Limitações quanto à administração via sonda enteral de medicamentos prescritos para pacientes submetidos a operações do trato gastrointestinal e de parede abdominal: perfil e fatores associados

Abstract

Nutritional therapy (NT) aims at maintaining or improving the patient's nutritional status; preventing and treating malnutrition; improving immune response; and decreasing postoperative complications and length of stay. Enteral nutrition (EN) is currently the most used and recommended form of NT in surgical patients. This practice involves the administration of industrialized or artisanal formulations by enteral tubes or ostomies, which routes are often shared for drug administration. Because of this, the aim of this study was to analyze the profile and associated factors of the limitations of administering drugs through enteral tubes among patients submitted to gastrointestinal and abdominal wall surgeries. To do so, we analyzed all electronic prescription orders issued from May 1, 2017 to December 5, 2017 for postoperative patients on enteral nutrition, admitted to the gastroenterology ward of a large general university hospital located in Belo Horizonte - Minas Gerais. The drugs prescribed for administration through enteral tubes were identified and then was proceeded a qualitative literature review of their individual limitations regarding their preparation and administration through this route. The prevalence of limitations regarding drug administration via enteral tube and associated factors was determined by uni (Pearson chi-square) and multivariate analysis (logistic regression). All analyzes were performed considering a significance level of 5%. A total of 341 prescriptions, belonging to 40 patients were evaluated (mean 8.52). We identified the prescription order for 725 drugs to be administered through feeding tube, corresponding to 44 different types of drugs. In the review, 49 articles were recovered, which allowed identifying 188 limitations regarding preparation/administration through feeding tube among the prescribed drugs (25.9% of the total). The presence of at least one limitation (prevalence = 57.5%; n=23) was positively associated with age 60 years or older (OR 4.67; IC95% 1.07-20.40). Due to the scarcity of articles and the lack of a database for drug administration via feeding tube, this study becomes a tool of great relevance to the process of pharmacotherapeutic care and quality and safety of treatment provided to the patient. The number of limitations identified was reduced, but its association with advanced age and severity of the study population reinforces the relevance of its identification and management. There is need still for further studies in the area, especially involving older surgical patients, whose more complex state demands greater attention.