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Background: Polypharmacy and the use of high-alert medications in patients with nasally placed feeding tube (NPFT) increase the risks of drug related problems. Objective: Characterize drugs prescribed to patients with NPFT and compare the rates of polypharmacy and high-alert medication use at admission and hospital discharge. Design and setting: Multicenter cross-sectional study with 327 participants. Methods: Data of patients with NPFT were obtained from the medical records and recorded in an electronic data collection tool. Mean number of drugs, polypharmacy and number of high-alert medications prescribed on admission and at discharge were compared using Wilcoxon or McNemar's tests. Generalized Estimating Equations analyzed the relationship between polypharmacy and high-alert medications according to age and time point. Primary reason for hospital admission, level of consciousness, severity of comorbid diseases and patient care complexity were also assessed. Results: Most patients were male, older people, hospitalized for circulatory system diseases and had at least one comorbidity. On admission, a significant number of patients were alert (59.9%), at high risk for death (43.1%) and high dependent on nursing care (35.4%). Additionally, 92% patients were on polypharmacy on admission, versus 84.7% at hospital discharge (p = 0,0011). The occurrence of polypharmacy was independent of age (p = 0.2377). >17% of all drugs prescribed were high-alert medications, with no statistically significant difference between admission and discharge (p = 0,3957). There was no statistical evidence that the use of high-alert medications increases with age (n = 0,5426). Conclusions: These results support the planning of multidisciplinary qualified actions for patients using NPFT.

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OBJECTIVES: To evaluate patterns and determinants of longitudinal growth among children requiring complex biventricular repair for congenital heart disease, as well as to assess for associations of growth with early feeding modality, comorbidities, postoperative complications, and socioeconomic characteristics. STUDY DESIGN: A single-institution retrospective cohort study was performed in children born February 1999 to March 2009 with complex congenital heart disease who underwent biventricular repair before age 4 years, defined by Risk Adjustment in Congenital Heart Surgery-1 category 3-5. Clinical characteristics, height, weight, and body mass index (BMI) from ages 2-12 years were collected by chart review. Neighborhood-level socioeconomic data were identified using a geographic information system approach. The adjusted association of covariates with growth outcomes was estimated using multivariable linear regression models using generalized estimating equations. RESULTS: Compared with population growth curves, the cohort (n = 150) trended toward early decrease in age-adjusted weight and height. Early tube feeding was significantly associated with decreased BMI before adolescence (-0.539; 95% CI -1.02, -0.054; P = .029). In addition, other clinical and perioperative characteristics had significant associations with growth, including low birth weight, preoperative tube feeds, need for multiple bypass runs, and diagnosis of feeding disorder. CONCLUSIONS: Early childhood growth in children with complex biventricular repair may be impaired. Early tube feeding was associated with decreased BMI over the course of early childhood, which may indicate a need for continued close nutrition follow-up and support even beyond the duration of tube feeds.

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OBJECTIVE: To examine rates and determinants of home nasogastric (NG)-tube feeding at hospital discharge in a cohort of very preterm infants within the Canadian Neonatal Network (CNN). STUDY DESIGN: This was a population-based cohort study of infants born <33 weeks of gestation and admitted to neonatal intensive care units (NICUs) participating in the CNN between January 1, 2010, and December 31, 2018. We excluded infants who had major congenital anomalies, required gastrostomy-tube, or were discharged to non-CNN facilities. Multivariable logistic regression analysis was used to identify independent determinants of home NG-tube feeding at hospital discharge. RESULTS: Among the 13 232 infants born very preterm during the study period, 333 (2.5%) were discharged home to receive NG-tube feeding. Rates of home NG-tube feeding varied across Canadian NICUs, from 0% to 12%. Determinants of home NG-tube feeding were gestational age (aOR 0.94 per each gestational week increase, 95% CI 0.88-0.99); duration of mechanical ventilation (aOR 1.02 per each day increase, 95% CI 1.01-1.02); high illness severity at birth (aOR 1.32, 95% CI 1.01-1.74); small for gestational age (aOR 2.06, 95% CI 1.52-2.78); male sex (aOR 0.61, 95% CI 0.49-0.77); severe brain injury (aOR 1.60, 95% CI 1.10-2.32); and bronchopulmonary dysplasia (aOR 2.22, 95% CI 1.67-2.94). CONCLUSIONS: Rates of home NG-tube feeding varied widely between Canadian NICUs. Higher gestational age and male sex reduced the odds of discharge home to receive NG-tube feeding; and in contrast small for gestational age, severe brain injury, prolonged duration on mechanical ventilation and bronchopulmonary dysplasia increased the odds.

