{"id":541,"date":"2025-06-04T00:00:00","date_gmt":"2025-06-04T03:00:00","guid":{"rendered":"https:\/\/lam.unitedforclinicalnutrition.com\/br\/blog\/como-e-aplicada-a-nutricao-parenteral\/"},"modified":"2025-08-04T12:05:51","modified_gmt":"2025-08-04T15:05:51","slug":"como-e-aplicada-a-nutricao-parenteral","status":"publish","type":"post","link":"https:\/\/lam.unitedforclinicalnutrition.com\/pt-br\/como-e-aplicada-a-nutricao-parenteral\/","title":{"rendered":"Como \u00e9 Aplicada a Nutri\u00e7\u00e3o Parenteral?"},"content":{"rendered":"

A nutri\u00e7\u00e3o parenteral \u00e9 um tratamento complexo e sujeito a diversos riscos, desde a sua indica\u00e7\u00e3o at\u00e9 a sua administra\u00e7\u00e3o (1). Dessa forma, \u00e9 essencial que os profissionais de sa\u00fade mantenham um aprendizado cont\u00ednuo, aprimorando a t\u00e9cnica e garantindo a seguran\u00e7a no processo.<\/span>\u00a0<\/span><\/p>\n

Neste artigo, abordaremos como deve ser feita a infus\u00e3o da nutri\u00e7\u00e3o parenteral, destacando as melhores pr\u00e1ticas, e as diferen\u00e7as entre os sistemas.<\/span>\u00a0<\/span><\/p>\n

 <\/p>\n

Sistema de frascos m\u00faltiplos vs<\/i> sistema 3 em 1<\/h2>\n

A depender das necessidades do paciente, da estabilidade dos componentes e das condi\u00e7\u00f5es de armazenamento, a nutri\u00e7\u00e3o parenteral pode ser preparada e administrada de duas formas principais: em <\/span>sistema de frascos m\u00faltiplos ou sistema 3 em 1.<\/span><\/b>\u00a0<\/span><\/p>\n

Sistema de frascos m\u00faltiplos\u00a0<\/span><\/b>\u00a0<\/span><\/p>\n

No sistema de frascos m\u00faltiplos, os componentes da nutri\u00e7\u00e3o parenteral (amino\u00e1cidos, glicose e emuls\u00e3o lip\u00eddica) s\u00e3o administrados a partir de frascos separados pela jun\u00e7\u00e3o de conectores m\u00faltiplos que alimentam um cateter intravenoso comum. Vitaminas e oligoelementos normalmente s\u00e3o adicionados \u00e0 NP a partir de preparados concentrados (2, 3, 4).<\/span>\u00a0<\/span><\/p>\n

 <\/p>\n

\"Sistema
Sistema de frascos m\u00faltiplos.<\/figcaption><\/figure>\n

 <\/p>\n

O sistema de frascos m\u00faltiplos conta com as seguintes <\/span>desvantagens<\/span><\/b> (2, 3, 4):<\/span>\u00a0<\/span><\/p>\n

    \n
  • Necessidade de um conector e m\u00faltiplos conjuntos de administra\u00e7\u00e3o<\/span>\u00a0<\/span><\/li>\n<\/ul>\n
      \n
    • Exige frequentes substitui\u00e7\u00f5es de frascos<\/span>\u00a0<\/span><\/li>\n<\/ul>\n
        \n
      • Necessidade de ajustar taxas de fluxos diferentes e irregulares, al\u00e9m de fazer muitas adi\u00e7\u00f5es<\/span>\u00a0<\/span><\/li>\n<\/ul>\n
          \n
        • Probabilidade maior de erros de administra\u00e7\u00e3o<\/span>\u00a0<\/span><\/li>\n<\/ul>\n
            \n
          • Exige muito tempo<\/span>\u00a0<\/span><\/li>\n<\/ul>\n
              \n
            • Exige verifica\u00e7\u00e3o frequente de glicemia e eletr\u00f3litos plasm\u00e1ticos<\/span>\u00a0<\/span><\/li>\n<\/ul>\n

