{"id":1216,"date":"2024-12-01T10:00:42","date_gmt":"2024-12-01T13:00:42","guid":{"rendered":"https:\/\/www.nutrimedrj.com.br\/?p=1216"},"modified":"2024-11-22T16:12:46","modified_gmt":"2024-11-22T19:12:46","slug":"dissipando-mitos-sobre-o-uso-da-nutricao-parenteral","status":"publish","type":"post","link":"https:\/\/www.nutrimedrj.com.br\/index.php\/2024\/12\/01\/dissipando-mitos-sobre-o-uso-da-nutricao-parenteral\/","title":{"rendered":"Dissipando mitos sobre o uso da Nutri\u00e7\u00e3o Parenteral"},"content":{"rendered":"<p><img decoding=\"async\" loading=\"lazy\" class=\"alignnone size-full wp-image-1221\" src=\"http:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/11\/IMAGEM-PRINCIPAL-DO-BLOG.png\" alt=\"\" width=\"1024\" height=\"596\" srcset=\"https:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/11\/IMAGEM-PRINCIPAL-DO-BLOG.png 1024w, https:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/11\/IMAGEM-PRINCIPAL-DO-BLOG-300x175.png 300w, https:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/11\/IMAGEM-PRINCIPAL-DO-BLOG-768x447.png 768w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/p>\n<p>&nbsp;<\/p>\n<p class=\"cvGsUA direction-ltr align-justify para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">A nutri\u00e7\u00e3o parenteral (NP), uma das aquisi\u00e7\u00f5es mais not\u00e1veis da medicina moderna, atua como uma modalidade da terapia nutricional que salva e\/ ou mant\u00e9m vidas e, pode ser iniciada para pacientes de todas as faixas et\u00e1rias, quando as necessidades nutricionais n\u00e3o s\u00e3o atingidas pela via oral ou via enteral.<\/span><\/p>\n<p class=\"cvGsUA direction-ltr align-justify para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Embora sustente a vida, a NP possui risco de efeitos colaterais de curto ou longo prazo. Para maior seguran\u00e7a e efic\u00e1cia da NP, deve-se aderir \u00e0s boas pr\u00e1ticas e realizar um monitoramento atento.<\/span><\/p>\n<p class=\"cvGsUA direction-ltr align-justify para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Ainda assim, apesar dos fatos, v\u00e1rios mitos sobre o in\u00edcio e a administra\u00e7\u00e3o segura de NP ainda existem.<\/span><\/p>\n<p class=\"cvGsUA direction-ltr align-justify para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Este documento foi elaborado pela Sociedade Americana de Nutri\u00e7\u00e3o Parenteral e Enteral (ASPEN), para dissipar mitos relacionados \u00e0s condi\u00e7\u00f5es dos pacientes, componentes da NP, estabilidade e compatibilidade e administra\u00e7\u00e3o.<\/span><\/p>\n<p class=\"cvGsUA direction-ltr align-start para-style-body\">\n<p>&nbsp;<\/p>\n<h3><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Mitos relacionados ao Paciente<\/span><\/h3>\n<ul>\n<li><strong><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Pacientes Adultos com hiperglicemia n\u00e3o devem nunca ser iniciados na NP\u00b9\u00b4\u00b2:<\/span><\/strong>\n<ul>\n<li>\n<p class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Garantir o in\u00edcio cuidadoso de NP em pacientes adultos com hiperglicemia (glicose &gt; 180 mg\/ dL).<\/span><\/p>\n<\/li>\n<li>\n<p class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">As complica\u00e7\u00f5es metab\u00f3licas podem ser prevenidas atrav\u00e9s da implementa\u00e7\u00e3o das seguintes estrat\u00e9gias:<\/span><\/p>\n<ul>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Iniciar a NP com baixa dose de glicose, ajustada para hiperglicemia.<\/span><\/li>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Progress\u00e3o mais conservadora na NP, com monitoramento atento aos dados laboratoriais e pronta interven\u00e7\u00e3o, se indicado.<\/span><\/li>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Considerar o uso di\u00e1rio de emuls\u00e3o lip\u00eddica (EL) para ofertar calorias n\u00e3o provenientes da glicose.<\/span><\/li>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Usar insulina, de acordo com os protocolos da institui\u00e7\u00e3o, para controlar os n\u00edveis de glicose.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\"><strong>Pacientes Adultos com hipertrigliceridemia n\u00e3o devem ser iniciados na NP\u00b9<\/strong>.<\/span>\n<ul>\n<li>\n<p class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Garantir o in\u00edcio cuidadoso de NP em pacientes adultos com hipertrigliceridemia (triglic\u00e9rides s\u00e9rico &gt; 200 mg\/ dL).