Reducing Lung Injury from Blind Insertion of Small-Bore Feeding Tubes.

ABSTRACT: Using a blind insertion technique to insert small-bore feeding tubes can result in inadvertent placement in the lungs, leading to lung perforation and even mortality. In a Magnet-designated, 500-bed, level 2 trauma center, two serious patient safety events occurred in a four-week period due to nurses blindly inserting a small-bore feeding tube. A patient safety event review team convened and conducted an assessment of reported small-bore feeding tube insertion events that occurred between March 2019 and July 2021. The review revealed six lung perforations over this two-year period. These events prompted the creation of a multidisciplinary team to evaluate alternative small-bore feeding tube insertion practices. The team reviewed the literature and evaluated several evidence-based small-bore feeding tube placement methods, including placement with fluoroscopy, a two-step X-ray, electromagnetic visualization, and capnography. After the evaluation, capnography was selected as the most effective method to mitigate the complications of blind insertion. In this article, the authors describe a quality improvement project involving the implementation of capnography-guided small-bore feeding tube placement to reduce complications and the incidence of lung perforation. Since the completion of the project, which took place from December 13, 2021, through April 18, 2022, no lung injuries or perforations have been reported. Capnography is a relatively simple, noninvasive, and cost-effective technology that provides nurses with a means to safely and effectively insert small-bore feeding tubes, decrease the incidence of adverse events, and improve patient care.

Desenvolvimento de protótipo de aplicativo móvel sobre cuidados de enfermagem para paciente cirúrgico oncológico com sonda enteral / Development of a mobile application prototype on nursing care for surgical oncology patients with enteral tubes

Objetivo: descrever a etapa de criação do protótipo de um aplicativo móvel, baseado em evidências, com informações sobre os cuidados de enfermagem para utilização de sonda enteral em pacientes cirúrgicos oncológicos. Método: estudo metodológico com uso do design instrucional fixo, que percorreu as fases de análise, desenho e desenvolvimento. Foram realizados storyboards com base nas evidências dos principais conteúdos sobre a administração de dietas e de medicamentos via sondas enterais nos seguintes guidelines: Diretrizes Brasileiras de Práticas de Enfermagem e Diretriz Americana de Práticas Seguras para Terapia de Nutrição Enteral. Resultados: na etapa de desenho, foram mapeados os conteúdos que entrariam no aplicativo e elaborados dois roteiros, denominados storyboards, sendo um para o cuidado durante a Administração de Dietas e outro para o cuidado na etapa de Administração de Medicamentos. Nos storyboards, foram descritas as sequências das telas, o conteúdo que seria apresentado em cada uma delas sob forma de texto e de imagem e como esse conteúdo deveria ser organizado no layout da tela. Os storyboards foram submetidos à validação de conteúdo por seis enfermeiros especialistas da área. Em seguida, foram realizados ajustes nos conteúdos e forma de apresentação descritos nos storyboards. Conclusão: o protótipo de aplicativo baseado em evidências científicas atuais é uma ferramenta tecnológica que poderá ser consultada pela equipe de enfermagem durante o cuidado à beira do leito, aumentando a segurança do paciente. O embasamento científico e metodológico para o desenvolvimento do storyboard viabiliza a confiabilidade do produto educativo. Ademais, a validação de conteúdo e aparência por especialistas na área torna tal dispositivo seguro para o público-alvo e uma importante ferramenta profissional, passível de ser utilizada como atividade de educação em saúde

Objective: describe the step of creating the prototype of a mobile application, based on evidence, with information about nursing care for the use of enteral tubes in surgical oncology patients. Method: methodological study using fixed instructional design, which went through the phases of analysis, design, and development. Storyboards were made based on the evidence of the main contents about the administration of diets and medications via enteral tubes in the following guidelines: Brazilian Guidelines for Nursing Practice and American Guideline for Safe Practices for Enteral Nutrition Therapy. Results: in the design stage, the contents that would enter the application were mapped and two scripts were developed, called storyboards, one for the care during Diet Administration and the other for the care in the Medication Administration stage. The storyboards described the screen sequences, the content that would be presented on each screen in text and image form, and how this content should be organized in the screen layout. The storyboards were submitted for content validation by five specialist nurses. Then, adjustments were made to the content and presentation form described in the storyboards. Conclusion: the prototype application based on current scientific evidence is a technological tool that can be consulted by the nursing team during bedside care, increasing patient safety. The scientific and methodological basis for the storyboard development enables the reliability of the educational product. Moreover, the validation of content and appearance by experts in the field makes this device safe for the target audience and an important professional tool, which can be used as a health education activity

