Complicações do PICC em adultos: prevenção e estratégias de enfermagem baseadas em evidências
DOI:
https://doi.org/10.33159/25959484.repen.2026v37a04Palabras clave:
PICC, Complicações, Enfermagem, Trombose, InfecçãoResumen
Objetivo: Analizar las principales complicaciones relacionadas con el uso del Catéter Central de Inserción Periférica (PICC) en adultos, con énfasis en infecciones del torrente sanguíneo, trombosis venosa y obstrucción del lumen, además de identificar estrategias de prevención centradas en la actuación de la enfermería. Métodos: Para ello, se realizó una revisión integradora de la literatura, abarcando publicaciones de los últimos diez años que trataron factores clínicos, técnicos y organizacionales asociados al uso del PICC. Los estudios incluidos consideraron prácticas de enfermería, protocolos asistenciales y el uso de tecnologías como la ecografía. Resultados: El análisis reveló que la adopción de prácticas basadas en la evidencia, la capacitación continua del equipo de enfermería y la estandarización de protocolos contribuyen significativamente a la prevención de complicaciones. La inserción, el mantenimiento y el monitoreo correctos del PICC se asociaron con una reducción significativa de los riesgos de infección, trombosis y obstrucción, promoviendo mayor seguridad y eficacia en los tratamientos intravenosos de larga duración. Conclusión: Se concluye que el PICC es una alternativa segura y eficaz para el acceso venoso en pacientes adultos, siempre que esté bien indicado y gestionado. La actuación del personal de enfermería es fundamental para minimizar riesgos y garantizar la calidad del cuidado, especialmente en contextos clínicos complejos, donde la personalización de la atención y el uso de tecnologías desempeñan un papel central.
Descriptores: Catéter PICC; Complicaciones; Enfermería; Trombosis; Infección.
Citas
1. Waitt C, Waitt P, Pirmohamed M. Intravenous therapy. Postgrad Med J. 2004;80(939):1–6. https://doi.org/10.1136/pmj.2003.010421
2. Merrell SW, Peatross BG, Grossman MD, Sullivan JJ, Harker WG. Peripherally inserted central venous catheters: Low-risk alternatives for ongoing venous access. West J Med [Internet]. 1994[cited 2025 Jun 30];160(1):25–30. Available from: https://pubmed.ncbi.nlm.nih.gov/8128698/
3. Sharp R, Grech C, Fielder A, Mikocka Walus A, Esterman A. Vein diameter for peripherally inserted catheter insertion: a scoping review. J Assoc Vasc Access. 2016;21(3):166–75. https://doi.org/10.1016/j.java.2016.02.002
4. Johansson E, Hammarskjöld F, Lundberg D, Arnlind MH. Advantages and disadvantages of peripherally inserted central venous catheters (PICC) compared to other central venous lines: A systematic review of the literature. Acta Oncol. 2013;52(5):886–92. https://doi.org/10.3109/0284186X.2013.773072
5. Moureau N. Vascular safety: it’s all about PICCs. Nurs Manage. 2006;37(5):22–27. https://doi.org/10.1097/00006247-200605000-00007
6. Nicholson J. Development of an ultrasound-guided PICC insertion service. Br J Nurs. 2010;19(10):S9–17. https://doi.org/10.12968/bjon.2010.19.Sup3.48212
7. Von Eiff C, Jansen B, Kohnen W, Becker K. Infections associated with medical devices: Pathogenesis, management, and prophylaxis. Drugs. 2005;65(2):179–214. https://doi.org/10.2165/00003495-200565020-00003
8. Pelling H, Nzakizwanayo J, Milo S, Denham EL, Macfarlane WM, Bock LJ, et al. Bacterial biofilm formation on indwelling urethral catheters. Lett Appl Microbiol. 2019;68(4):277–93. https://doi.org/10.1111/lam.13144
9. Busch LM, Kadri SS. Antimicrobial treatment duration in sepsis and serious infections. J Infect Dis. 2020;222(Suppl 2):S142–55. https://doi.org/10.1093/infdis/jiaa247
