Objective: To evaluate the performance of an institutional protocol for the management of subcutaneous intravascular catheters in a neonatal intensive care unit (NICU) in a level III and IV institution.
Methodology: Descriptive-longitudinal study. 67 procedures related to catheters like insertion (31), cure (17) and drug administration (19) were evaluated, using a check list instrument and glance to personal to avoid observation bias. Informed consent of medical staff of the unit was obtained.
Results: The main deficiency observed in the fulfilment of the technical norm of catheter insertion was the absence of surgical hand washing in 27% of percutaneus iv central catheters (PICC) and 37% of umbilical catheters. There were omissions in the x-ray postinsertion in 27% PICC and 37% of umbilical catheters. In relation to the materials for the insertion of the umbilical catheter, it was found the absence of the three-way clock in 25% of the procedures and the use of in 100% of the procedures of a very large eye field which exposed an area larger than it was necessary for the procedure, demanding much more manipulation and increasing the risk of contamination from the personal. The main deficiencies for the fulfilment of the catheters cure protocol were related to the fact that clean gloves were not worn when manipulating contaminated dressings (47%). During the drug administration, deficiencies were observed related to the absence of use of personal protection elements (masks and clean gloves) and the fact that there were no clinical hands washing before the procedure (42%). However, drug preparation was made with a rigorous aseptic technique.
Conclusions: The management and care that was given to subcutaneous and umbilical catheters at the NICU presented some institutional deficiencies (equipments) as well as human deficiencies (low adherence to handwashing protocols), most of them of easy improvement. The paper discusses the strengths and weaknesses in the execution of the procedures according to institutional and international guidelines.