Patrícia Kuerten Rocha

Background: Accurate peripherally inserted central catheter ( PICC ) tip positioning in neonates remains challenging, with high rates of malposition reported using traditional measurement methods. Aim: To evaluate the effectiveness of the Tomazoni method for PICC positioning in neonates compared with the traditional method. Study Design: Pragmatic, parallel‐group randomised clinical trial with stratified block randomisation, conducted in a neonatal intensive care unit in Brazil between June 2024 and April 2025. Results: Of 62 randomised procedures, 55 were evaluable (27 in the experimental group, 28 in the control group). Central positioning was achieved in 21 of 27 procedures (77.8%) in the experimental group versus 5 of 28 (17.9%) in the control group ( p < 0.001). PICC insertion procedures assessed using the Tomazoni method were 4.36 times more likely to achieve central tip placement ( RR = 4.36; 95% CI : 1.91–9.88). Catheter withdrawal was required in 3 of 27 procedures (11.1%) in the experimental group versus 16 of 28 (57.1%) in the control group ( p = 0.001; RR = 0.19; 95% CI : 0.06–0.59). Conclusions: The Tomazoni measurement method was associated with substantially higher rates of central PICC tip positioning and reduced need for catheter withdrawal compared with the traditional method. Relevance to Clinical Practice: The Tomazoni method offers a reproducible, low‐cost measurement strategy that can be implemented in neonatal intensive care units to improve catheter positioning accuracy and reduce procedure‐related manipulations, with potential implications for patient safety. The trial, titled ‘Comparison between measurements of peripherally inserted central catheters in children and newborns’, was registered in the Brazilian Clinical Trials Registry under the identifier RBR ‐55zwb45. Trial Registration: This trial is registered in the Brazilian Clinical Trials Registry (ReBEC) under the identifier RBR‐55zwb45

Resumo Objetivo Relatar o desenvolvimento de um cenário de simulação in situ para o manejo da insuficiência respiratória em pediatria por enfermeiros. Métodos Trata-se de um estudo descritivo, do tipo relato de experiência, estruturado em duas fases: desenvolvimento do caso clínico e elaboração do cenário. A equipe de pesquisa incluiu enfermeiros com especialização e/ou experiência em pediatria, além de um médico especializado em urgência e emergência. Resultados O caso clínico foi desenvolvido em três reuniões virtuais para identificar a piora [...] Resumo Objetivo Relatar o desenvolvimento de um cenário de simulação in situ para o manejo da insuficiência respiratória em pediatria por enfermeiros. Métodos Trata-se de um estudo descritivo, do tipo relato de experiência, estruturado em duas fases: desenvolvimento do caso clínico e elaboração do cenário. A equipe de pesquisa incluiu enfermeiros com especialização e/ou experiência em pediatria, além de um médico especializado em urgência e emergência. Resultados O caso clínico foi desenvolvido em três reuniões virtuais para identificar a piora

Objetivo: verificar o efeito da intervenção educativa sobre a Ferramenta I-DECIDED® no conhecimento de profissionais de Enfermagem Pediátrica. Método: estudo quase experimental, do tipo antes e depois, realizado em unidade de internação pediátrica no Sul do Brasil, com 27 profissionais de enfermagem, entre 2023 e 2024. A coleta de dados ocorreu em duas etapas: pré e pós-intervenção. Aplicou-se Questionário Pré e Pós-Intervenção (49 questões, 19 analisadas sobre complicações, prevenção de infecção e cobertura/estabilização). A intervenção educativa incluiu apresentação teórica da Ferramenta, simulação de baixa fidelidade e materiais educativos. Resultados: em 11 (68,8%) das respostas sobre avaliação do cateter intravenoso periférico, houve aumento de acertos pós-intervenção. Em todas as questões de autoavaliação, as respostas passaram de “concordo parcialmente” para “totalmente”. Conclusão: a intervenção educativa com a Ferramenta I-DECIDED® aumentou as respostas corretas pós-intervenção, indicando melhora no conhecimento dos profissionais sobre complicações, prevenção de infecção e cobertura/estabilização.

Background: Proper documentation of peripheral intravenous catheter assessment and care is essential for improving outcomes related to its use. However, adherence to peripheral intravenous catheter documentation remains low, despite nursing documentation being essential for continuity of care, timely identification of complications and safe clinical decision-making. Aim: To determine the impact of the I-DECIDED ^® tool on nursing staff documentation of peripheral intravenous catheter assessment in a paediatric inpatient unit and to assess its impact across different nursing roles. Methods: A quasi-experimental interrupted time series study. The sample included 810 peripheral intravenous catheters documentation observations (405 pre- and 405 post-intervention) performed by 27 nursing staff. Data were collected at six points: three pre- and three post-intervention. Data were analysed using the Generalised Estimating Equations model. Results: After the use of the I-DECIDED ^® tool, compliance with peripheral intravenous catheter assessment documentation significantly improved in six of the eight evaluated items overall ( p < 0.05), with notable increases in device need, effective function and complications, all with p < 0.001. Documentation reliability by nursing staff, assessed by comparing their records with researcher observations, improved significantly, from 42.9% to 75.4% ( p < 0.001). Conclusion: The I-DECIDED ^® tool increased both the compliance and reliability of nursing documentation related to peripheral intravenous catheter assessment. However, challenges remain regarding full adherence to all tool items, especially among nursing technicians/assistants.