10. Ahmed SS, McCaskey MS, Bringman S, Eigen H. Catheter-associated bloodstream infection in the pediatric intensive care unit: a multidisciplinary approach. Pediatr Crit Care Med. 2012;13(2):e69–72. https://doi.org/10.1097/PCC.0b013e31820ac2e1
11. Zochios V, Umar I, Simpson N, Jones N. Peripherally inserted central catheter (PICC)-related thrombosis in critically ill patients. J Vasc Access. 2014;15(5):329–37. https://doi.org/10.5301/jva.5000239
12. Dougherty L. Frequency, diagnosis, and management of occlusive and mechanical PICC complications. In: Peripherally inserted central venous catheters. Milano: Springer Milan; 2014. p. 85–94. https://doi.org/10.1007/978-88-470-5665-7_8
13. Pina TV, Cunha NC, Ferreira EB, Rocha PRS. Complications of peripherally inserted central catheter: integrative review. Rev Enferm UFPE. 2023;17(1). https://doi.org/10.5205/1981-8963.2023.253981
14. Oliveira RM, Leitão IMTA, Silva LMSD, Figueiredo SV, Sampaio RL, Gondim MM. Strategies for promoting patient safety: from the identification of the risks to evidence-based practices. Esc Anna Nery. 2014;18:122–9. https://doi.org/10.5935/1414-8145.20140018
15. Xu B, Zhang J, Hou J, Ma M, Gong Z, Tang S. Nurses’ attitudes and knowledge of peripherally inserted central catheter maintenance in primary hospitals in China: a cross-sectional survey. Risk Manag Healthc Policy. 2020;13:903–13. https://doi.org/10.2147/RMHP.S250741
16. Aljanabi HM, Mousa O, Al Zawad MA, Sindi FR, Asalem RA, Alqasim AA, et al. Evaluating the knowledge and attitudes of nurses toward PICC care before and after specialized training in Dammam Health Network (DHN) in the KSA. Gland Surg. 2024;9(2):481–516. https://doi.org/10.13140/RG.2.2.23971.57129
17. Hebl JR. The importance and implications of aseptic techniques during regional anesthesia. Reg Anesth Pain Med. 2006;31(4):311–23. https://doi.org/10.1016/j.rapm.2006.04.004
18. Mendes KDS, Silveira RCDCP, Galvão CM. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto Contexto Enferm. 2008;17:758-64. https://doi.org/10.1590/S0104-07072008000400018
19. Oliveira JLR, Beccaria LM, Pereira GAA, Poletti NA, Gabriel CS. Cateter central de inserção periférica em adultos hospitalizados: competências necessárias à sua inserção. Rev Bras Enferm. 2020;73(Supl. 4):e20190240. https://doi.org/10.1590/0034-7167-2019-0240
20. Pereira FG, Oliveira AC, Paula AO, Souza RM. (). Infraestrutura hospitalar e segurança do paciente: uma análise a partir das boas práticas em terapia intravenosa. Rev Bras Enferm. 2019;72(6):1562–8. https://doi.org/10.1590/0034-7167-2018-0680
21. Walters B, Price C. Quality improvement initiative reduces the occurrence of complications in peripherally inserted central catheters. J Infus Nurs. 2019;42(1):29–36. https://doi.org/10.1097/NAN.0000000000000310
22. Meyer BM. Understanding the patient experience of peripherally inserted central catheter-related deep vein thrombosis using interpretive phenomenology. J Infus Nurs. 2017;40(5):287-96. https://doi.org/10.1097/nan.0000000000000238
23. Sharp R, Cummings M, Fielder A, Mikocka-Walus A, Grech C, Esterman A. The catheter to vein ratio and rates of symptomatic venous thromboembolism in patients with a peripherally inserted central catheter (PICC): a prospective cohort study. Int J Nurs Stud. 2015;52(3):677–85. https://doi.org/10.1016/j.ijnurstu.2014.12.002
24. Chang C, Zhang H, Wang Y, Liu F, Li Y. Prognostic factors for catheter-related thrombosis in hematological patients with peripherally inserted central catheters. Thromb Res. 2025;223:105507. https://doi.org/10.1097/MD.0000000000041181