Elaboração de instrumento para conhecer o preparo e administração de medicamentos via sonda pela equipe de enfermagem / Instrumento de preparación para saber la preparación y administración de medicamentos a través de la sonda equipo de enfermería / Elaboration of instrument to know practice of preparation and administration of drugs enteral feeding tube by nursing professionals

Objective: to describe the scientific process of elaboration of an instrument in order to know the practice of preparation and administration of drugs via enteral feeding tube by nursing professionals in clinical adult inpatient units. Methods: Methodological study, the preparation of the instrument succeeded from the systematic and intentional search of texts in the Virtual Library in Health (BIREME) in April 2014. Results: Used seven studies from the literature review, resulting in an instrument with six questions about participants and 24 questions for the direct observation of the nursing team work. Conclusion: It is expected to contribute to the production of research on the administration of drugs via enteral feeding tube, which will serve to promote further discussions in health. In addition to these contributions, in the future, this study may help hospital institutions in developing guidelines and protocols, from the systematic observation of their workers.

Objetivo: descrever o processo científico de elaboração de um instrumento para conhecer a prática de preparo e administração de medicamentos via sonda por profissionais de enfermagem, em unidades de internação clínica adulto. Métodos: Estudo metodológico, cuja elaboração do instrumento ocorreu a partir da busca sistematizada e intencional de textos na Biblioteca Virtual em Saúde (BIREME), em abril de 2014. Resultados: Utilizaram-se sete estudos provenientes da revisão de literatura, obtendo-se um instrumento com seis questões de caracterização dos participantes e 24 questões para a observação direta do trabalho da equipe de enfermagem. Conclusão: Espera-se contribuir para a produção de pesquisas a respeito de administração de medicamentos via sonda, que servirão para fomentar novos debates no campo da saúde. Além dessas contribuições, os resultados desse estudo poderão ajudar instituições hospitalares no desenvolvimento de guias e protocolos, futuramente, a partir da observação sistemática dos seus trabalhadores.

Objetivo: describir el proceso científico de desarrollar una herramienta para conocer la práctica de la preparación y administración de medicamentos a través de la sonda por profesionales de enfermería en las unidades de hospitalización de adultos clínica. Métodos: Estudio metodológico, la redacción de los cuales era el instrumento de la búsqueda sistemática y deliberada de los textos en la Biblioteca Virtual en Salud (BIREME) en abril de 2014. Resultados: Se utilizaron siete estudios de la revisión de la literatura, la obtención de una instrumento con seis preguntas sobre los participantes y 24 preguntas para la observación directa del trabajo en equipo de enfermería. Conclusión: Se espera que contribuya a la producción de la investigación sobre la administración de fármacos a través de la sonda, que servirá para promover nuevos debates en el campo de la salud. Además de estas aportaciones, los resultados de este estudio pueden ayudar a los hospitales para desarrollar directrices y protocolos en el futuro, a partir de la observación sistemática de sus trabajadores.

Nurse-Assisted Percutaneous Endoscopic Gastrostomy Tube Placement Is a Safe Procedure in Adult Patients.

