Franciele Anziliero

Nasoenteral tube: factors associated with delay between indication and use in emergency services

Objetivo: conhecer o tempo entre indicacao e uso da sonda nasoenteral (SNE) e fatores associados a atrasos. Metodo: coorte prospectiva que acompanhou adultos de uma Emergencia brasileira, desde a indicacao ao uso da SNE, avaliando-se variaveis clinicas e do processo de trabalho. Adotou-se o modelo de Equacoes de Estimacoes Generalizadas para identificar fatores associados a atrasos em cada etapa do processo. Resultados: o tempo entre indicacao e uso da SNE foi 573 (IQR: 360-1093) minutos, em 150 insercoes de SNE. Insercoes em pacientes que anteriormente nao a utilizavam, retardos na rotina assistencial medica, da nutricao e enfermagem, uso de ventilacao mecânica, noradrenalina e jejum foram fatores para maior tempo ate o uso da sonda. Conclusao: o tempo entre indicacao e uso de SNE foi elevado, excedendo 10 horas em metade dos casos. Fatores relacionados as condicoes clinicas do paciente e a gestao da assistencia contribuiriam para atrasos.OBJECTIVE to know the time between indication and use of a nasoenteral tube (NET) and factors associated with delays. METHOD A prospective cohort study that followed adults in a Brazilian emergency department, since the indication of the use of a NET, evaluating clinical variables and the work process. The Generalized Estimated Equations model was adopted to identify factors associated with the delays in each stage of the process. RESULTS the time between indication and use of NET was 573 (IQR: 3601,093) minutes, in 150 insertions of NET. Insertions in patients who previously did not use it; delays in the medical, nutrition, and nursing care routine; use of mechanical ventilation; noradrenaline; and fasting were factors for longer time before the use of the tube. CONCLUSION the time between indication and use of NET was high, exceeding 10 hours in half of the cases. Factors related to the clinical condition of the patient and to the care management would contribute to delays.

Feeding tube placement: auscultatory method and x-ray agreement

OBJECTIVE to evaluate the correlation between the auscultation test and X-ray when detecting the position of an enteral feeding tube. METHODS cross-sectional study in an intensive care unit in southern Brazil, in 2011. Clinical nurse and nurse researcher performed auscultation test recording the impressions regarding the placement of an enteral feeding tube in 80 patients. A doctor evaluated the X-ray. Kappa coefficient and PABAK reviewed the agreements. RESULTS The X-ray showed that 70% of the enteral tubes were in the stomach, 27.4% in the duodenum, 1.3% in the esophagus, and 1.3% in the right lung. There was a weak correlation between clinical nurses and nurse researchers (PABAK=0.054; P=0.103), clinical nurses and X-rays (PABAK=0.188; P=0.111) and nurse researchers and X-rays (PABAK=0.128; P=0.107) . The auscultation test did not detect two risk conditions, enteral feeding tube in the esophagus and the bronchus. CONCLUSION the auscultation test showed little agreement with the X-ray on the enteral feeding tube location.

Sonda nasoenteral : fatores associados ao delay entre indicação e uso em emergência

Objetivo: conhecer o tempo entre indicacao e uso da sonda nasoenteral (SNE) e fatores associados a atrasos. Metodo: coorte prospectiva que acompanhou adultos de uma Emergencia brasileira, desde a indicacao ao uso da SNE, avaliando-se variaveis clinicas e do processo de trabalho. Adotou-se o modelo de Equacoes de Estimacoes Generalizadas para identificar fatores associados a atrasos em cada etapa do processo. Resultados: o tempo entre indicacao e uso da SNE foi 573 (IQR: 360-1093) minutos, em 150 insercoes de SNE. Insercoes em pacientes que anteriormente nao a utilizavam, retardos na rotina assistencial medica, da nutricao e enfermagem, uso de ventilacao mecânica, noradrenalina e jejum foram fatores para maior tempo ate o uso da sonda. Conclusao: o tempo entre indicacao e uso de SNE foi elevado, excedendo 10 horas em metade dos casos. Fatores relacionados as condicoes clinicas do paciente e a gestao da assistencia contribuiriam para atrasos.OBJECTIVE to know the time between indication and use of a nasoenteral tube (NET) and factors associated with delays. METHOD A prospective cohort study that followed adults in a Brazilian emergency department, since the indication of the use of a NET, evaluating clinical variables and the work process. The Generalized Estimated Equations model was adopted to identify factors associated with the delays in each stage of the process. RESULTS the time between indication and use of NET was 573 (IQR: 3601,093) minutes, in 150 insertions of NET. Insertions in patients who previously did not use it; delays in the medical, nutrition, and nursing care routine; use of mechanical ventilation; noradrenaline; and fasting were factors for longer time before the use of the tube. CONCLUSION the time between indication and use of NET was high, exceeding 10 hours in half of the cases. Factors related to the clinical condition of the patient and to the care management would contribute to delays.