              No entanto, se forem manuseados corretamente, os sistemas de frasco \u00fanico contam com certas <\/span>vantagens<\/span><\/b>. Por exemplo, oferecem uma maior flexibilidade no que diz respeito \u00e0 dosagem e na elabora\u00e7\u00e3o de NP altamente espec\u00edfica, ajustando-se a v\u00e1rias necessidades do paciente (2, 3, 4).<\/span><\/p>\n

               <\/p>\n

              Sistema 3 em 1<\/h2>\n

              No sistema 3 em 1 (tamb\u00e9m conhecido como \u201call-in-one\u201d, AiO), h\u00e1 uma mistura total de nutrientes na mesma bolsa (5). Ao combinar a emuls\u00e3o lip\u00eddica com os demais componentes da NP, o crescimento microbiano \u00e9 inibido, permitindo que a terapia seja infundida por 24 horas (6).\u00a0<\/span>\u00a0<\/span><\/p>\n

              Suas principais <\/span>vantagens<\/span><\/b> incluem (4, 6):\u00a0<\/span>\u00a0<\/span><\/p>\n

                \n
              • Economia de custos durante a prepara\u00e7\u00e3o, manuseio e entrega<\/span>\u00a0<\/span><\/li>\n<\/ul>\n
                  \n
                • Melhor utiliza\u00e7\u00e3o e assimila\u00e7\u00e3o de nutrientes<\/span>\u00a0<\/span><\/li>\n<\/ul>\n
                    \n
                  • Facilidade de armazenamento e administra\u00e7\u00e3o<\/span>\u00a0<\/span><\/li>\n<\/ul>\n
                      \n
                    • Taxa reduzida de complica\u00e7\u00f5es metab\u00f3licas (por exemplo, hiperglicemia e dist\u00farbios eletrol\u00edticos), diminuindo ainda mais o custo do monitoramento<\/span>\u00a0<\/span><\/li>\n<\/ul>\n
                        \n
                      • Redu\u00e7\u00e3o do risco de contamina\u00e7\u00e3o por toque durante a administra\u00e7\u00e3o<\/span>\u00a0<\/span><\/li>\n<\/ul>\n
                          \n
                        • Crescimento bacteriano retardado<\/span>\u00a0<\/span><\/li>\n<\/ul>\n
                            \n
                          • Diminui\u00e7\u00e3o do tempo de enfermagem<\/span>\u00a0<\/span><\/li>\n<\/ul>\n
                              \n
                            • Simplifica\u00e7\u00e3o do processo ao remover a necessidade de duas infus\u00f5es separadas, reduzindo erros de medica\u00e7\u00e3o<\/span>\u00a0<\/span><\/li>\n<\/ul>\n

                              Al\u00e9m disso:<\/span>\u00a0<\/span><\/p>\n

                              \u2013 Substituir parte da glicose por gordura reduz o risco de efeitos adversos associados \u00e0 ingest\u00e3o excessiva de glicose;<\/span>\u00a0<\/span><\/p>\n

                              \u2013 A adi\u00e7\u00e3o de emuls\u00e3o de gordura reduz a irrita\u00e7\u00e3o venosa ao diminuir a osmolaridade da f\u00f3rmula nutricional, permitindo a administra\u00e7\u00e3o por veias perif\u00e9ricas;<\/span>\u00a0<\/span><\/p>\n

                              \u2013 Devido a menos conex\u00f5es, menor manuseio de trocas de frascos e outras manipula\u00e7\u00f5es, a taxa de sepse diminui.\u00a0<\/span>\u00a0<\/span><\/p>\n