The percutaneous endoscopic gastrostomy (PEG) procedure is normally carried out by two doctors. Preliminary experience has suggested that this procedure may be accomplished with the same safety level using one doctor and a specially trained endoscopy nurse. The aim of the study was to assess the immediate outcome and 30 days' procedure-related morbidity following nurse-assisted percutaneous endoscopic gastrostomy (NA-PEG) in an unselected population of adult patients. Retrospective, nonconsecutive analysis of NA-PEG procedures were registered between 2008 and 2014. Demographic data, indications, and early and late procedure complications were registered. During the study period, a total of 222 nonconsecutive adult patients had a NA-PEG placement. Neurologic (56%) and malignant diseases (35%) were the major indications for the PEG placement. The NA-PEGs were performed by six specially trained endoscopy nurses. NA-PEG-related overall morbidity was 24%, and all complications were minor. No procedure-related mortality occurred. When NA-PEG was compared with standard PEG placement literature, there was no increase in the number of complications, and the types of complications were similar. Despite being performed in patients with multiple co-morbid conditions, NA-PEG was a safe procedure with no mortality and minor complications. We suggest that NA-PEG should be used on a larger scale with the intention of saving time and medical costs.

Nasoenteric feeding discharge planning for cancer patients in a Brazilian teaching hospital: a best practice implementation project.

OBJECTIVES: The objective of this project was to improve local practice in nasoenteric feeding discharge planning for cancer patients in a cancer teaching hospital in São Paulo, Brazil. INTRODUCTION: Nasoenteric tubes are commonly used for enteral nutrition in patients with cancer for over seven days during their recovery and this may be continued at home, with clear benefits. RESULTS: Baseline audit results indicated poor compliance (between 0% and 22%) with the current evidence, although good compliance (100%) was observed for three audit criteria. Implementation of the strategies, including changes to achieve higher participation of caregivers, resulted in an improvement of the audited criteria (100% compliance was maintained for three criteria, compliance increased from 22% to 67% for a further three criteria, with 0% compliance for one criterion). CONCLUSIONS: Despite the short time frame of this study, an increase in compliance with best practices proposed by the Joanna Briggs Institute was observed. Implementing a multidisciplinary meeting before patient discharge remains a challenge.

Improved Safety and Efficacy of Small-Bore Feeding Tube Confirmation Using an Electromagnetic Placement Device.

BACKGROUND: Early enteral nutrition has been shown to decrease complications and improve patient outcomes. Post pyloric feeding is recommended for patients with gastric intolerance or at high risk for aspiration. Feeding tube placement can be challenging and pose risk of pulmonary complications. Reliance on radiographic confirmation for feeding tube placement exposes the patient to radiation. Electromagnetic placement device (EMPD) may offer a method to minimize pulmonary complications, increase successful placement, and decrease radiation exposure to the patient. OBJECTIVE: The purpose of this study was to evaluate the safety and efficacy of using EMPD verification, instead of routine abdominal radiographic confirmation, for small-bore feeding tube placement. RESULTS: Variables evaluated were adverse events, utilization of radiographs for confirmation, and success rate of feeding tube placement in the ordered location. Two time frames were reviewed. In a 1-year period, 3754 small-bore feeding tubes were placed using EMPD, with zero adverse events noted. Radiographic confirmation was utilized in 0%-29.2% of the EMPD placed tubes. Successful placement of feeding tubes using EMPD ranged from 94%-99.6%. During a 5-year period, 7081 EMPD feeding tubes were evaluated. One adverse event, pneumothorax, occurred during the placement of these 7081 tubes, for a rate of 0.014%. CONCLUSION: Feeding tube placement confirmation is safe and efficacious via EMPD providing an effective method of feeding tube placement with a success rate >94% into the desired location. EMPD is an accurate verification method of distal tip location, eliminating the need for routine abdominal radiographic confirmation.

Electromagnetic-guided placement of nasoduodenal feeding tubes versus endoscopic placement: a randomized, multicenter trial.