Incidents and adverse events in enteral feeding tube users: warnings based on a cohort study

INTRODUCTION few studies clearly describe incidents or adverse events that occur during the enteral nutrition process, which hinders the identification of critical points. OBJECTIVE to describe breaches of protocol, incidents and adverse events, during the period beginning with indications until the use of enteral feeding tube in an Emergency Department. METHODS trained nurses prospectively monitored a cohort of adults in a Brazilian Emergency Department where use of enteral feeding tube was indicated and up to their use. The study sought to identify breaches of protocol, such as verbal orders to insert feeding tubes, or authorization of their use without X-rays to confirm the position of the feeding tubes. Incidents were characterized as events that could have caused harm to patients, while adverse events were those that did actually cause harm. The study was approved by the institutions Research Ethics Committee. RESULTS in 150 feeding tube insertions, there were 169 breaches of protocol: verbal orders for feeding tube insertion (n = 59); no X-rays taken (n = 11); and no examination of the X-rays by physicians (n = 12). There were 30 incidents: unintentional removal of the feeding tube (n = 23); and administration of enteral nutrition after breach of preventive barriers. There was one adverse event: aspiration of enteral nutrition. CONCLUSION there was a high frequency of breaches of safety protocols; many developed into incidents, and one resulted in an adverse event.

Sonda Nasogástrica: factores asociados al delay entre indicación y uso en Servicio de Urgencia

Objetivo: conhecer o tempo entre indicacao e uso da sonda nasoenteral (SNE) e fatores associados a atrasos. Metodo: coorte prospectiva que acompanhou adultos de uma Emergencia brasileira, desde a indicacao ao uso da SNE, avaliando-se variaveis clinicas e do processo de trabalho. Adotou-se o modelo de Equacoes de Estimacoes Generalizadas para identificar fatores associados a atrasos em cada etapa do processo. Resultados: o tempo entre indicacao e uso da SNE foi 573 (IQR: 360-1093) minutos, em 150 insercoes de SNE. Insercoes em pacientes que anteriormente nao a utilizavam, retardos na rotina assistencial medica, da nutricao e enfermagem, uso de ventilacao mecânica, noradrenalina e jejum foram fatores para maior tempo ate o uso da sonda. Conclusao: o tempo entre indicacao e uso de SNE foi elevado, excedendo 10 horas em metade dos casos. Fatores relacionados as condicoes clinicas do paciente e a gestao da assistencia contribuiriam para atrasos.OBJECTIVE to know the time between indication and use of a nasoenteral tube (NET) and factors associated with delays. METHOD A prospective cohort study that followed adults in a Brazilian emergency department, since the indication of the use of a NET, evaluating clinical variables and the work process. The Generalized Estimated Equations model was adopted to identify factors associated with the delays in each stage of the process. RESULTS the time between indication and use of NET was 573 (IQR: 3601,093) minutes, in 150 insertions of NET. Insertions in patients who previously did not use it; delays in the medical, nutrition, and nursing care routine; use of mechanical ventilation; noradrenaline; and fasting were factors for longer time before the use of the tube. CONCLUSION the time between indication and use of NET was high, exceeding 10 hours in half of the cases. Factors related to the clinical condition of the patient and to the care management would contribute to delays.