                              Das poucas <\/span>desvantagens<\/span><\/b> deste sistema, inclui-se a impossibilidade de remover uma subst\u00e2ncia de uma bolsa j\u00e1 preparada (por exemplo, pot\u00e1ssio, quando h\u00e1 um aumento inesperado no pot\u00e1ssio s\u00e9rico ap\u00f3s a bolsa ter sido preparada e a infus\u00e3o iniciada) (4).\u00a0<\/span>\u00a0<\/span><\/p>\n

                              Al\u00e9m disso, a inspe\u00e7\u00e3o visual de precipitados ou material particulado na mistura fica prejudicada (6).<\/span>\u00a0<\/span><\/p>\n

                              Os sistemas AiO s\u00e3o dispon\u00edveis em tr\u00eas formas:<\/span>\u00a0<\/span><\/p>\n

                                \n
                              1. Bolsas com m\u00faltiplos compartimentos<\/span><\/b> (2, 3, 13, 14, 15, 16, 17, 18, 19):<\/span><\/li>\n<\/ol>\n

                                Dispon\u00edveis em vers\u00f5es de dois ou tr\u00eas compartimentos, essas bolsas mant\u00eam os macronutrientes separados at\u00e9 o momento da administra\u00e7\u00e3o. S\u00e3o seguras, pr\u00e1ticas e est\u00e1veis, com menor risco de contamina\u00e7\u00e3o e menor custo em compara\u00e7\u00e3o com as NP manipuladas.<\/span>\u00a0<\/span><\/p>\n

                                  \n
                                • Bolsas de dois compartimentos: cont\u00eam glicose e amino\u00e1cidos separados, com a emuls\u00e3o lip\u00eddica adicionada pouco antes da infus\u00e3o.<\/span>\u00a0<\/span><\/li>\n<\/ul>\n
                                  \"Bolsa
                                  Bolsa com dois compartimentos<\/figcaption><\/figure>\n

                                   <\/p>\n

                                    \n
                                  • Bolsas de tr\u00eas compartimentos: incluem glicose, amino\u00e1cidos e lip\u00eddios em compartimentos distintos, permitindo uma administra\u00e7\u00e3o mais completa e conveniente.<\/span><\/span>\u00a0<\/span><\/li>\n<\/ul>\n
                                    \"Bolsa
                                    Bolsa com tr\u00eas compartimentos<\/figcaption><\/figure>\n

                                     <\/p>\n

                                      \n
                                    1. NP manipulada <\/span><\/b>(2, 3, 7, 8, 9, 10):<\/span><\/li>\n<\/ol>\n

                                      Misturas personalizadas preparadas manualmente, geralmente em farm\u00e1cias hospitalares, para atender \u00e0s necessidades espec\u00edficas dos pacientes.\u00a0<\/span>\u00a0<\/span><\/p>\n

                                      S\u00e3o indicadas para pacientes com requisitos metab\u00f3licos vari\u00e1veis, mas apresentam alto custo, maior risco de erro na prescri\u00e7\u00e3o e maior risco de infec\u00e7\u00e3o quando comparadas \u00e0s bolsas multic\u00e2maras.<\/span>\u00a0<\/span><\/p>\n

                                        \n
                                      1. Manipula\u00e7\u00e3o automatizada <\/span><\/b>(11, 12):<\/span><\/li>\n<\/ol>\n

                                        Utiliza dispositivos automatizados para preparar a nutri\u00e7\u00e3o parenteral, reduzindo o risco de erro humano e melhorando a precis\u00e3o da formula\u00e7\u00e3o. \u00c9 mais eficiente que a manipula\u00e7\u00e3o manual, pois economiza tempo e otimiza o uso de recursos hospitalares.<\/span>\u00a0<\/span><\/p>\n

                                         <\/p>\n

                                        Sistema gravitacional vs.<\/i> bomba de infus\u00e3o<\/h2>\n

                                        A NP pode ser administrada usando uma bomba para alimenta\u00e7\u00e3o intravenosa ou por gravidade. Os crit\u00e9rios para a escolha do meio de administra\u00e7\u00e3o apropriado incluem:<\/span>\u00a0<\/span><\/p>\n