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PURPOSE: To verify the factors associated with the need of tube feeding (TF) during patients post-ischemic stroke hospitalization. METHOD: This is a retrospective study with 70 adult post-ischemic hemispheric stroke adult patients hospitalized in the Neurology department at a tertiary public hospital in Santa Catarina, Brazil. We investigated associations between the need of a feeding tube during hospitalization and the variables age, gender, admission and discharge NIHSS and FOIS, length of hospital stay in days, presence of thrombolytic therapy, extensive stroke, hemisphere affected, prior stroke, pneumonia during hospitalization, presence of signs of laryngeal penetration and laryngotracheal aspiration and dysphagia in the first and last swallowing clinical evaluation. RESULTS: A total of 33 participants used tube feeding. There was a significant relationship among tube feeding and the following parameters: NIHSS (p value .001), FOIS (p value .001), extensive stroke (p value .034), left hemisphere involvement (p value .035), pneumonia during hospitalization (p value .001), length of hospital stay in days (p value .001), signs of laryngotracheal penetration/aspiration (p value .001) and dysphagia in speech-language assessment (p value .001). CONCLUSION: Tube feeding during patients hospitalization after ischemic hemispheric stroke was predicted by the severity of stroke and signs of airway permeation.Key pointsSwallowing difficulty is one of the most common post-stroke consequences.There are few studies on the characterization of post-stroke patients with tube feeding.Tube feeding after ischemic stroke predictors were severity of stroke and signs of airway permeation.

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A alta prevalência de pacientes críticos tem aumentado a demanda pela terapia nutricional para recuperação da saúde. As sondas enterais possibilitam a oferta de nutrientes e a melhora do estado nutricional de pacientes com problemas de deglutição, desde que o sistema digestório mantenha sua capacidade de absorção. A equipe que assiste o paciente com necessidade de receber terapia nutricional através de sonda enteral deve ter conhecimento sobre a passagem da sonda e sobre a administração das dietas, com treinamento para prevenir, reconhecer e tratar as possíveis complicações. Neste trabalho foram entrevistados enfermeiros envolvidos na passagem de sonda enteral no Hospital Irmandade de Misericórdia do Jahu, registrando opiniões e problemas enfrentados durante esse procedimento, com o intuito de produzir a seguir um manual técnico para oferecer suporte ao procedimento realizado pelos servidores do hospital. Os resultados apontaram algumas carências de padronizações e certa resistência na exposição de dúvidas, mesmo por meio do questionário. Após o conhecimento sobre as respostas dos entrevistados, elaborou-se um manual de orientação padronizado sobre a introdução e o posicionamento da sonda enteral, com o objetivo de contribuir com a atualização da equipe e permitirá realização de procedimentos mais seguros.(AU)

The high prevalence of critically ill patients has increased the demand for nutritional therapy for health recovery. Enteral probes make it possible to provide nutrients and improve the nutritional status of patients with swallowing problems if the digestive system maintains its absorption capacity. The team that assists the patient in need of receiving nutritional therapy through an enteral tube must have knowledge about the passage of the tube and about the administration of diets, with training to prevent, recognize and treat possible complications. In this work, nurses involved in the passage of enteral tubes at the Irmandade de Misericórdia do Jahu Hospital were interviewed, recording opinions and problems faced during this procedure, in order to produce a technical manual to support the procedure performed by the hospital servers. The results pointed out some lack of standardization and some resistance in the exposition of doubts, even though the questionnaire. After knowledge of the respondents' responses, a standardized guidance manual on the introduction and placement of the enteral tube was developed, with the aim of contributing to the updating of the team and will allow for safer procedures.(AU)

La alta prevalencia de pacientes críticos ha aumentado la demanda de terapia nutricional para la recuperación de la salud. Las sondas enterales permiten proporcionar nutrientes y mejorar el estado nutricional de los pacientes con problemas para tragar, siempre que el sistema digestivo mantenga su capacidad de absorción. El equipo que ayuda al paciente que necesita recibir terapia nutricional a través de un tubo enteral debe tener conocimiento sobre el paso del tubo y sobre la administración de dietas, con capacitación para prevenir, reconocer y tratar posibles complicaciones. En este trabajo, se entrevistó a enfermeras involucradas en el paso de tubos enterales en el Hospital Irmandade de Misericórdia do Jahu, registrando opiniones y problemas enfrentados durante este procedimiento, con el !n de producir un manual técnico para respaldar el procedimiento realizado por los servidores del hospital. Los resultados señalaron cierta falta de estandarización y cierta resistencia en la exposición de dudas, incluso a través del cuestionario. Después de conocer las respuestas de los encuestados, se desarrolló un manual de orientación estandarizado sobre la introducción y colocación del tubo enteral, con el objetivo de contribuir a la actualización del equipo y permitir procedimientos más seguros.(AU)