<\/span><\/p>\n<\/li>\n<li>\n<p class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">As complica\u00e7\u00f5es metab\u00f3licas podem ser prevenidas atrav\u00e9s da implementa\u00e7\u00e3o das seguintes estrat\u00e9gias:<\/span><\/p>\n<ul>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Iniciar a NP com baixas doses de EL para hipertrigliceridemia basal.<\/span><\/li>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Progress\u00e3o da NP mais conservadora, com monitoramento atento aos dados laboratoriais e pronta interven\u00e7\u00e3o, se indicado.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\"><strong>NP causa infec\u00e7\u00f5es relacionadas ao cateter central.\u00b9<\/strong><\/span>\n<ul>\n<li>\n<p class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">A ades\u00e3o e a utiliza\u00e7\u00e3o de um conjunto de procedimentos de cuidados, baseados em evid\u00eancias, para inser\u00e7\u00e3o e manuten\u00e7\u00e3o do cateter venoso central, as melhorias nos dispositivos de cuidados com o cateter e o controle da glicose no sangue reduziram a taxas de infec\u00e7\u00f5es ao longo do tempo, restringindo um dos mais comuns e s\u00e9rios eventos adversos<\/span> <span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">associados<\/span> <span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">com a administra\u00e7\u00e3o da NP.<\/span><\/p>\n<p class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">As t\u00e9cnicas para preven\u00e7\u00e3o de infec\u00e7\u00e3o incluem:<\/span><\/p>\n<ul>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Procedimentos de prepara\u00e7\u00e3o ass\u00e9ptica<\/span><\/li>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Ades\u00e3o aos padr\u00f5es e pol\u00edticas de cuidados com o acesso venoso e equipos<\/span><\/li>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Gest\u00e3o do controle de infe\u00e7\u00e3o e sepse<\/span><\/li>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Estrat\u00e9gias nutricionais e controle da glicose<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Pacientes n\u00e3o devem iniciar a NP domiciliar sem antes ter iniciado a NP no hospital\u00b9.<\/span><\/strong>\n<ul>\n<li>\n<p class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Pacientes adultos podem iniciar, com seguran\u00e7a, a NP domiciliar quando as etapas abaixo forem seguidas:<\/span><\/p>\n<ul>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Estabelecer as pol\u00edticas institucionais que delineiam as circunst\u00e2ncias onde a NP domiciliar (NPD) pode ocorrer.<\/span><\/li>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Delinear os crit\u00e9rios de elegibilidade, centrados no paciente, para iniciar a NPD.<\/span><\/li>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Desenvolver protocolos e procedimentos rigorosos para iniciar a NP, monitorar as respostas \u00e0 terapia, a educa\u00e7\u00e3o do paciente e, o registro dos resultados.<\/span><\/li>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Conduzir uma avalia\u00e7\u00e3o m\u00e9dica, cl\u00ednica e psicossocial do paciente candidato a fim de verificar fatores de risco para eventos adversos relacionados com o in\u00edcio da NPD.<\/span><\/li>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Considerar iniciar<\/span> <span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">terapia de NPD somente quando a avalia\u00e7\u00e3o confirmar que os benef\u00edcios s\u00e3o maiores do que os riscos.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">A NP n\u00e3o \u00e9 indicada at\u00e9 que o paciente adulto com desnutri\u00e7\u00e3o esteja em dieta zero por 7 dias\u00b9.<\/span><\/strong><\/li>\n<\/ul>\n<p class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Em pacientes adultos com desnutri\u00e7\u00e3o ou em risco de desnutri\u00e7\u00e3o<\/span> <span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">E<\/span><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\"> os pacientes que possuem contraindica\u00e7\u00e3o para a Nutri\u00e7\u00e3o Enteral (NE), presen\u00e7a de intoler\u00e2ncia \u00e0 NE ou se h\u00e1 fun\u00e7\u00e3o intestinal insuficiente para manter ou restaurar o estado nutricional, a NP deve ser iniciada precocemente:<\/span><\/p>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Risco nutricional: 3-5 dias<\/span><\/li>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Desnutri\u00e7\u00e3o moderada ou grave: assim que for vi\u00e1vel<\/span>\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Entretanto, \u00e9 aceit\u00e1vel aguardar 7 dias para iniciar a NP em pacientes est\u00e1veis e bem nutridos se forem capazes de atingir &gt;50% das necessidades nutricionais pela via oral<\/span> <span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">ou atrav\u00e9s da nutri\u00e7\u00e3o enteral.