Microteoria da ocorrência do trauma vascular periférico na administração intravascular de meios de contraste

Abstract

Introduction: Nursing has made a significant contribution to Diagnostic Imaging Units, improving the quality of services provided. Among its various responsibilities, peripheral venipuncture is the most frequently performed procedure for the intravascular administration of contrast media. Although it is considered a routine and relatively simple nursing intervention, local complications may occur, known as vascular trauma. Extravasation is the most widely addressed type of trauma, as contrast media are classified as irritant substances. However, the literature describes other types of vascular trauma that should also be considered in this context. Nursing is a constantly evolving field that generates its own body of knowledge; however, a gap between theory and practice still persists, partly due to the difficulty of applying existing models and nursing grand theories in clinical settings. Bridging the gap between theory, research, and practice is essential to advance nursing knowledge, foster scientific development, and generate evidence-based outcomes through the construction of microtheories. Objective: To develop a descriptive and explanatory microtheory regarding the occurrence of vascular trauma in adults during peripheral venipuncture and intravascular administration of contrast media during Computed Tomography and Magnetic Resonance Imaging. Method: Theoretical research based on the General Method for Theory Construction in Applied Disciplines, supported by an integrative review guided by the approach of Whittemore and Knafl. Results: Ten studies were included in the integrative review, providing information on the types of vascular trauma, associated clinical signs and symptoms, and potential risk factors for their occurrence. The concept of peripheral vascular trauma was defined as a nursing phenomenon, characterized as a human response manifested by types such as extravasation and phlebitis, and clinically diagnosed through signs and symptoms including edema, erythema, and induration. Several elements were identified as potential risk factors as conditions that precede the trauma. Grouping by similarity enabled the identification of three categories of risk factors: those related to contrast media and imaging exam dynamics, those related to patient characteristics, and those related to the peripheral venipuncture procedure. The mechanisms of trauma occurrence refer to the processes triggered when risk factors act independently or synergistically, activating the trauma process. Despite differing origins, all mechanisms converge on a local inflammatory response, leading to increased vascular permeability and decreased vascular compliance, thereby compromising the integrity of the punctured vein. These mechanisms explain how the human response to the trauma phenomenon occurs and can be diagnosed by nurses. Final Considerations: The developed microtheory offers relevant insights for clinical nursing practice and contributes to the advancement of nursing education. Its well-defined scope and level of abstraction, appropriate for a microtheory, allow for the exploration of a specific phenomenon (peripheral vascular trauma) in a specific population (adults undergoing contrast-enhanced imaging examinations), supporting critical reflection on nursing practice in this context. Its specificity and applicability are expected to improve nursing care outcomes.