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Resumen: El uso de apoyo nutricional ambulatorio, enteral o parenteral, ha sido un paso necesario en la opti mización del soporte nutricional en pacientes, que, por diversas patologías, no logran cumplir con sus requerimientos por vía oral (VO). En el presente artículo se presentan las recomendaciones de la Rama de Nutrición, dirigidas a los equipos de salud que atienden pacientes pediátricos, que requieran alimentación enteral por un tiempo prolongado. Su objetivo general es entregar pautas para un co rrecto manejo en estos pacientes. Se describe la conformación ideal del equipo de salud para atención y seguimiento de dichos pacientes, los criterios de ingreso al programa y su forma de evaluación en el tiempo. Además, se describen características generales de la alimentación enteral, vías de admi nistración, fórmulas enterales disponibles, complicaciones de este soporte nutricional y por último monitorización y seguimiento del paciente.

Abstract The use of home enteral or parenteral nutrition has been a necessary step in the optimization of nu tritional support in patients who, due to several diseases, fail to meet their nutritional requirements by oral feeding. This article presents the recommendations of the Chilean Pediatric Society Nutritio nal Branch, aimed at health teams that treat pediatric patients who require enteral feeding for a long time. The general objective is to provide guidelines for the proper management of these patients. It describes the ideal conformation of the health team for the care and follow-up of those patients, the program admission criteria, and its evaluation method over time. In addition, it describes general characteristics of enteral feeding, routes of administration, available enteral formulas, complications, and patient follow-up.

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RESUMO Este artigo teve por objetivo descrever a progressão da disfagia e a decisão pela via de alimentação em um caso de síndrome MELAS, sob o olhar dos cuidados paliativos. Trata-se de um caso do sexo feminino, que, por volta dos 26 anos de idade sofreu os primeiros sintomas da doença e teve sua função de deglutição progressivamente impactada. Foi realizado acompanhamento fonoaudiológico durante seis meses, com aplicação do protocolo de Avaliação da Segurança da Deglutição, da Functional Oral Intake Scale (FOIS) e gerenciamento da deglutição, com retornos ambulatoriais semanais e mensais. Em seis meses de seguimento, a paciente evoluiu de disfagia moderada a disfagia moderada a grave e variou entre os níveis 5 e 1 da FOIS. Manteve a alimentação por via oral, com restrição de consistências, manobra de deglutições múltiplas e controle de volume para ingestão de líquido, até que, ao final dos seis meses de seguimento, foi realizada gastrostomia. A alimentação por via oral em mais de uma consistência, porém com compensações, foi reduzida a uma alimentação exclusiva por via alternativa, ao longo do acompanhamento fonoaudiológico. Optou-se por manter a via oral de alimentação até a colocação da gastrostomia. A não sugestão de sonda nasoenteral se embasou no respeito à vontade da paciente e na possibilidade de alimentar-se, minimamente, de uma consistência por via oral.

ABSTRACT This article aims to describe a dysphagia progression and a choice of the feeding options in a case of MELAS syndrome, under the perspective of palliative care. It is a case in which a woman at the age of 26 years suffered the first symptoms of the disease and had the swallowing functionality progressively impacted. Speech-Language Therapy follow-up was performed at 6 months with the application of a swallowing safety assessment protocol, Functional Oral Intake Scale (FOIS) and swallowing management, with weekly and monthly outpatient returns. At six months of follow-up, the patient progressed from moderate dysphagia to moderate to severe dysphagia and ranged from levels 5 to 1 of FOIS. The patient maintained oral feeding with consistency restriction, dry swallowing maneuver, and control of volume for liquid intake until the end of the six months of follow-up, when gastrostomy was made. Oral feeding in more than one consistency but with compensations was reduced to exclusive non-oral feeding. We chose to maintain oral feeding until the gastrostomy was placed. Non-suggestion of nasoenteral tube was based on the patient's desire and the possibility of oral feeding in at least one food consistency.

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Introdução: a Enfermagem desempenha um papel preponderante, ativo e de responsabilidade crescente no controle da nutrição enteral, uma vez que além de promover sua administração, realiza a vigilância, manutenção e controle da via escolhida e o volume administrado com importante atenção para a prevenção de possíveis complicações. Objetivo: caracterizar as principais falhas relacionadas ao conhecimento e a prática da assistência de enfermagem à pacientes em uso de sonda gastrointestinal, por meio de uma revisão integrativa. Métodos: trata-se de uma revisão integrativa de literatura realizada no período de abril a maio de 2013 nas bases de dados Literatura Latino-Americana e do Caribe (LILACS), Base de Dados de Enfermagem (BDENF), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Publicações Médicas (PubMed) e Isi Web of Knowledge, com uso de descritores controlados e não-controlados. Conclusão: a assistência de enfermagem apresentou condutas desfavoráveis que repercutiram de forma negativa no cuidado. Desse modo, evidencia-se a necessidade da implantação de protocolos para utilização durante a formação de recursos humanos em enfermagem, que norteiem a realização da assistência às pessoas alimentadas por sonda(AU)