<\/span><\/li>\n<li>\n<p class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">O in\u00edcio da NP deve ser<\/span> <span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">postergado em pacientes com grave instabilidade metab\u00f3lica at\u00e9 que as condi\u00e7\u00f5es do paciente melhorem.<\/span><\/p>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Pacientes com hiponatremia sempre necessitam de doses altas de s\u00f3dio na NP\u00b3\u00b4\u2074<br \/>\n<\/span><\/strong><\/p>\n<ul>\n<li class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Altas doses de s\u00f3dio, na presen\u00e7a de hiponatremia, nem sempre s\u00e3o necess\u00e1rias. A etiologia da hiponatremia deve ser estabelecida<\/span> <span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">a fim de guiar as dosagens de s\u00f3dio.<\/span>\n<ul>\n<li class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Se a etiologia da hiponatremia for por sobrecarga volum\u00e9trica, adicionar mais s\u00f3dio pode piorar a sobrecarga e a hiponatremia.<\/span><\/li>\n<li class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Pacientes podem necessitar de mais s\u00f3dio na NP se tiverem grandes perdas atrav\u00e9s de estomas, diarreia ou perdas g\u00e1stricas,<\/span><\/li>\n<li class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">A dosagem padr\u00e3o de s\u00f3dio da ASPEN para as necessidades de pacientes adultos = 1-2 mEq\/ kg\/ dia (doses para Pediatria variam de acordo com a faixa et\u00e1ria).<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Pacientes com n\u00edveis normais de c\u00e1lcio n\u00e3o necessitam de c\u00e1lcio na NP.\u00b3\u00b4\u2074<\/span><\/strong>\n<ul>\n<li class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Os ossos liberam c\u00e1lcio livre em resposta \u00e0 diminui\u00e7\u00e3o dos n\u00edveis s\u00e9ricos; a omiss\u00e3o prolongada de c\u00e1lcio na NP contribui para a progress\u00e3o da doen\u00e7a \u00f3ssea metab\u00f3lica.<\/span><\/li>\n<li class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Os padr\u00f5es para dosagens de c\u00e1lcio\/ ASPEN, em NP para pacientes adultos = 10-15mEq\/ dia (doses para pediatria variam de acordo com a faixa et\u00e1ria).<\/span><\/li>\n<li class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Realizar o monitoramento adequado dos n\u00edveis de c\u00e1lcio, de acordo com<\/span> <span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">os protocolos da institui\u00e7\u00e3o.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<h3><\/h3>\n<h3><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Mitos relacionados \u00e0 Compatibilidade e Estabilidade<\/span><\/h3>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Utilizar e aplicar a literatura existente, sobre compatibilidade e estabilidade, aos produtos utilizados\u2075.<\/span><\/strong>\n<ul>\n<li class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">A literatura existente \u00e9 baseada em determinados produtos e n\u00e3o deve ser extrapolada para os novos produtos dispon\u00edveis no mercado, atualmente.<\/span><\/li>\n<li class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Para avalia\u00e7\u00e3o da estabilidade ou compatibilidade, verificar as informa\u00e7\u00f5es dos produtos utilizados. Entrar em contato com os fabricantes para detalhamentos.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">A validade \u00e9 baseada apenas na esterilidade\u2079.<\/span><\/strong>\n<ul>\n<li class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Para <\/span><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">NP, a data de validade deve ser baseada na compatibilidade, estabilidade e esterilidade<\/span><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">:<\/span>\n<ul>\n<li class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Apesar de n\u00e3o ser destacado na USP&lt;797&gt;, \u00e0 complexidade da NP<\/span> <span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">atribui-se a Categoria de Prepara\u00e7\u00e3o Est\u00e9ril (CSP), ou seja, de medica\u00e7\u00f5es preparadas em ambientes classificado, de Salas Limpas, utilizando t\u00e9cnicas ass\u00e9pticas para garantir que estejam livres de microorganismos.