonates. There was no statistically significant difference between groups in relation to heart rate, sleep pattern and eyes squeezed during PVP. In relation to oxygen saturation, protruding eyebrows and deep nasolabial sulcus, there was a statistical difference between the groups. Despite the slight difference between the groups at the time of puncture, there are no significant advantages of one technique over the other. The importance of continuous training of the team was evidenced, since professionals value the information passed from one member to another. The transfer of knowledge from one professional to another favors the incorporation of the technique. The team is concerned with performing techniques that are less aggressive to the newborn and perform the broken needle technique because they believe the technique is more advantageous and beneficial and has no adverse effects on the neonate. The technique studied seems to have no effect on the parameters related to neonatal pain, not demonstrating a decrease or increase in pain scores in neonates when compared to the cannon technique. No relation was found regarding the occurrence of adverse events / complications with PVP. It should be emphasized that attention should be drawn to patient safety in the puncture procedure and the team should review the tendency to the mechanistic model of care. It is suggested that other studies, including national studies, be carried out.