SIimulador ex vivo de punção venosa: descrição, validação, análise técnica qualitativa com fluoresceína e correlações clínicas

Abstract

Introduction: Peripheral venipuncture is one of the most invasive methods performed in the hospital environment, constituting about 85% of the activities performed by nursing professionals. A hybrid placental simulator was built in order to train the venipuncture tech-nique that reliably simulates the procedure in different clinical situations. There are on the market, in addition to descriptions in the literature, models of synthetic materials (industrial) that have a high cost to manufacture and obtainment, or biological simulators (low fidelity). The training in a simulator before the real act on the patient is extremely ethical and continues to be the target of research in order to favor its applicability, validation and use in improvement of technical skills. To prove the success of the technique used, as well as the visualization of possible vascular lesions, it was used in the study the fluorescein, which consists of a dibasic acid dye. Objective: To validate the hybrid simulator for venipuncture with analysis of vascular wall injury through fluorescein infusion. Methods: The first phase of data collection was carried out by observing the venipuncture procedures performed by 60 health professionals and academics in public and private hospitals in Belo Horizonte and in a public hospital in Ouro Branco - Minas Gerais, to analyze the main difficulties encountered in the real procedure. In a second moment for validation of the simulator, 30 punctures were performed by 5 nurses with more than one year of practice in assistance in independent areas, in the simulator made in the Neurosurgery Laboratory. 15 punctures were performed in large, easily accessible vessels and 15 punctures in deep and superficial vessels. The results obtained were validated by the programming language R, version 3.6.1 for Windows. The linear regression method was applied to analyze the variables correlation degree; time spent and number of lesions in lage and filiform vessels. Results: The number of puncture attempts has a positive correlation with the number of lesions, evidenced by the use of fluorescein that allowed the visualization of the leakage of the substance outside the vessel. He observed a stronger and positive linear correlation represented by the Pearson correlation coefficient R multiple = 0.807 for the filiform vessels (difficult access) and r = 0.784 for the large vessels (easy access). The determination coefficient R2 was 0.625 and the S or standard error 0.6405 in the filiform vessels, in the calibrated vessels it presented an R2 of 0.585 and the standard error of 0.226. Conclusion: The proposed simulator presents positive validation, has fidelity and similarity to the real procedure. The clinical condition, age of the patient and the vascular access quality were the main difficulties identified by the clinical trial. The number of attempts at venipuncture was the variable that most correlated with the number of lesions found on the vessel wall, evidenced by the visualization of the leakage of fluorescein, which proved to be a good method of investigation to verify the quality of the performed procedure.