                                          \n
                                        • Velocidade da infus\u00e3o<\/span>\u00a0<\/span><\/li>\n<\/ul>\n
                                            \n
                                          • Dura\u00e7\u00e3o da infus\u00e3o<\/span>\u00a0<\/span><\/li>\n<\/ul>\n
                                              \n
                                            • Precis\u00e3o exigida<\/span>\u00a0<\/span><\/li>\n<\/ul>\n
                                                \n
                                              • Objetivos terap\u00eauticos<\/span>\u00a0<\/span><\/li>\n<\/ul>\n

                                                A<\/span> infus\u00e3o gravitacional<\/span><\/b> depende da press\u00e3o hidrost\u00e1tica sem o aux\u00edlio de uma bomba de infus\u00e3o. A velocidade da infus\u00e3o \u00e9 regulada por um controlador de fluxo passivo e calculada com base no gotejamento. O controlador de fluxo pode ser uma pin\u00e7a rolete interagindo diretamente com a sonda ou um controlador espec\u00edfico de fluxo. Este fornece maior precis\u00e3o e estabilidade do fluxo.<\/span>\u00a0<\/span><\/p>\n

                                                A infus\u00e3o por gravidade \u00e9 recomendada se n\u00e3o houver uma necessidade muito grande de velocidade e precis\u00e3o de infus\u00e3o.<\/span>\u00a0<\/span><\/p>\n

                                                A <\/span>infus\u00e3o auxiliada por bomba<\/span><\/b> \u00e9 realizada por meio de uma bomba volum\u00e9trica trabalhando com conjunto com sistemas de infus\u00e3o ou por meio de seringas controlando o fluxo com um pist\u00e3o movido a motor. Essa abordagem \u00e9 apropriada para infus\u00f5es de baixo volume. A infus\u00e3o auxiliada por bomba garante a alta precis\u00e3o com velocidade constante de infus\u00e3o e permite o ajuste do ciclo.<\/span>\u00a0<\/span><\/p>\n

                                                 <\/p>\n

                                                Administra\u00e7\u00e3o cont\u00ednua vs<\/i> c\u00edclica<\/h2>\n

                                                Finalmente, a nutri\u00e7\u00e3o parenteral pode ser administrada de duas formas principais: cont\u00ednua ou c\u00edclica. A escolha entre esses m\u00e9todos depende das condi\u00e7\u00f5es cl\u00ednicas do paciente, toler\u00e2ncia metab\u00f3lica e objetivos terap\u00eauticos.<\/span>\u00a0<\/span><\/p>\n

                                                Na <\/span>NP cont\u00ednua<\/span><\/b>, a infus\u00e3o da nutri\u00e7\u00e3o parenteral ocorre de maneira ininterrupta ao longo de 24 horas. Pacientes que necessitam de NP de curto prazo, que representam a maioria dos pacientes hospitalizados com NP, geralmente recebem NP cont\u00ednua (20).<\/span>\u00a0<\/span><\/p>\n

                                                Essa forma de administra\u00e7\u00e3o permite menos manipula\u00e7\u00e3o e uma menor taxa de infus\u00e3o, limitando a sobrecarga de glicose e fluidos (20).<\/span>\u00a0<\/span><\/p>\n

                                                Por outro lado, a <\/span>NP c\u00edclica<\/span><\/b> consiste na administra\u00e7\u00e3o intermitente de solu\u00e7\u00f5es intravenosas, com per\u00edodos regulares de pausa na infus\u00e3o. Normalmente, \u00e9 administrada em infus\u00f5es \u00fanicas de 10 a 14 horas, podendo variar entre 8 e 23 horas (21).<\/span>\u00a0<\/span><\/p>\n