<\/span><\/li>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Diferente de outros produtos da Categoria CPSs 2, onde a data de validade baseia-se apenas na esterilidade, para a NP, al\u00e9m da esterilidade, a data de validade deve levar em considera\u00e7\u00e3o a estabilidade f\u00edsica e qu\u00edmica (compatibilidade e estabilidade).<\/span><\/li>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Para NP, a data de validade da Tabela 13 da USP &lt;797&gt; n\u00e3o deve ser seguida; uma outra validade deve ser atribu\u00edda onde considere-se a estabilidade f\u00edsica e qu\u00edmica.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Mitos relacionados \u00e0 Administra\u00e7\u00e3o<\/span><\/h3>\n<ul>\n<li><strong><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">A NP deve sempre ser infundida atrav\u00e9s de cateter venoso central\u00b2\u00b4\u2076\u00b4\u00b9\u00b2.<\/span><\/strong>\n<ul>\n<li class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">A NP pode ser infundida atrav\u00e9s de acesso venoso central ou perif\u00e9rico, dependendo da osmolaridade final da mistura, entretanto a via central \u00e9 o acesso de prefer\u00eancia.<\/span><\/li>\n<li class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Para utiliza\u00e7\u00e3o de acesso perif\u00e9rico, a NP n\u00e3o pode exceder 900 mOsm\/ L.<\/span><\/li>\n<li class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Evite utilizar o termo \u201cNPT, nutri\u00e7\u00e3o parenteral total\u201d. Este termo \u00e9 antiquado.<\/span><\/li>\n<li class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Diga NP Central ou NP Perif\u00e9rica, para evitar confus\u00e3o em rela\u00e7\u00e3o ao acesso de infus\u00e3o.<\/span><\/li>\n<li class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Leia no r\u00f3tulo qual o acesso venoso deve ser utilizado, cateter central ou perif\u00e9rico \u2013 esta especifica\u00e7\u00e3o deve sempre estar descrita no r\u00f3tulo.<\/span><\/li>\n<li class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">As emuls\u00f5es lip\u00eddicas podem ser infundidas atrav\u00e9s de ambos acessos venosos, central e<\/span> <span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">perif\u00e9rico.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">O uso de filtro de infus\u00e3o n\u00e3o \u00e9 necess\u00e1rio na administra\u00e7\u00e3o da NP\u00b9\u00b2.<\/span><\/strong>\n<ul>\n<li class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">\u00c9 recomendado a utiliza\u00e7\u00e3o de filtros de infus\u00e3o para a administra\u00e7\u00e3o de NP.<\/span>\n<ul>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">O uso de v\u00e1rios filtros para a administra\u00e7\u00e3o caiu em desuso; a utiliza\u00e7\u00e3o de <\/span><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">um \u00fanico filtro de infus\u00e3o, <\/span><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">ao inv\u00e9s de v\u00e1rios filtros, \u00e9 uma pr\u00e1tica mais simples e pode aumentar a ades\u00e3o \u00e0 utiliza\u00e7\u00e3o do filtro.<\/span><\/li>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Um \u00fanico filtro de 1,2 micras \u00e9 recomendado durante a infus\u00e3o de todos os tipos de formula\u00e7\u00f5es de<\/span> <span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">NP.<\/span><\/li>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Um \u00fanico filtro de 1,2 micras pode prevenir a infus\u00e3o de part\u00edculas &gt;2 micras, que s\u00e3o de alto risco se infundidas.<\/span><\/li>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Posicione o filtro em linha o mais pr\u00f3ximo ao eixo do cateter.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">As emuls\u00f5es lip\u00eddicas (EL) podem ser infundidas em Y, com a NP 2&#215;1, por 24h\u2076\u00b4\u2077.<\/span><\/strong>\n<ul>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Se a NP contiver EL (NP 3&#215;1), a NP pode ser infundida em at\u00e9 24h.