25. Santacruz Cerdá E, Arcano K, Arrieta Blanco F, Ortiz Flores A, Mateo Lobo R, Botella Carretero JI, et al. Eficacia de la nutrición parenteral domiciliaria de larga evolución con catéter de acceso periférico: a propósito de un caso. Nutr Hosp. 2016;33(1):185–7. https://doi.org/10.20960/nh.31
26. Alsaleh K, Alosaimi D, Almousawi A, Alshaikh M, Omar H. Effectiveness of a nurse-led peripherally inserted central catheter service: a retrospective cohort study. J Vasc Access. 2024;26(4). https://doi.org/10.1177/11297298241263886
27. Assis GLC, Mota ANB, Cesar VF, Turrini RNT, Ferreira LM. Custo direto da inserção do cateter central de inserção periférica por enfermeiros em adultos hospitalizados. Rev Bras Enferm. 2021;74:e20190663. https://doi.org/10.1590/0034-7167-2019-0663
28. Mitelmão FCR, Mangini Filho S, Chaud MV, Vila MMDC, Balcão VMCF, Oliveira Junior JMD. Caracterização física de cateteres centrais de inserção periférica (CCIP). Matéria (Rio J). 2020;25:e-12545. https://doi.org/10.1590/S1517-707620200001.0870
29. Lv L, Wang H, Zhang X, Zhang M. Cluster nursing in the prevention of PICC related venous thrombosis and its influence on tumor patients' coagulation functions. Int J Clin Exp Med [Internet]. 2020[cited 2025 Jun 30];13(12):10005–11. Available from: https://e-century.us/files/ijcem/13/12/ijcem0120598.pdf
30. Huang R, Jiang Y, Le X. [Retracted] Prevention and nursing research of PICC catheter related complications in patients with digestive system malignant tumors based on smart medical blockchain. J Healthc Eng. 2021;2021(1):5519722. https://doi.org/10.1155/2021/5519722
31. McDiarmid S, Scrivens N, Carrier M, Sabri E, Toye B, Huebsch L, et al. Outcomes in a nurse led peripherally inserted central catheter program: a retrospective cohort study. CMAJ Open. 2017;5(3):E535–9. https://doi.org/10.9778/cmajo.20170010
32. Mielke D, Wittig A, Teichgräber U. Peripherally inserted central venous catheter (PICC) in outpatient and inpatient oncological treatment. Support Care Cancer. 2020;28:4753–60. https://doi.org/10.1007/s00520-019-05276-0
33. Grau D, Clarivet B, Lotthé A, Bommart S, Parer S. Complications with peripherally inserted central catheters (PICC) used in hospitalized patients and outpatients: a prospective cohort study. Antimicrob Resist Infect Control. 2017;6:1–8. https://doi.org/10.1186/s13756-016-0161-0
34. Curto García N, García Suárez J, Callejas Chavarria M, Gil Fernández JJ, Martín Guerrero Y, Magro Mazo E, et al. A team based multidisciplinary approach to managing peripherally inserted central catheter complications in high risk haematological patients: a prospective study. Support Care Cancer. 2015;24:93–101. https://doi.org/10.1007/s00520-015-2754-1
35. Ullman AJ, August D, Kleidon T, Walker R, Marsh NM, Bulmer A, et al. Peripherally Inserted Central catheter iNnovation to reduce Infections and Clots (the PICNIC trial): a randomized controlled trial protocol. BMJ Open. 2021;11(4):e042475. https://doi.org/10.1136/bmjopen-2020-042475
36. Zheng LY, Peng Y, Yuan H, Liu SX, Xue H, Zhang XY. Nurses’ knowledge of the management of drug induced peripherally inserted central catheter obstruction: a descriptive phenomenological study. J Vasc Access. 2020;21(5):680–6. https://doi.org/10.1177/1129729819900864
37. Morano SG, Latagliata R, Girmenia C, Massaro F, Berneschi P, Guerriero A, et al. Catheter associated bloodstream infections and thrombotic risk in hematologic patients with peripherally inserted central catheters (PICC). Support Care Cancer. 2015;23:3289–95. https://doi.org/10.1007/s00520-015-2740-7
38. Tolera BD, Hui F. Exploring individual and organizational factors influencing registered nurses in preventing peripherally inserted central catheter-related complications. J Nurs Pract. 2025;4(4). https://doi.org/10.5281/zenodo.546199
