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Master's Dissertation
DOI
Document
Author
Full name
Roberta Maria de Pina Pereira
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2019
Supervisor
Committee
Kusumota, Luciana (President)
Baracioli, Flavia Fernanda Luchetti Rodrigues
Oliveira, Marília Pilotto de
Sousa, Fernanda Raphael Escobar Gimenes de
Title in Portuguese
Incidentes relacionados ao uso de sondas nasogástricas e nasoentéricas: Um estudo de coorte com idosos hospitalizados
Keywords in Portuguese
Acidentes
Hospitalização
Nutrição enteral
Saúde do idoso
Segurança do paciente
Abstract in Portuguese
Introdução: No Brasil e no mundo, a literatura científica sobre estudos que avaliam a terapia de nutrição enteral (TNE) com foco em idosos ainda é escassa. Contudo, as pesquisas realizadas nesse campo demonstram alta prevalência de pacientes com idade superior a 60 anos em TNE e consequentemente, supõe-se que o número de incidentes relacionados ao uso de sondas nasogátricas (SNG) e nasoentéricas (SNE) em pacientes idosos também seja alto. Objetivos: Identificar e analisar os incidentes relacionados ao uso de SNG e SNE, suas consequências e os respectivos fatores associados e óbito em idosos durante o período de hospitalização. Material e método: Trata-se de um estudo de coorte prospectivo, descritivo e analítico realizado nas unidades de internação de clínica médica de um hospital público no interior paulista. Os participantes foram idosos que atenderam aos critérios de seleção e concordaram com a participação na pesquisa. Os instrumentos utilizados na coleta de dados foram: formulários de dados gerais, sobre incidentes e de acompanhamento; Classificação de pacientes (Fugulin); Índice de Comorbidades de Charlson (ICC) e Nível de Consciência Simplificado (MEWS). Foram atendidas às recomendações éticas para pesquisa com seres humanos conforme Res. 466/2012 e o projeto foi aprovado por um Comitê de Ética em Pesquisa. Os dados coletados foram importados para o programa estatístico R, no qual foram geradas as análises estatísticas descritivas. Para a análise de associação entre as variáveis categóricas foram utilizados testes de Qui-quadrado ou testes exatos de Fisher. Para análise de comparação entre os incidentes e variáveis independentes foi realizado o teste de KruskalWallis e modelos de regressão logística com desfecho incidentes e óbito. O nível de significância adotado foi de 5%. Resultados: A coorte acompanhou a internação hospitalar de 86 idosos, dos quais 83,72% tinham entre 60 e 79 anos. As neoplasias representaram 31,39% dos motivos da internação, 39,53% tinham alta dependência dos cuidados da enfermagem, 73,05% estavam alerta no momento da admissão e 59,30% apresentavam alto risco de óbito calculado. Foram registrados 101 incidentes para 37 idosos, dos quais o saque não planejado da sonda enteral e a diarreia foram mais frequentes. Dentre as consequências dos incidentes para os pacientes, 81,2% dos incidentes causaram danos leves ou moderados. Houve apenas um caso registrado para a maioria (59,98%) dos pacientes que sofreu incidentes. Pacientes classificados com cuidados mínimos não apresentaram incidente mecânico. Conclusões: A idade se apresentou como um fator que aumenta as chances de ocorrência de incidentes gastrointestinais e mecânicos, e desta forma o aumento da idade torna os idosos mais vulneráveis a estes incidentes relacionados ao uso de SNG/SNE. A ocorrência de incidentes não teve relação com o óbito, contudo a mortalidade dos idosos seguidos na coorte foi alta (30,23%)
Title in English
Incidents related to the use of nasogastric and nasoenteral tubes: A cohort study in hospitalized elderly
Keywords in English
Accidents
Enteral nutrition
Health of the elderly
Hospitalization
Patient safety
Abstract in English
Introduction: Scientific literature on studies that evaluate the enteral nutrition therapy (ENT) with focus on the elderly is still scarce in Brazil and in the world. However, the researches carried out in that field demonstrate high prevalence of ENT patients over 60 years old, which is justifiable, due to changes related to senescence and senility. Consequently, it is assumed that the number of incidents related to the use of enteral tubes in elderly patients is equally high. Objectives: Identify and analyse the incidents related to the use of Nasogastric tube (NGT) and Nasoenteric tube (NET), its consequences, the respective factors associated to it, and death in elderly patients during hospitalization. Material and method: This is a prospective, descriptive and analitical cohort study carried out in general practice hospitalization units of a public hospital in São Paulo State inland. The participants were elderly patients which met the research selection criteria and agreed to participate. The instruments used in the data collection were the following: General data forms, about incidents and accompaniment; Classification of patients (Fugulin); Charlson Índex of Comorbity (CCI) and a simplified level of consciousness (MEWS). Ethical recommendations for research with human beings have been observed, according to Res. 466/2012 and the Project was approved by a Research Ethics Committee. Data gathered were imported to the Statistics program R, where the descriptive statistical analysis have been generated. Q Square test or Exact Fisher tests have been used for the association analysis among the categorical variables. For the analysis of comparison amongst the incidents and independent variables, the test of Kruskal-Wallis and models of logistic regression with outcome of incidents and death. The level of significance adopted for the statistical analysis was 5% (? = 0,05). Results: The cohort accompanied the hospital admission of 86 elderly patients - 83,72 of them were aged between 60 and 79 years. The neoplasms represented 31,39% of the reasons for hospitalization, 39,53% had high dependance on the nursing care; 73,05% were responsive at the moment of admission and e 59,30% presented high calculated risk of death. The non planned withdrawal of the enteral tube and diahrrea were the most frequent among the 101 incidents registered for 37 elderly patients. Amongst the consequences of the incidents, regarding the patients, 81,2% caused light or moderate damage. For the majority of the patients (59,98%) who suffered incidentes, there was only one case registered. Pacients classified with minimal care did not present any mechanical incidents. Conclusions: Age has appeared as a factor that increases the chances of gastrointestinal and mechanical incidents, Therefore, the increase in age that makes the elderly more vulnerable to these incidents related to the use of NGT and NET. The occurance of incidentes was not related to the death, however, the mortality of elderly patients followed by the cohort was high (30,23%)
 
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Publishing Date
2019-11-07
 
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