BACKGROUND AND AIMS: Electromagnetic-guided placement (EMP) of a nasoduodenal feeding tube by trained nurses is an attractive alternative to EGD-guided placement (EGDP). We aimed to compare EMP and EGDP in outpatients, ward patients, and critically ill patients with normal upper GI anatomy. METHODS: In 3 centers with no prior experience in EMP, patients were randomized to placement of a single-lumen nasoduodenal feeding tube either with EGDP or EMP. The primary endpoint was post-pyloric position of the tube on abdominal radiography. Patients were followed for 10 days to assess patency and adverse events. The analyses were performed according to the intention-to-treat principle. RESULTS: In total, 160 patients were randomized to EGDP (N = 76) or EMP (N = 84). Three patients withdrew informed consent, and no abdominal radiography was performed in 2 patients. Thus, 155 patients (59 intensive care unit, 38%) were included in the analyses. Rates of post-pyloric tube position between EGDP and EMP were comparable (79% vs 82%, odds ratio 1.16; 90% confidence interval, 0.58-2.38; P = .72). Adverse events were observed in 4 patients after EMP (hypoxia, GI blood loss, atrial fibrillation, abdominal pain) and in 4 after EGDP (epistaxis N = 2, GI blood loss, hypoxia). Costs of tube placements were lower for EMP compared with EGDP: $519.09 versus $622.49, respectively (P = .04). CONCLUSIONS: Success rates and safety of EMP and EGDP in patients with normal upper GI anatomy were comparable. Lower costs and potential logistic advantages may drive centers to adopt EMP as their new standard of care. (Clinical trial registration number: NTR4286.).

Cortrak tube placement part 2: guidance to avoid misplacement is inadequate.

Electromagnetic (EM)-guided tube placement has been successfully used to pre-empt lung misplacement, but undetected misplacements continue to occur. The authors conducted an audit to investigate whether official Cortrak or local guidance enabled differentiation of gastrointestinal (GI) from lung traces. X-ray, pH or an EM trace beyond the gastric body were used to independently confirm gastric position. The authors undertook 596 nasointestinal (NI) tube placements, of which 361 were primary GI placements and 41 lung misplacements. Official guidance that in GI traces a midline deviation is absent cannot differentiate GI from lung traces because deviation is common in both. However, when comparing a trace in the same patient, midline deviation during lung misplacement always occurred >18 cm above the horizontal line compared with only 33% of the subsequent GI deviation (p<0.0001). Official guidance could lead to aborted GI placements or undetected lung placements. EM-guided placement must have an expert-led understanding of the 3D trace pattern, artefact correction and appraised practical experience differentiating GI from lung placement. The authors invite Halyard Health to update guidance in view of these findings.

Validação de conteúdo de instrumento sobre a habilidade em sondagem nasogástrica / Instrument content validation on nasogastric intubation skills

Objetivou-se realizar a validação de conteúdo de um instrumento sobre a habilidade em sondagem nasogástrica com base no modelo de validação de conteúdo de Pasquali. Trata-se de estudo metodológico desenvolvido com 23 enfermeiros docentes de instituições públicas de ensino superior do Rio Grande do Norte, por meio da aplicação do Índice de Validação de Conteúdo (IVC) e do índice Kappa. Na avaliação geral, o instrumento obteve IVC com valores acima de 0,75, IVC total de 0,95 e Kappa total de 0,91. No entanto, algumas alterações foram realizadas e se concentraram nos requisitos sequência instrucional dos tópicos, clareza e vocabulário. Desse modo, o instrumento apresentou confiabilidade e fidedignidade para observar a qualidade da assistência de enfermagem e pode ser utilizado por serviços de saúde e instituições formadoras para avaliar a habilidade dos profissionais e alunos de graduação, no entanto exige outras fases para uma validação de conteúdo mais precisa e específica.

The objective was to validate the content of an instrument on nasogastric intubation skills based on Pasquali's model of content validation. This was a methodological study conducted with 23 nursing teachers in public higher education institutions in Rio Grande do Norte. The Content Validation Index (CVI) and Kappa Index was applied. In the overall evaluation, the instrument obtained a CVI with values above 0.75 with a total CVI of 0.95 and a total Kappa of 0.91. However, some changes were made on the instructional sequence requirements of the topics, and to vocabulary. The instrument proved to be reliable and trustworthy in facilitating nursing care quality and can be used for health services and educational institutions to assess skill levels of professionals and undergraduate students. However, the instrument requires additional stages for a more precise and specific content validation.

The effects of systematic educational interventions about nasogastric tube feeding on caregivers' knowledge and skills and the incidence of feeding complications.

