As sondas de alimentação constituem uma via alternativa para a administração de medicamentos em pacientes cuja situação clínica impede a utilização da via oral. É sabido que a utilização de medicamentos nesses pacientes requer cuidados especiais, tanto na seleção da forma farmacêutica quanto no preparo e na administração dos mesmos. Para se conhecer as características dos pacientes internados usando sondas de nutrição enteral (SNE) no Hospital de Clínicas de Porto Alegre, bem como os medicamentos prescritos e utilizados via SNE, foram analisados 315 prontuários médicos na primeira etapa do estudo. A maioria dos pacientes era formada por adultos (51%) do sexo masculino (59%), com diagnóstico de câncer (32%) ou doença neurológica (21%). A média de uso da SNE foi de 15 dias. Noventa e cinco por cento dos pacientes utilizaram algum fármaco na forma farmacêutica sólida, principalmente comprimidos (72%), cápsulas (12%) e drágeas (9%). A taxa de troca de sonda correspondeu a 32%. Na segunda etapa do estudo, auxiliares de enfermagem foram observados em suas rotinas de trabalho no hospital, visando analisar o processo de preparo e administração dos medicamentos aos pacientes. Foi observado que esses profissionais não utilizavam técnicas adequadas nos momentos de preparo dos medicamentos e administração dos mesmos aos pacientes com SNE. A alta incidência do uso de formas farmacêuticas sólidas, o número de medicamentos prescritos, os dias de uso da sonda e a diversidade de métodos de trabalho utilizados no momento da derivação, diluição e administração dos medicamentos pelos auxiliares de enfermagem mostram que, apesar da ampla informação disponível na literatura sobre o uso de medicamentos em pacientes com SNE, a prática clínica está sendo realizada de modo inconsistente em relação aos dados disponíveis, trazendo assim dificuldades para o tratamento dos pacientes. / The tube feeding constitutes an alternative way for patients with a clinic situation that the oral way is hindered. It is known that these patients require particular methods in the drug utilization process, even in the selection of the pharmaceutical form of the medicine as in the preparation and administration of these drugs. To understand the patient characteristics using enteral tube feeding (ETF) in the Hospital de Clínicas de Porto Alegre as well as the drugs prescribed by ETF way, the medical records of 315 interned patients were analyzed in the first stage of the research. The majority of patients was adults (51%) of male gender (59%) with cancer (32%) or neurological disease (21%) diagnostic. The ETF using average was 15 days. Ninety five per cent of the analyzed patients used some kind of drug in the solid pharmaceutical form, mainly tablets (72%), capsule (12%) and coated tablet (9%). The ETF using average was 15 days. Ninety five per cent of the analyzed patients used some kind of drug in the solid pharmaceutical form, mainly tablets (72%), capsule (12%) and coated tablet (9%). The average of ETF changing was 32%. In the second stage of this research, nurse assistants were observed in their routine of working in the hospital to analyze the process of preparation and administration of the drugs to patients with ETF. It was observed that the nurses assistant neither use proper techniques in the moment of the drugs preparation nor in the administration of these drugs to patients with ETF. The high incidence of using solid pharmaceutical forms; the number of drugs prescribed, the using days of ETF and the diversity of working methods used in the derivation, dilution and administration moment by the nurse assistants showed that despite good amount of information in the literature about the administration of drugs in patients using ETF, the clinical practice is being carried out in a way that is inconsistent with the data available, causing difficulties for the patient treatment.

Syftet med denna litteraturstudie är att undersöka vad omvårdnad innebär utifrån ett sjuksköterskeperspektiv och etiska faktorer gällande enteral näringstillförsel vid palliativ vård. Forskningsansatsen har varit en systematisk litteraturstudie baserad på Goodmans sju steg i forskningsprocessen. Studiens resultat baseras på 10 vetenskapliga artiklar. Utifrån dessa artiklars resultat utkristalliserades olika teman såsom riktlinjer, dokumentation, åtgärder, komplikationer och effekter inom området omvårdnad kring enteral näringstillförsel. Resultatet påvisar att enteral nutrition ingår i sjuksköterskans ansvarsområde. Det finns skrivna riktlinjer gällande enteral nutrition. Dock visades sig att det finns luckor mellan vad som är rekommenderad vård och vad som sker ute i klinisk verksamhet. Den mest förekommande komplikationen med nasogastrisk sond är aspiration av maginnehåll till lungorna. / The aim of this systematic review is to study what nursing care can imply from a nursing perspective and ethical issues regarding enteral nutrition in palliative care. The research approach has been a systematic literature review based on Goodmans seven principles. The result of the study is based on 10 scientific articles. From the results of the articles different themes, emerged such as guidelines, documentation, interventions, complications and effects within the area of enteral nutrition and nursing care. The results show that enteral nutrition is part of the nurse’s scope of practice and that written recommendations and guidelines exist. However, the review also shows that gaps between recommended nursing care and practice exist. The most frequent complication concerning enteral nutrition is lung aspiration.

Indiana University-Purdue University Indianapolis (IUPUI) / Gastric residual volume (GRV) is a clinical assessment to evaluate gastric emptying and enteral feeding tolerance. Factors such as the tube size, tube material, tube port configuration, placement of the tube in the gastric fluid, the amount of fluid and person completing the assessment may influence the accuracy of residual volume assessment. Little attention has been paid to assessing the accuracy of GRV measurement when the actual volume being aspirated is known, and no studies have compared the accuracy in obtaining RV using the three different techniques reported in the literature that are used to obtain aspirate in practice (syringe, suction, and gravity drainage). This in vitro study evaluated three different methods for aspirating feeding formula through two different tube sizes (10 Fr [small] and 18 Fr [large]), tube materials (polyvinyl chloride and polyurethane), using four levels of nursing experience (student, novice, experienced and expert) blinded to the five fixed fluid volumes of feeding formula in a simulated stomach, to determine if the RV can be accurately obtained. The study design consisted of a 3x2x2x4x5 completely randomized factorial ANOVA (with a total of 240 cells) and 479 RV assessments were made by the four nurse participants. All three methods (syringe, suction and gravity) used to aspirate RV did not perform substantially well in aspirating fluid, and on average, the methods were able to aspirate about 50% of the volume available. The syringe and suction techniques were comparable and produced higher proportions of RVs, although the interrater reliability of RV assessment was better with the syringe method. The gravity technique generally performed poorly. Overall, the polyvinyl chloride material and smaller tubes were associated with higher RV assessments. RV assessment is a variable assessment and the three methods did not perform well in this in vitro study. These findings should be further explored and confirmed using larger samples. This knowledge will be important in establishing the best technique for assessing RV to maximize EN delivery in practice and will contribute to future research to test strategies to optimize EN intake in critically ill patients.