Sistema Manchester: tempo empregado na classificação de risco e prioridade para atendimento em uma emergência

Objetivo: Avaliar o tempo que antecede e o tempo empregado na classificacao de risco, na prioridade para atendimento e no destino dos pacientes 24 horas apos a admissao em uma Emergencia. Metodos: Coorte retrospectiva que incluiu adultos classificados pelo Sistema Manchester de Classificacao de Risco na maior Emergencia do sul do pais em 2012. Os dados foram disponibilizados em forma de planilha eletronica e analisados de acordo com suas caracteristicas e distribuicao. Resultados: Dos 139.556 atendimentos, metade dos pacientes chegou a classificacao no tempo preconizado (7; IQR: 2 – 20 minutos), sendo classificados em dois (IQR: 1 – 3) minutos. As classificacoes de menor prioridade e as altas hospitalares (88,4%) foram mais frequentes que hospitalizacoes (11,4%) e obitos (0,2%). Conclusao: O tempo envolvido em atividades que antecedem o primeiro atendimento medico permaneceu dentro do preconizado. A proporcao de classificacoes de menor prioridade e as altas, 24 horas apos a classificacao, foram elevadas. Palavras-chave: Servico hospitalar de enfermagem. Triagem. Enfermagem. Gestao em saude. Emergencias.Objective To assess the time before and time spent on risk classification, priority of care, and destination of patients within 24 hours after their admission to an emergency medical service. Methods Retrospective cohort study that included adults classified by the Manchester Triage System at the largest emergency medical service in the south of the country in 2012. The data were made available in the form of an electronic sheet and analyzed according to their characteristics and distribution. Results Of the 139,556 admissions, half of the patients arrived at classification within the time recommended (7; IQR: 2-20 minutes), and were classified within two (IQR: 1-3) minutes. Lower priority classifications and hospital discharges (88.4%) were more frequent than hospitalizations (11.4%) and deaths (0.2%). Conclusion The time involved in activities that precede the first medical care remained within the recommendation. The proportion of lower priority classifications and hospital discharges within 24 hours after classification was high.

Posicionamiento de la sonda enteral: concordancia entre el teste de ausculta y rayo-x

OBJECTIVE to evaluate the correlation between the auscultation test and X-ray when detecting the position of an enteral feeding tube. METHODS cross-sectional study in an intensive care unit in southern Brazil, in 2011. Clinical nurse and nurse researcher performed auscultation test recording the impressions regarding the placement of an enteral feeding tube in 80 patients. A doctor evaluated the X-ray. Kappa coefficient and PABAK reviewed the agreements. RESULTS The X-ray showed that 70% of the enteral tubes were in the stomach, 27.4% in the duodenum, 1.3% in the esophagus, and 1.3% in the right lung. There was a weak correlation between clinical nurses and nurse researchers (PABAK=0.054; P=0.103), clinical nurses and X-rays (PABAK=0.188; P=0.111) and nurse researchers and X-rays (PABAK=0.128; P=0.107) . The auscultation test did not detect two risk conditions, enteral feeding tube in the esophagus and the bronchus. CONCLUSION the auscultation test showed little agreement with the X-ray on the enteral feeding tube location.

Sondagem enteral: concordância entre teste de ausculta e raio-x na determinação do posicionamento da sonda

OBJECTIVE to evaluate the correlation between the auscultation test and X-ray when detecting the position of an enteral feeding tube. METHODS cross-sectional study in an intensive care unit in southern Brazil, in 2011. Clinical nurse and nurse researcher performed auscultation test recording the impressions regarding the placement of an enteral feeding tube in 80 patients. A doctor evaluated the X-ray. Kappa coefficient and PABAK reviewed the agreements. RESULTS The X-ray showed that 70% of the enteral tubes were in the stomach, 27.4% in the duodenum, 1.3% in the esophagus, and 1.3% in the right lung. There was a weak correlation between clinical nurses and nurse researchers (PABAK=0.054; P=0.103), clinical nurses and X-rays (PABAK=0.188; P=0.111) and nurse researchers and X-rays (PABAK=0.128; P=0.107) . The auscultation test did not detect two risk conditions, enteral feeding tube in the esophagus and the bronchus. CONCLUSION the auscultation test showed little agreement with the X-ray on the enteral feeding tube location.