1. Waitt C, Waitt P, Pirmohamed M. Intravenous therapy. Postgrad Med J. 2004;80(939):1–6. https://doi.org/10.1136/pmj.2003.010421 DOI: https://doi.org/10.1136/pmj.2003.010421
2. Merrell SW, Peatross BG, Grossman MD, Sullivan JJ, Harker WG. Peripherally inserted central venous catheters: Low-risk alternatives for ongoing venous access. West J Med [Internet]. 1994[cited 2025 Jun 30];160(1):25–30. Available from: https://pubmed.ncbi.nlm.nih.gov/8128698/
3. Sharp R, Grech C, Fielder A, Mikocka Walus A, Esterman A. Vein diameter for peripherally inserted catheter insertion: a scoping review. J Assoc Vasc Access. 2016;21(3):166–75. https://doi.org/10.1016/j.java.2016.02.002 DOI: https://doi.org/10.1016/j.java.2016.02.002
4. Johansson E, Hammarskjöld F, Lundberg D, Arnlind MH. Advantages and disadvantages of peripherally inserted central venous catheters (PICC) compared to other central venous lines: A systematic review of the literature. Acta Oncol. 2013;52(5):886–92. https://doi.org/10.3109/0284186X.2013.773072 DOI: https://doi.org/10.3109/0284186X.2013.773072
5. Moureau N. Vascular safety: it’s all about PICCs. Nurs Manage. 2006;37(5):22–27. https://doi.org/10.1097/00006247-200605000-00007 DOI: https://doi.org/10.1097/00006247-200605000-00007
6. Nicholson J. Development of an ultrasound-guided PICC insertion service. Br J Nurs. 2010;19(10):S9–17. https://doi.org/10.12968/bjon.2010.19.Sup3.48212 DOI: https://doi.org/10.12968/bjon.2010.19.Sup3.48212
7. Von Eiff C, Jansen B, Kohnen W, Becker K. Infections associated with medical devices: Pathogenesis, management, and prophylaxis. Drugs. 2005;65(2):179–214. https://doi.org/10.2165/00003495-200565020-00003 DOI: https://doi.org/10.2165/00003495-200565020-00003
8. Pelling H, Nzakizwanayo J, Milo S, Denham EL, Macfarlane WM, Bock LJ, et al. Bacterial biofilm formation on indwelling urethral catheters. Lett Appl Microbiol. 2019;68(4):277–93. https://doi.org/10.1111/lam.13144 DOI: https://doi.org/10.1111/lam.13144
9. Busch LM, Kadri SS. Antimicrobial treatment duration in sepsis and serious infections. J Infect Dis. 2020;222(Suppl 2):S142–55. https://doi.org/10.1093/infdis/jiaa247 DOI: https://doi.org/10.1093/infdis/jiaa247
10. Ahmed SS, McCaskey MS, Bringman S, Eigen H. Catheter-associated bloodstream infection in the pediatric intensive care unit: a multidisciplinary approach. Pediatr Crit Care Med. 2012;13(2):e69–72. https://doi.org/10.1097/PCC.0b013e31820ac2e1 DOI: https://doi.org/10.1097/PCC.0b013e31820ac2e1
11. Zochios V, Umar I, Simpson N, Jones N. Peripherally inserted central catheter (PICC)-related thrombosis in critically ill patients. J Vasc Access. 2014;15(5):329–37. https://doi.org/10.5301/jva.5000239 DOI: https://doi.org/10.5301/jva.5000239
12. Dougherty L. Frequency, diagnosis, and management of occlusive and mechanical PICC complications. In: Peripherally inserted central venous catheters. Milano: Springer Milan; 2014. p. 85–94. https://doi.org/10.1007/978-88-470-5665-7_8 DOI: https://doi.org/10.1007/978-88-470-5665-7_8
13. Pina TV, Cunha NC, Ferreira EB, Rocha PRS. Complications of peripherally inserted central catheter: integrative review. Rev Enferm UFPE. 2023;17(1). https://doi.org/10.5205/1981-8963.2023.253981 DOI: https://doi.org/10.5205/1981-8963.2023.253981
14. Oliveira RM, Leitão IMTA, Silva LMSD, Figueiredo SV, Sampaio RL, Gondim MM. Strategies for promoting patient safety: from the identification of the risks to evidence-based practices. Esc Anna Nery. 2014;18:122–9. https://doi.org/10.5935/1414-8145.20140018 DOI: https://doi.org/10.5935/1414-8145.20140018