                                                A administra\u00e7\u00e3o c\u00edclica durante uma parte do dia ou da noite permite que o paciente fique livre do tubo intravenoso e do aparelho de bomba. Ela \u00e9 frequentemente administrada para pacientes em nutri\u00e7\u00e3o parenteral domiciliar, bem como uma estrat\u00e9gia contra o comprometimento hep\u00e1tico associado \u00e0 NP (20).<\/span>\u00a0<\/span><\/p>\n

                                                Quando a administra\u00e7\u00e3o c\u00edclica \u00e9 proposta, a glicemia deve ser monitorada para evitar hipoglicemia ap\u00f3s a descontinua\u00e7\u00e3o, assim como hiperglicemia devido ao aumento da taxa de infus\u00e3o (20).<\/span><\/p>\n

                                                 <\/p>\n

                                                Conclus\u00e3o<\/span><\/b>\u00a0<\/span><\/h5>\n

                                                A infus\u00e3o de nutri\u00e7\u00e3o parenteral \u00e9 um processo complexo, que exige precis\u00e3o e cuidado. Os sistemas de frascos m\u00faltiplos e tudo em um (AiO) apresentam diferentes vantagens e desvantagens, que devem ser consideradas de acordo com as necessidades do paciente. A escolha entre infus\u00e3o por gravidade ou bomba tamb\u00e9m depende de fatores cl\u00ednicos espec\u00edficos.\u00a0<\/span>\u00a0<\/span><\/p>\n

                                                Independentemente do m\u00e9todo, \u00e9 fundamental que os profissionais de sa\u00fade sigam boas pr\u00e1ticas para garantir a seguran\u00e7a e efic\u00e1cia do tratamento.<\/span>\u00a0<\/span><\/p>\n