Objetivo: verificar fatores que influenciam as práticas assistenciais da equipe de enfermagem relacionadas à avaliação do cateter intravenoso periférico, prevenção de infecções e à avaliação de complicações durante a administração de medicamentos. Método: estudo transversal, analítico. Amostra composta por 360 observações de administrações de medicamentos intravenosos em cateter intravenoso periférico em Unidade de Internação Pediátrica. Foi realizada análise descritiva e calculado razão de risco com intervalo de confiança de 95%. Considerou-se significativo o valor de p≤0,05. Resultados: a adesão as práticas em relação ao cateter variaram. Porém, apenas a higienização das mãos apresentou diferença estatisticamente significativa. Profissionais com >20 anos de formação (94,2% de adesão), formação adicional (92,1%) e ≥10 anos de atuação na unidade (93,8%) apresentaram maior adesão à higienização das mãos, com resultados estatisticamente relevantes (p <0,05). Conclusão: evidenciaram-se fragilidades relacionadas à avaliação da necessidade do cateter, realização correta da desinfecção e avaliação de complicações.

Background: Peripherally inserted central catheters (PICC) are widely used in neonates and children requiring intravenous therapy due to their clinical advantages. However, incorrect catheter tip positioning remains frequent and may lead to serious complications. The conventional anatomical landmark–based measurement presents important accuracy limitations. A new approach, the Tomazoni method, has been proposed to improve tip positioning, but current evidence is limited to a small single-center study, highlighting the need for further investigation in broader populations. The objective is to describe a study protocol designed to prospectively evaluate the effectiveness of the Tomazoni measurement method for PICC insertion in neonates and children. Methods: Study protocol for a pragmatic, parallel-group, double-blind randomized clinical trial. Eligible participants will be neonates and children requiring upper-limb PICC insertion. The control group will undergo the traditional measurement method, while the experimental group will receive the Tomazoni method. Data will be collected using an instrument including patient, procedure, and catheter characteristics. Analyses are planned to involve frequency distributions, association tests, and relative risk. The primary outcome will be the initial catheter tip position. Conclusions: The findings are expected to contribute to the development of safer and more effective practices in PICC insertion in children and neonates’ populations, supporting patient safety and quality of care in critical neonatal and pediatric environments.

Context: Central venous access devices (CVADs) are essential in paediatric care but pose significant risks. Synthesising existing evidence is needed to guide safe, effective, and equitable practice amid evolving interventions and complex management needs. Objective: To develop an evidence and gap map (EGM) to identify, categorise, and visualise paediatric evidence on interventions aimed at improving CVAD outcomes. Data Sources: Following Campbell Collaboration guidance, systematic searches were conducted in PubMed, CINAHL, Scopus, and CENTRAL (date limits: 2014 to 30 June 2024). Study Selection: Eligible studies included patients (0–18 years) evaluating an intervention to improve CVAD outcomes, including randomised and non‐randomised trials, implementation studies, and systematic reviews. Data Extraction: Two reviewers independently screened and extracted data on CVAD type, intervention, setting, outcomes, and study design. Data were descriptively analysed and visualised in Tableau. Results: Of 952 studies in the broader EGM, 151 were paediatric‐specific. Most were conducted in high‐income countries (72%) and high‐acuity settings, including critical care (41.9%) and oncology (38.5%). CVAD type was unspecified in 80.1% of studies. Systematic reviews (22.5%) and randomised controlled trials (28.5%) were available, though 40.4% of studies were before‐and‐after studies without controls. Common interventions addressed infection prevention, insertion technologies, and flushing. Clinical outcomes, particularly bloodstream infection (27.8%), dominated reporting, while patient‐reported, economic, and device removal outcomes were rarely reported (< 2%). Limitations: Only studies from the last 10 years and English‐language databases were included. No formal quality appraisal was conducted. Conclusions: Significant evidence gaps exist. Future research should prioritise rigorous, paediatric‐specific studies across diverse settings and outcome domains. Trial Registration: Open Science Framework (OSF) q6gcr: https://osf.io/q6gcr/overview

Objetivo: Relatar o protocolo de uma revisão de escopo que visa mapear e sintetizar as evidências científicas disponíveis sobre as definições de lesões de pele relacionadas a adesivos médicos e das lesões de pele associadas a cateteres em locais de inserção de dispositivos intravenosos. Métodos: Trata-se de um protocolo de revisão de escopo, desenvolvido em cinco etapas: Identificação da questão de pesquisa, utilizando a estratégia População, Conceito e Contexto; Identificação dos estudos relevantes, no qual a busca dos estudos será realizada nas principais bases de dados da área da saúde; Seleção dos estudos: será realizada a triagem inicial, a seleção dos estudos e a extração dos dados na plataforma Covidence; Análise dos dados, será realizada a caracterização e descrição dos artigos; e, Agrupamento, resumo e apresentação dos resultados de forma narrativa e quantitativa descritiva, integrando os achados aos objetivos da revisão de escopo, seguindo o Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews.

Objective: To map the scientific literature on bundles used to prevent infiltration in short peripheral intravenous catheters (SPIVC) in children. Method: A scoping review based on the Joanna Briggs Institute (JBI) guidelines, with searches conducted in the following databases: PubMed, Embase, LILACS, and Scopus. Eligible studies included those with a quantitative or mixed-methods approach, published in any language, and presenting bundles for the prevention of infiltration in SPIVC in children. Studies were excluded if they did not address bundle components, focused on a different population, involved a different type of intravenous catheter, or were unavailable in full text. Selection was performed independently by two reviewers using Rayyan© software. The study protocol was previously developed and registered in the Open Science Framework (OSF) repository. Results: Four bundles were identified, conducted in countries such as India, Australia, the United States, and Thailand. Study designs included Quality Improvement Projects (QI), prospective pre-post mixed-methods projects, and quasi-experimental prospective studies. All studies were published in English between 2014 and 2021. The number of components in the bundles ranged from 4 to 7 interventions, with “SPIVC stabilization and dressing” being the most frequently reported intervention. Conclusion: There is no standardization of the components in the bundles. Therefore, more robust studies are needed to establish standardized interventions.