15. Xu B, Zhang J, Hou J, Ma M, Gong Z, Tang S. Nurses’ attitudes and knowledge of peripherally inserted central catheter maintenance in primary hospitals in China: a cross-sectional survey. Risk Manag Healthc Policy. 2020;13:903–13. https://doi.org/10.2147/RMHP.S250741 DOI: https://doi.org/10.2147/RMHP.S250741
16. Aljanabi HM, Mousa O, Al Zawad MA, Sindi FR, Asalem RA, Alqasim AA, et al. Evaluating the knowledge and attitudes of nurses toward PICC care before and after specialized training in Dammam Health Network (DHN) in the KSA. Gland Surg. 2024;9(2):481–516. https://doi.org/10.13140/RG.2.2.23971.57129
17. Hebl JR. The importance and implications of aseptic techniques during regional anesthesia. Reg Anesth Pain Med. 2006;31(4):311–23. https://doi.org/10.1016/j.rapm.2006.04.004 DOI: https://doi.org/10.1016/j.rapm.2006.04.004
18. Mendes KDS, Silveira RCDCP, Galvão CM. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto Contexto Enferm. 2008;17:758-64. https://doi.org/10.1590/S0104-07072008000400018 DOI: https://doi.org/10.1590/S0104-07072008000400018
19. Oliveira JLR, Beccaria LM, Pereira GAA, Poletti NA, Gabriel CS. Cateter central de inserção periférica em adultos hospitalizados: competências necessárias à sua inserção. Rev Bras Enferm. 2020;73(Supl. 4):e20190240. https://doi.org/10.1590/0034-7167-2019-0240
20. Pereira FG, Oliveira AC, Paula AO, Souza RM. (). Infraestrutura hospitalar e segurança do paciente: uma análise a partir das boas práticas em terapia intravenosa. Rev Bras Enferm. 2019;72(6):1562–8. https://doi.org/10.1590/0034-7167-2018-0680 DOI: https://doi.org/10.1590/0034-7167-2018-0680
21. Walters B, Price C. Quality improvement initiative reduces the occurrence of complications in peripherally inserted central catheters. J Infus Nurs. 2019;42(1):29–36. https://doi.org/10.1097/NAN.0000000000000310 DOI: https://doi.org/10.1097/NAN.0000000000000310
22. Meyer BM. Understanding the patient experience of peripherally inserted central catheter-related deep vein thrombosis using interpretive phenomenology. J Infus Nurs. 2017;40(5):287-96. https://doi.org/10.1097/nan.0000000000000238 DOI: https://doi.org/10.1097/NAN.0000000000000238
23. Sharp R, Cummings M, Fielder A, Mikocka-Walus A, Grech C, Esterman A. The catheter to vein ratio and rates of symptomatic venous thromboembolism in patients with a peripherally inserted central catheter (PICC): a prospective cohort study. Int J Nurs Stud. 2015;52(3):677–85. https://doi.org/10.1016/j.ijnurstu.2014.12.002 DOI: https://doi.org/10.1016/j.ijnurstu.2014.12.002
24. Chang C, Zhang H, Wang Y, Liu F, Li Y. Prognostic factors for catheter-related thrombosis in hematological patients with peripherally inserted central catheters. Thromb Res. 2025;223:105507. https://doi.org/10.1097/MD.0000000000041181 DOI: https://doi.org/10.1097/MD.0000000000041181
25. Santacruz Cerdá E, Arcano K, Arrieta Blanco F, Ortiz Flores A, Mateo Lobo R, Botella Carretero JI, et al. Eficacia de la nutrición parenteral domiciliaria de larga evolución con catéter de acceso periférico: a propósito de un caso. Nutr Hosp. 2016;33(1):185–7. https://doi.org/10.20960/nh.31 DOI: https://doi.org/10.20960/nh.31
26. Alsaleh K, Alosaimi D, Almousawi A, Alshaikh M, Omar H. Effectiveness of a nurse-led peripherally inserted central catheter service: a retrospective cohort study. J Vasc Access. 2024;26(4). https://doi.org/10.1177/11297298241263886 DOI: https://doi.org/10.1177/11297298241263886
27. Assis GLC, Mota ANB, Cesar VF, Turrini RNT, Ferreira LM. Custo direto da inserção do cateter central de inserção periférica por enfermeiros em adultos hospitalizados. Rev Bras Enferm. 2021;74:e20190663. https://doi.org/10.1590/0034-7167-2019-0663 DOI: https://doi.org/10.1590/0034-7167-2019-0663