AIMS AND OBJECTIVES: To compare the influence of a systematic nursing intervention on primary caregivers' knowledge and skills about nasogastric tube feeding and the number of nasogastric tube-related complications with that of routine nursing instructions BACKGROUND: To ensure the quality of care and reduce the incidence of complications, it is crucial that primary caregivers receive comprehensive health education about nasogastric tube feeding before hospital discharge. DESIGN: A quasi-experimental research with pretest/post-test evaluations. METHODS: The control group included 127 inpatients whose caregivers received routine education about nasogastric tube feeding, while the experimental group included 106 inpatients whose caregivers received systematic nursing intervention including comprehensive educational pamphlets and video education. The evaluation questionnaire included demographic variables, a nasogastric tube care knowledge scale, and a nasogastric tube skills assessment scale. The post-test was administered after the caregiver performed nasogastric tube feeding for the first time, and complications were noted at follow-up within three months of discharge. RESULTS: In terms of post-test knowledge and skills, the experimental group scored significantly higher than the control group, despite no difference in the pretests. In addition, the incidence rates for constipation, diarrhoea and abdominal distention were lower in the experimental group. CONCLUSIONS: Systematic nursing intervention, including comprehensive educational pamphlets and video education, significantly improved the knowledge and skills of primary caregivers for nasogastric tube feeding. The increased ability of caregivers may have contributed to less incidence of complication. RELEVANCE TO CLINICAL PRACTICE: The results of this study underlined the importance of developing nasogastric tube-related nursing interventions and educational strategies for clinical nurses, home care nurses and caregivers. The research tool used here may serve as a reference for assessing the technical operations of healthcare professionals and the knowledge and skills of caregivers.

Nasogastric tube placement and verification in children: review of the current literature.

Placement of a nasogastric enteral access device (NG-EAD), often referred to as a nasogastric tube, is common practice and largely in the domain of nursing care. Most often an NG-EAD is placed at the bedside without radiographic assistance. Correct initial placement and ongoing location verification are the primary challenges surrounding NG-EAD use and have implications for patient safety. Although considered an innocuous procedure, placement of an NG-EAD carries risk of serious and potentially lethal complications. Despite acknowledgment that an abdominal radiograph is the gold standard, other methods of verifying placement location are widely used and have success rates from 80% to 85%. The long-standing challenges surrounding bedside placement of NG-EADs and a practice alert issued by the Child Health Patient Safety Organization on this issue were the stimuli for the conception of The New Opportunities for Verification of Enteral Tube Location Project sponsored by the American Society for Parenteral and Enteral Nutrition. Its mission is to identify and promote best practices with the potential of technology development that will enable accurate determination of NG-EAD placement for both the inpatient and outpatient pediatric populations. This article presents the challenges of bedside NG-EAD placement and ongoing location verification in children through an overview of the current state of the science. It is important for all health care professionals to be knowledgeable about the current literature, to be vigilant for possible complications, and to avoid complacency with NG-EAD placement and ongoing verification of tube location.

Comparing bedside methods of determining placement of gastric tubes in children.

PURPOSE: The purpose of this study was to compare the accuracy and predictive validity of pH, bilirubin, and CO2 in identifying gastric tube placement errors in children. DESIGN AND METHODS: After the tube was inserted into 276 children, the CO2 monitor reading was obtained. Fluid was then aspirated to test pH and bilirubin. RESULTS: Lack of ability to obtain tube aspirate was the best predictor of NG/OG placement errors with a sensitivity of 34.9% and a positive predictive value of 66.7%. Measuring pH, bilirubin, and CO2 of tube aspirate was less helpful. PRACTICE IMPLICATIONS: Healthcare providers should suspect NG/OG tube misplacement when no fluid is aspirated.

Safe, timely, convenient, and cost-effective: a single-center experience with bedside placement of enteral feeding tubes by midlevel providers using fluoroscopic guidance.