<\/span><\/li>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Se a EL \u00e9 infundida em separado<\/span><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">, em Y com uma NP 2&#215;1, seja em uma bolsa manipulada ou no recipiente original, <\/span><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">o tempo m\u00e1ximo de infus\u00e3o \u00e9 limitado em 12 horas<\/span><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">. Isto deve-se ao risco aumentado de contamina\u00e7\u00e3o microbiana devido \u00e0 natureza isot\u00f4nica das EL.<\/span><\/li>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Se, clinicamente for necess\u00e1rio mais de 12h de infus\u00e3o de EL (ex.: pacientes pedi\u00e1tricos e neonatais), a dose di\u00e1ria deve ser dividida em duas bolsas iguais e a administra\u00e7\u00e3o deve ser de 12h para cada uma.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<h3><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Mitos relacionados aos Componentes<\/span><\/h3>\n<ul>\n<li><strong><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">O Gluconato de C\u00e1lcio e o Cloreto de C\u00e1lcio s\u00e3o intercambi\u00e1veis\u2075.<\/span><\/strong>\n<ul>\n<li class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">O Gluconato de C\u00e1lcio (GlCa) e o Cloreto de C\u00e1lcio (CaCl2) <\/span><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">N\u00c3O s\u00e3o intercambi\u00e1veis<\/span><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">.<\/span><\/li>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">O GlCa tem o pH de 6,0 a 8,2 e sofre menos dissocia\u00e7\u00e3o em \u00e1gua do que o CaCl2, resultando em menos c\u00e1lcio livre para formar fosfato de c\u00e1lcio.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Todas as Emuls\u00f5es Lip\u00eddicas (EL) s\u00e3o criadas iguais\u2076\u00b4\u2077.<\/span><\/strong>\n<ul>\n<li class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Todas as ELs s\u00e3o fontes de calorias e \u00e1cidos graxos essenciais.<\/span><\/li>\n<li class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Existem quatro ELs aprovadas pelo FDA para uso em adultos e elas n\u00e3o s\u00e3o equivalentes.<\/span><\/li>\n<li class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Existem tr\u00eas ELs aprovadas pelo FDA para uso em pacientes neonatais e pedi\u00e1tricos e elas n\u00e3o s\u00e3o equivalentes.<\/span><\/li>\n<li class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">As misturas de ELs cont\u00e9m menores quantidades de \u00f3leo de soja e, adi\u00e7\u00e3o de \u00f3leo de peixe, TCM e \u00f3leo de oliva. Apenas um produto \u00e9 composto por 100% \u00f3leo de peixe.<\/span><\/li>\n<li class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Cada apresenta\u00e7\u00e3o de EL<\/span> <span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">(ex.: 100% \u00f3leo de soja; TCM\/ TCL; 100% \u00f3leo de oliva; 100% \u00f3leo de peixe; \u00f3leo de soja, TCM, oliva e peixe) \u00e9 \u00fanica em diversas maneiras incluindo, mas n\u00e3o apenas a:<\/span>\n<ul>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Indica\u00e7\u00e3o de uso para pacientes neonatais, pedi\u00e1tricos e adultos<\/span><\/li>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Conte\u00fado de \u00e1cidos graxos<\/span><\/li>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Dose necess\u00e1ria para suplementar adequadamente os \u00e1cidos graxos essenciais (vide recomenda\u00e7\u00f5es da ASPEN)<\/span><\/li>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Compatibilidade e estabilidade na NP.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">As bolsas industrializadas multicompartimentadas de NP<\/span> <span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">s\u00e3o prontas para a administra\u00e7\u00e3o no paciente\u2078\u00b4\u2079.<\/span><\/strong>\n<ul>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">MCB-NP** n\u00e3o s\u00e3o prontas para a administra\u00e7\u00e3o; as c\u00e2maras precisam ser ativadas (misturadas) num ambiente est\u00e9ril antes da administra\u00e7\u00e3o.<\/span><\/li>\n<li><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">As <\/span><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">MCB-NP N\u00c3O s\u00e3o uma NP completa. <\/span><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Vitaminas e oligoelementos devem ser adicionados \u00c0 MCB-NP antes das administra\u00e7\u00e3o. ***<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li><strong><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Qualquer combina\u00e7\u00e3o\/ concentra\u00e7\u00e3o de eletr\u00f3litos pode ser adicionada \u00e0 MCB-NP\u00b9\u2070\u00b4\u00b9\u00b9.