28. Mitelmão FCR, Mangini Filho S, Chaud MV, Vila MMDC, Balcão VMCF, Oliveira Junior JMD. Caracterização física de cateteres centrais de inserção periférica (CCIP). Matéria (Rio J). 2020;25:e-12545. https://doi.org/10.1590/S1517-707620200001.0870 DOI: https://doi.org/10.1590/s1517-707620200001.0870
29. Lv L, Wang H, Zhang X, Zhang M. Cluster nursing in the prevention of PICC related venous thrombosis and its influence on tumor patients' coagulation functions. Int J Clin Exp Med [Internet]. 2020[cited 2025 Jun 30];13(12):10005–11. Available from: https://e-century.us/files/ijcem/13/12/ijcem0120598.pdf
30. Huang R, Jiang Y, Le X. [Retracted] Prevention and nursing research of PICC catheter related complications in patients with digestive system malignant tumors based on smart medical blockchain. J Healthc Eng. 2021;2021(1):5519722. https://doi.org/10.1155/2021/5519722 DOI: https://doi.org/10.1155/2021/5519722
31. McDiarmid S, Scrivens N, Carrier M, Sabri E, Toye B, Huebsch L, et al. Outcomes in a nurse led peripherally inserted central catheter program: a retrospective cohort study. CMAJ Open. 2017;5(3):E535–9. https://doi.org/10.9778/cmajo.20170010 DOI: https://doi.org/10.9778/cmajo.20170010
32. Mielke D, Wittig A, Teichgräber U. Peripherally inserted central venous catheter (PICC) in outpatient and inpatient oncological treatment. Support Care Cancer. 2020;28:4753–60. https://doi.org/10.1007/s00520-019-05276-0 DOI: https://doi.org/10.1007/s00520-019-05276-0
33. Grau D, Clarivet B, Lotthé A, Bommart S, Parer S. Complications with peripherally inserted central catheters (PICC) used in hospitalized patients and outpatients: a prospective cohort study. Antimicrob Resist Infect Control. 2017;6:1–8. https://doi.org/10.1186/s13756-016-0161-0 DOI: https://doi.org/10.1186/s13756-016-0161-0
34. Curto García N, García Suárez J, Callejas Chavarria M, Gil Fernández JJ, Martín Guerrero Y, Magro Mazo E, et al. A team based multidisciplinary approach to managing peripherally inserted central catheter complications in high risk haematological patients: a prospective study. Support Care Cancer. 2015;24:93–101. https://doi.org/10.1007/s00520-015-2754-1 DOI: https://doi.org/10.1007/s00520-015-2754-1
35. Ullman AJ, August D, Kleidon T, Walker R, Marsh NM, Bulmer A, et al. Peripherally Inserted Central catheter iNnovation to reduce Infections and Clots (the PICNIC trial): a randomized controlled trial protocol. BMJ Open. 2021;11(4):e042475. https://doi.org/10.1136/bmjopen-2020-042475 DOI: https://doi.org/10.1136/bmjopen-2020-042475
36. Zheng LY, Peng Y, Yuan H, Liu SX, Xue H, Zhang XY. Nurses’ knowledge of the management of drug induced peripherally inserted central catheter obstruction: a descriptive phenomenological study. J Vasc Access. 2020;21(5):680–6. https://doi.org/10.1177/1129729819900864 DOI: https://doi.org/10.1177/1129729819900864
37. Morano SG, Latagliata R, Girmenia C, Massaro F, Berneschi P, Guerriero A, et al. Catheter associated bloodstream infections and thrombotic risk in hematologic patients with peripherally inserted central catheters (PICC). Support Care Cancer. 2015;23:3289–95. https://doi.org/10.1007/s00520-015-2740-7 DOI: https://doi.org/10.1007/s00520-015-2740-7
38. Tolera BD, Hui F. Exploring individual and organizational factors influencing registered nurses in preventing peripherally inserted central catheter-related complications. J Nurs Pract. 2025;4(4). https://doi.org/10.5281/zenodo.546199
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2026 Revista Paulista de Enfermagem
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
Propriedade intelectual
Todo o conteúdo da REPEn, exceto onde está identificado, está licenciado sob uma Licença Creative Commons do tipo atribuição CC-BY (https://creativecommons.org/licenses/by/4.0/deed.pt_BR).