Introducción: la Enfermería juega un papel importante, activo y creciente en el control de la nutrición integral, así como la promoción de su gestión, monitorización, mantenimiento y control del volumen administrado para la prevención de complicaciones. Objetivo: caracterizar las principales fallas relacionadas al conocimiento y la práctica de la asistencia de enfermería a pacientes sometidos al uso de sonda gastrointestinal. Métodos: revisión integrativa de la literatura realizada en el periodo de abril a mayo de 2013 en las bases de datos Literatura Latino-Americana e do Caribe (LILACS), Base de Dados de Enfermagem (BDENF), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Publicações Médicas (PubMed) e Isi Web of Knowledge, con el uso de los descriptores controlados y no controlados. Conclusión: la asistencia de enfermería presentó conductas desfavorables que repercutieron de manera negativa en el cuidado. De ese modo, se evidencia la necesidad de la implantación de protocolos para utilización durante la formación de recursos humanos en enfermería, que guíen la realización de la asistencia a las personas alimentadas por sonda(AU)

Introduction: nursing play an important rol in the integral nutrition control. Objective: to characterize the main defects related to the knowledge and the practice of the nursing care regarding patients using gastrointestinal tube, thru an integrative revision. Method: it is an integrative revision of literature performed in the period between April and May of 2013 in the databases Literatura Latino-Americana e do Caribe (LILACS), Base de Dados de Enfermagem (BDENF), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Publicações Médicas (PubMed) and Isi Web of Knowledge, using controlled and non-controlled descriptors. Conclusion: the nursing care presented unfavorable behaviors that affected the care in a negative way. Thus, it became evident the necessity of the implementation of protocols to be used during the training of human resources in nursing, to guide the performance of the care to people being fed by tube(AU)

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RACIONAL: O correto posicionamento da sonda nasogástrica para nutrição enteral tem sido alvo de várias investigações, demonstrando as controvérsias e a complexidade do procedimento. OBJETIVO: Prever as medidas antropométricas para realizar a inserção de sonda para nutrição enteral até o estômago empregando a esofagogastroduodenoscopia para calcular-se o comprimento necessário até o estômago. MÉTODO: Medidas externas foram obtidas entre a ponta do nariz vs lobo da orelha vs apêndice xifóide vs umbigo e altura correlacionadas com a medida padrão obtida em pacientes submetidos à esofagogastroduodenoscopia diagnóstica. RESULTADOS: Encontrou-se correlação estatisticamente significativa entre a transição esofagogástrica identificada durante a endoscopia, acrescida da distância da rima labial à arcada dentária superior, com a distância compreendida entre os pontos anatômicos lóbulo da orelha e apêndice xifóide (r=0.75). CONCLUSÃO: A distância entre o lóbulo da orelha ao apêndice xifóide (0.75) e a distância entre o lóbulo da orelha ao apêndice xifóide até o ponto médio da cicatriz umbilical, subtraindo a distância da ponta do nariz ao lóbulo da orelha, foram parâmetros anatômicos seguros para estimar-se a distância da transição esofagogástrica. A altura na posição em pé (r = 0,72) também pode ser utilizada como um indicador da distância necessária para inserir o tubo no estômago.

BACKGROUND:The correct placement of a nasogastric tube for enteral nutrition is subject of several investigations, demonstrating the controversy of the procedure. AIM: To establish an external measure that can correspond to the internal measurement which determines the insertion length of nasogastric feeding tube up to the stomach. METHODS: External measures were obtained between points: nose tip vs earlobe vs xiphoid appendix vs umbilicus and height correlated with the standard measures obtained from patients undergoing diagnostic esophagogastroduodenoscopy. RESULTS: It was found a significative statistical correlation between esophagogastric junction, identified during the esophagogastroduodenoscopy, with the distance measured between the anatomic points of the earlobe and xiphoid appendix (r= 0.75) and from this line with the orthostatic height (r=0.72). CONCLUSION: The distance between the earlobe to the xiphoid appendix (0.75) and the distance between the earlobe to the xiphoid appendix to the midpoint of the umbilicus, subtracting the distance from tip of nose to earlobe, were safe anatomical parameters to reach the esophagogastric junction. The height in the standing position (r= 0.72) also can be used as an indicator of the length necessary to insert the tube into the stomach. The height in the standing position (r= 0.72) also can be used as an indicator of the length necessary to insert the tube into the stomach.

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