Luciana Bento

Oximetria de Bulbo Jugular | SaúdeExperts

Atendendo ao pedido de alguns profissionais que atuam em neurologia, hoje escrevo sobre a oximetria de bulbo jugular.

Definição

A oximetria de bulbo jugular tem como objetivo avaliar as condições de oxigenação cerebral em pacientes neurocríticos. A monitorização da saturação de bulbo jugular (SvjO2) é utilizada para determinar se há equilíbrio entre a perfusão cerebral e o metabolismo cerebral.

Identifica os seguintes estados de perfusão cerebral: (Knobel, 2009)

  • Perfusão cerebral global
  • Igualdade entre o fluxo sanguíneo cerebral e o metabolismo cerebral de oxigênio
  • Hipoperfusão cerebral
  • Isquemia cerebral global
  • Monitorização dos efeitos das intervenções terapêuticas

Para isso, é realizada a inserção de um cateter no bulbo da veia jugular interna do lado da lesão ou à direita, quando a lesão for difusa. Pode ser utilizado um cateter de fibra óptica para monitorização contínua ou um cateter normal para monitorização intermitente. A confirmação é feita por meio de radiografia e o cateter deve estar posicionado no bulbo jugular – acima da segunda vértebra cervical.

Bulbo Jugular

Figura 1: O bulbo jugular – Fonte: Neurointensivismo

O valor da SvjO2 é determinado pelo fluxo sanguíneo cerebral, pela saturação arterial de O2 e pela taxa de extração de O2. Valor normal em pacientes sem lesão cerebral = 55 a 75%. Resultados de SvjO2 inferiores a 55% sugerem situações isquêmicas (oferta de oxigênio inadequada, causada pelo aumento do metabolismo cerebral ou pela diminuição do fluxo sanguíneo cerebral), aumento da PIC, redução da PaCO2. Resultados elevados de SvjO2, superiores a 75%, podem ser decorrentes de hiperemia encefálica, sedação, comunicação arteriovenosa, hipotermia ou morte cerebral.

Algumas indicações

  • Traumatismos cranioencefálicos graves
  • Ato anestésico em procedimentos neurocirúrgicos
  • Hipertensão craniana refratárias a medidas terapêuticas iniciais
  • Monitorização da PIC

Contraindicações relativas

  • Coagulopatias
  • Trauma cervical
  • Infecção localizada
  • Traqueostomia
  • Drenagem venosa cerebral prejudicada

Complicações

  • Punção de carótida
  • Trombose
  • Embolia pulmonar
  • Infecção – flebite séptica
  • Perfuração atrial
  • Tamponamento cardíaco
  • Pneumotórax
  • Hemorragias
  • Lesão do nervo frênico
  • Lesão de gânglios cervicais

Atuação do enfermeiro

No momento da inserção do cateter:

  • Identificar a veia jugular interna a ser cateterizada
  • Elevar o decúbito a 30 graus
  • Posicionar a cabeça em alinhamento céfalo-caudal e lateralizá-la somente no momento da introdução do cateter (evitar aumento da PIC)
  • Preparar o material
  • Preparar o equipamento (monitorização contínua)
  • Monitorar os sinais vitais durante o procedimento (principalmente a pressão arterial e a PIC)
  • Fazer curativo compressivo no local
  • Agilizar a radiografia de coluna cervical lateral ou de base de crânio (verificar posicionamento do cateter)

Na manutenção do cateter:

  • Avaliar sinais vitais, SvjO2 e PIC
  • Realizar exame neurológico: avaliação pupilar, nível de consciência -escala de Glasgow/ Ramsay, avaliação de reflexo cutâneo-plantar, córneo-palpebral, óculocefálico e patelar
  • Estabelecer uso exclusivo do cateter para coleta de sangue
  • Colher a gasometria com intervalos variados, ou sempre que houver alterações clínicas (monitorização intermitente)
  • Calibrar o equipamento uma vez ao dia (monitorização contínua)
  • Manter o cateter de fibra óptica livre de dobras – garantir a leitura adequada pelo monitor
  • Trocar os dispositivos do sistema de monitoração de acordo com o protocolo da instituição
  • Trocar o curativo diariamente
  • Monitorar o local de inserção do cateter (presença de sinais flogísticos)
  • Manter técnica asséptica

Referências

  • Knobel E. Terapia Intensiva: enfermagem. São Paulo: Editora Atheneu, 2009.
  • Moraes RB et al. Medicina intensiva: consulta rápida. Porto Alegre: Artmed, 2014.
  • Hernández OI et al. Monitorización de la oximetría del bulbo de la yugular. Revista Habanera de Ciencias Médicas. v.6, n.3 Ciudad de La Habana, jul.-sep. 2007.

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Prof. Dra. Elizabeth Galvão

Doutora em Ciências (EEUSP), pós-graduada em Administração Hospitalar (UNAERP) e Saúde do Adulto Institucionalizado (EEUSP), especialista em Terapia Intensiva (SOBETI) e em Gerenciamento em Enfermagem (SOBRAGEN). É professora titular da Universidade Paulista no Curso de Enfermagem, e professora do Programa de Especialização Lato-sensu em Enfermagem em Terapia Intensiva e Enfermagem do Trabalho na Universidade Paulista.

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