Sobreutilização de cateter venoso central em terapia intensiva à luz da iniciativa Choosing Wisely: um estudo transversal

Abstract

This research focuses on the overutilization of healthcare technologies in light of the Choosing Wisely initiative, with a specific focus on the use of central line catheters (CLs) in critically ill patients. The overuse of medical devices has been increasing with the availability of new technologies. Therefore, a careful evaluation is necessary in order to optimize their use. In this regard, the indication and maintenance of any technology should be thoroughly considered and based on evidence, to avoid overutilization. The objective of this dissertation is to analyze the occurrence of CL overuse in an Intensive Care Unit (ICU) of a general hospital in Rio de Janeiro. The study follows a quantitative, documentary, cross-sectional, and retrospective design, in accordance with the recommendations of the Strengthening the Reporting of Observational Studies in Epidemiology. The study was conducted in two intensive care units of a general hospital located in the state of Rio de Janeiro. The units of analysis were catheters inserted in the units that remained in the patient for at least 48 hours. A total of 158 participants were selected for the study, generating 248 CLs for analysis. The catheters were predominantly inserted in male patients over 60 years old with cardiopulmonary alterations. The majority of the CLs were installed in the jugular vein (48.39%), with an average duration of 11.95 days. It is worth noting that 89.52% of the catheters did not have a registered therapeutic plan for their insertion. The most prevalent indication was prolonged antibiotic therapy (87.10%). The main adverse event identified was bloodstream infection (25.46%), with Klebsiella pneumoniae carbapenemase being the main agent. The strongest association was found between the length of stay in the ICU and the occurrence of adverse events (p-value < 0.001). In 2019 and 2020, each day of hospitalization increased the chance of an adverse event by 9.6% and 22.2%, respectively. The results show that the Choosing Wisely initiative can contribute to the daily practice of evaluating what is essential and what is unnecessary. The main reasons for overutilization and the occurrence of adverse events related to maintenance were associated with the length of hospitalization and the duration of CL placement. The predominant adverse event was central line association bloodstream infection and its maintenance.