<\/span><\/strong>\n<ul>\n<li class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Cada MCB-NP possui diferentes componentes que afetam a compatibilidade e estabilidade final.<\/span><\/li>\n<li class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Informa\u00e7\u00f5es espec\u00edficas sobre estabilidade e compatibilidade devem ser obtidas com os fabricantes antes da adi\u00e7\u00e3o \u00e0 MCB-NP, antes da administra\u00e7\u00e3o. ***<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">**MCB &#8211; NP : <\/span><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">multi chamber bags<\/span><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">, bolsa com m\u00faltiplas c\u00e2mar<\/span><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">as.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">Refer\u00eancia:<\/span><\/p>\n<p class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">ASPEN\/ 2023: Dispelling Myths About Parenteral Nutrition Use.<\/span><\/p>\n<p class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">@American Society of Parenteral and Enteral Nutrition, 09\/11\/23.<\/span><\/p>\n<p class=\"cvGsUA direction-ltr align-start para-style-body\"><span class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-none text-strikethrough-none\">In: <\/span><a class=\"OYPEnA font-feature-liga-off font-feature-clig-off font-feature-calt-off text-decoration-underline text-strikethrough-none\" draggable=\"false\" href=\"https:\/\/www.nutritioncare.org\/uploadedFiles\/Documents\/Guidelines_and_Clinical_Resources\/PN_Resources\/PN-Myths-Practice-Tool.pdf\" target=\"_blank\" rel=\"noopener\">https:\/\/www.nutritioncare.org\/uploadedFiles\/Documents\/Guidelines_and_Clinical_Resources\/PN_Resources\/PN-Myths-Practice-Tool.pdf<\/a><\/p>\n<p>&nbsp;<\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"alignleft wp-image-1219 size-full\" src=\"http:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/11\/final-e1732302402926.png\" alt=\"\" width=\"1891\" height=\"1080\" srcset=\"https:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/11\/final-e1732302402926.png 1891w, https:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/11\/final-e1732302402926-300x171.png 300w, https:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/11\/final-e1732302402926-1024x585.png 1024w, https:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/11\/final-e1732302402926-768x439.png 768w, https:\/\/www.nutrimedrj.com.br\/wp-content\/uploads\/2024\/11\/final-e1732302402926-1536x877.png 1536w\" sizes=\"(max-width: 1891px) 100vw, 1891px\" \/><\/p>\n","protected":false},"excerpt":{"rendered":"<p>&nbsp; A nutri\u00e7\u00e3o parenteral (NP), uma das aquisi\u00e7\u00f5es mais not\u00e1veis da medicina moderna, atua como uma modalidade da terapia nutricional que salva e\/ ou mant\u00e9m vidas e, pode ser iniciada para pacientes de todas as faixas et\u00e1rias, quando as necessidades [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":1220,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[3],"tags":[],"_links":{"self":[{"href":"https:\/\/www.nutrimedrj.com.br\/index.php\/wp-json\/wp\/v2\/posts\/1216"}],"collection":[{"href":"https:\/\/www.nutrimedrj.com.br\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.nutrimedrj.com.br\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.nutrimedrj.com.br\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.nutrimedrj.com.br\/index.php\/wp-json\/wp\/v2\/comments?post=1216"}],"version-history":[{"count":1,"href":"https:\/\/www.nutrimedrj.com.br\/index.php\/wp-json\/wp\/v2\/posts\/1216\/revisions"}],"predecessor-version":[{"id":1222,"href":"https:\/\/www.nutrimedrj.com.br\/index.php\/wp-json\/wp\/v2\/posts\/1216\/revisions\/1222"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.nutrimedrj.com.br\/index.php\/wp-json\/wp\/v2\/media\/1220"}],"wp:attachment":[{"href":"https:\/\/www.nutrimedrj.com.br\/index.php\/wp-json\/wp\/v2\/media?parent=1216"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.nutrimedrj.com.br\/index.php\/wp-json\/wp\/v2\/categories?post=1216"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.nutrimedrj.com.br\/index.php\/wp-json\/wp\/v2\/tags?post=1216"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}