BACKGROUND: Enteral feeding tube placement has been performed by nurses, gastroenterologists using endoscopy, and interventional radiologists. We hypothesized that midlevel providers placed feeding tubes at bedside using fluoroscopy safely, rapidly, and cost-effectively. METHODS: We retrospectively analyzed bedside feeding tube placement under fluoroscopy by trained nurse practitioners. We compared charges for this method with charges for placement by other practitioners. RESULTS: Nurse practitioners placed 632 feeding tubes in 462 patients. Three hundred seventy-nine placements took place in mechanically ventilated placements. Ninety-seven percent of tubes were positioned past the pylorus. The mean fluoroscopy time was 0.7 ± 1.2 minutes. The mean procedure time was 7.0 ± 5.1 minutes. All tubes were placed within 24 hours of the request. There were no complications. Institutional charges for tube placement were $149 for nurse practitioners, $226 for gastroenterologists, and $328 for interventional radiologists. CONCLUSIONS: The placement of feeding tubes under fluoroscopy by nurse practitioners is safe, timely, and cost-effective.

Avaliação do desempenho da equipe de enfermagem na administração de fármacos via intubação gastrointestinal / Nursing team's performance evaluation regarding the administration of drugs via gastrointestinal intubation / Evaluación del desempeño del equipo de enfermería en la administración de fármacos vía intubación gastrointestinal

Esta pesquisa objetivou avaliar o desempenho de técnicos e auxiliares de enfermagem durante o preparo e a administração de fármacos via intubação gastrointestinal. Trata-se de estudo prospectivo, observacional, realizado em um hospital universitário entre julho e setembro de 2009. Os dados foram coletados a partir de observação não participante e análise dos prontuários. O formulário utilizado registrou dados sobre a caracterização dos profissionais, técnica de preparo e administração dos medicamentos. Constatou-se que 69% dos fármacos utilizados estavam na forma farmacêutica sólida, submetidos a processos de derivação. Dos medicamentos administrados, 11 (42%) foram preparados sozinhos, já os demais, 15 (58%), foram associados a outro medicamento no momento da administração. Destes, 6 preparações continham associações que poderiam ocasionar interação após preparo e administração concomitantes. Concluiu-se que havia desigualdades entre o conhecimento da prática recomendada pela literatura específica e a prática clínica, comprometendo a segurança do paciente...

The objective of study was to evaluate the performance of nursing aides and technicians in the preparation and administration of drugs delivered via gastrointestinal intubation. This prospective, observational study was performed at a university hospital between July and September of 2009. Data collection was performed by non-participant observation and patient record analysis. A form was used to register the characterization of the professionals and the technique used to prepare and administer drugs. It was found that 69% of the drugs used were solid, submitted to derivation. Of all the drugs administered, 11 (42%) were prepared alone, while the other 15 (58%) were associated to another drug at the time of administration. Six preparations contained ingredients that could cause harmful interactions when simultaneously prepared and administered. It is concluded that there were differences between the practices recommended by the specific literature and actual clinical practices, thus compromising patient safety...

Se objetivó evaluar el desempeño de técnicos y auxiliares de enfermería durante la preparación y administración de fármacos vía intubación gastrointestinal. Estudio prospectivo, observacional, realizado en hospital universitario ente julio y setiembre de 2009. Datos recolectados mediante observación no participante y análisis de historias clínicas. El formulario utilizado registró datos sobre caracterización de los profesionales, técnicas de preparación y administración de los medicamentos. Se constató que 69% de los fármacos utilizados eran de forma farmacéutica sólida, sometidos a procesos de derivación. De los medicamentos administrados, 11 (42%) fueron administrados como monodroga, mientras los otros 15 (58%) fueron asociados a otro medicamento al momento de la administración. De éstas, seis preparaciones contenían asociaciones que podrían ocasionar interacción luego de la preparación y administración concomitante. Se concluye en que existía desigualdad entre el conocimiento de la práctica recomendada por la literatura específica y la práctica clínica, comprometiéndose la seguridad del paciente...

Maintaining placement of temporary enteral feeding tubes in adults: a critical appraisal of the evidence.

Maintaining placement of temporary enteral feeding tubes requires ongoing bedside nursing assessment. Tube placement verification is essential to detect and minimize adverse effects. A critical appraisal of current evidence and best practice recommendations regarding temporary feeding tubes is provided.

Bedside assessment of enteral tube placement: aligning practice with evidence.

Since the flexible Levin tube was introduced in 1921, enteral feeding has become ubiquitous. From the out-set, nurses have been responsible for confirming the correct placement of enteral feeding tubes prior to their use for alimentation or medication administration, but current nursing practice doesn't always reflect the best evidence. Although research has established the inadequacy of auscultation to determine proper tube placement, this method is still commonly practiced. The authors examine the research that's been conducted over the past 25 years and compare the accumulated evidence with current practice, as reflected in a convenience sample of 28 New England hospitals. In addition, they evaluate various methods for assessing enteral feeding tubes and make evidence-based practice recommendations.

Evaluation of Intensivist-Nurses’ Knowledge Concerning Medication Administration Through Nasogastric and Enteral Tubes / Avaliação do conhecimento do enfermeiro de unidade de terapia intensiva sobre administração de medicamentos por sonda nasogástrica e nasoenteral / Evaluación del conocimiento del enfermero de terapia intensiva sobre administración de medicamentos por sonda nasogástrica y nasoentérica

This study evaluates the knowledge of nurses working in intensive care units concerning recommendations for the proper administration of medication through nasogastric and enteral tubes. This exploratory-descriptive study with a quantitative approach was carried out with 49 nurses in an intensive care unit of a tertiary hospital in Fortaleza, CE, Brazil. A total of 36.7 percent of nurses reported they disregard the dosage forms provided by the pharmacy at the time of administering the medication through tubes. Metal, wood, or a plastic mortar is the method most frequently reported (42.86 percent) for crushing prescribed solid forms; 32.65 percent leave the drugs in 20ml of water until dissolved; 65.3 percent place the responsibility for choosing the pharmaceutical formulation and its correlation with the tube site, either into the stomach or into the intestine, on the physician. The results indicate there is a gap between specific literature on medication administered through tubes and knowledge of nurses on the subject.

O estudo objetivou avaliar o conhecimento do enfermeiro de unidade de terapia intensiva sobre as recomendações para a correta administração de medicamentos, por sondas nasogástrica e nasoenteral. Estudo exploratório-descritivo, com abordagem quantitativa, realizado com 49 enfermeiros em uma unidade de terapia intensiva de um hospital terciário, localizado na cidade de Fortaleza, no Estado do Ceará, Brasil. Dos enfermeiros, 36,7 por cento relataram não dar atenção às formas farmacêuticas disponibilizadas pelo setor de farmácia na hora da utilização por sonda. O pilão de metal, madeira ou plástico foi o método mais referido (42,86 por cento) para triturar as formas sólidas prescritas. Sendo que 32,65 por cento costuma deixar os fármacos em 20mL de água até dissolver, 65,3 por cento atribuem ao médico a responsabilidade sobre a decisão da formulação farmacêutica e a correlação com a localização da sonda no trato gastrointestinal. Os achados apontam para diferença entre a literatura específica para medicamentos administrados por sonda e o conhecimento de enfermeiros sobre o assunto.

El objetivo del estudio fue evaluar los conocimientos del enfermero de la unidad de cuidados intensivos sobre las recomendaciones para la correcta administración de medicamentos por sonda nasogástrica y nasoentérica. Se trata de un estudio exploratorio-descriptivo y cuantitativo con 49 enfermeros en una unidad de cuidados intensivos de un hospital terciario, en la ciudad de Fortaleza, estado de Ceará, Brasil. 36,7 por ciento no prestan atención a las formas disponibles en el sector de farmacia en el momento de su utilización por sonda. El pilón de metal, madera o plástico fue el método más citado (42,86 por ciento) para triturar las formas sólidas prescritas. 32,65 por ciento dejan los fármacos en 20mL de agua hasta que se disuelvan. 65,3 por ciento atribuyen al médico la responsabilidad de decidir sobre la formulación y la correlación con la ubicación de la sonda en el tracto gastrointestinal. Los resultados indican que hay una diferencia entre la literatura para los medicamentos administrados por sonda y el conocimiento de los enfermeros sobre el tema.