                                                \u00a0<\/span><\/p>\n

                                                Refer\u00eancias:\u00a0<\/strong><\/h5>\n
                                                  \n
                                                1. Gon\u00e7alves RC, de Matos LBN, Cunha HFR, Totti F, Kawagoe JY, Martin LGR, de Almeida AM, Castro MG, Ribeiro PC, Campos W, da Silva MJS, Barbosa LMG, de Oliveira Netto ACS, Toledo DO, Correia MITD. Manual BRASPEN de Compet\u00eancias Relacionadas \u00e0 Dispensa\u00e7\u00e3o e \u00e0 Administra\u00e7\u00e3o de Nutri\u00e7\u00e3o Parenteral. Braspen J. 2023;34(3):217-232.<\/span><\/li>\n
                                                2. M\u00fchlebach S, Franken C, Stanga Z et al. Practical handling of AIO admixtures \u2013 Guidelines on Parenteral Nutrition, Chapter 10. Ger Med Sci 2009;7(18).<\/li>\n
                                                3. Pertkiewicz M, Dudrick SJ. Different systems for parenteral nutrition (AIO vs. MB). In: Sobotka L, editor. Basics in Clinical Nutrition. Praga: Galen 2011;370-372.<\/li>\n
                                                4. Pertkiewicz M, Dudrick SJ. Basics in clinical nutrition: Systems for parenteral nutrition, different systems for parenteral nutrition (AIO vs. MB). e-SPEN 2009;4:e123-e124.<\/li>\n
                                                5. Lappas BM, Patel D, Kumpf V, Adams DW, Seidner DL. Parenteral Nutrition: Indications, Access, and Complications. Gastroenterol Clin North Am. 2018 Mar;47(1):39-59.<\/li>\n
                                                6. Derenski K, Catlin J, Allen L. Parenteral nutrition basics for the clinician caring for the adult patient. Nutr Clin Pract. 2016;31(5):578-595.<\/li>\n
                                                7. Valentin A, Capuzzo M, Guidet B et al. Errors in administration of parenteral drugs in intensive care units: Multinational prospective study. BMJ 2009;338:b814.<\/li>\n
                                                8. Turpin RS, Canada T, Rosenthal V et al. Bloodstream infections associated with parenteral nutrition preparation methods in the United States: A retrospective, large database analysis. JPEN 2012;36:169-176.<\/li>\n
                                                9. Turpin RS, Canada T, Liu FX et al. Nutrition therapy cost analysis in the US: Pre-mixed multi chamber bag. Appl Health Econ Health Policy 2011;9:281-292.<\/li>\n
                                                10. Braga M, Ljungqvist O, Soeters P et al. ESPEN Guidelines on Parenteral Nutrition: Surgery. Clin Nutr 2009;28:378-386.<\/li>\n
                                                11. Crill CM, Hak EB, Helms RA. Accuracy of parenteral nutrition solutions compounded with automated systems and by hand. Am J Health Syst Pharm 2005;62(22):2345,2348.<\/li>\n
                                                12. Dickson LB, Somani SM, Herrmann G et al. Automated compounder for adding ingredients to parenteral nutrition base solutions. Am J Hosp Pharm 1993;50:678-682.<\/li>\n
                                                13. Sandstr\u00f6m R, Hyltander A, K\u00f6rner U et al. The effect of energy and nitrogen metabolism by continuous bolus, or sequential infusion of a defined total parenteral nutrition formulation in patients after major surgical procedures. JPEN 1995;19:333-340.<\/li>\n
                                                14. Meguid MM. Clinical applications and cost-effectiveness of All in One. Nutrition 1989;5(5):343-344.<\/li>\n
                                                15. Raper S, Milanov S, Park GR. The cost of multi-compartment \u2018big bag\u2019 total parenteral nutrition in an ICU. Anesthesia 2002;57(1):96-97.<\/li>\n
                                                16. Carter DM, Wheatley C, Payne-James JJ et al. Home nutrition survey in the UK: the patient\u2019s perspective. Clin Nutr 1993;12:208-212.<\/li>\n
                                                17. Rollins CJ, Elsberry VA, Pollack KA et al. Three-in-one parenteral nutrition: A safe and economical method of nutritional support for infants. JPEN 1990;14:290-294.<\/li>\n
                                                18. Mitchell KA, Jones EA, Meguid MM et al. Standardized TPN order form reduces staff time and potential for error. Nutrition 1990;6:457-460.<\/li>\n
                                                19. Flynn EA, Pearson RE, Barker KN. Observational study of accuracy in compounding I.V. admixtures at five hospitals. Am J Health Syst Pharm 1997;54:904-912.<\/li>\n
                                                20. Berlana D. Parenteral nutrition overview. Nutrients. 2022;14(21):4480.<\/li>\n
                                                21. Bae HJ, Shin SH, Kim EK, Kim HS, Cho YS, Gwak HS. Effects of cyclic parenteral nutrition on parenteral nutrition-associated cholestasis in newborns. Asia Pac J Clin Nutr. 2019;28(1):42-48.\u00a0<\/span><\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

                                                  A nutri\u00e7\u00e3o parenteral \u00e9 um tratamento complexo e sujeito a diversos riscos, desde a sua indica\u00e7\u00e3o at\u00e9 a sua administra\u00e7\u00e3o (1). Dessa forma, \u00e9 essencial que os profissionais de sa\u00fade mantenham um aprendizado cont\u00ednuo, aprimorando a t\u00e9cnica e garantindo a seguran\u00e7a no processo.\u00a0 Neste artigo, abordaremos como deve ser feita a infus\u00e3o da nutri\u00e7\u00e3o parenteral, […]<\/p>\n","protected":false},"author":1,"featured_media":2058,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[49],"tags":[287,288,67],"class_list":["post-541","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-artigo-5","tag-administracao-da-infusao-parenteral","tag-infusao-da-nutricao-parenteral","tag-nutricao-parenteral"],"acf":[],"yoast_head":"\nComo \u00e9 Aplicada a Nutri\u00e7\u00e3o Parenteral?<\/title>\n<meta name=\"description\" content=\"Misturas de nutri\u00e7\u00e3o parenteral (NP) cont\u00eam uma ampla variedade de componentes em diferentes quantidades e combina\u00e7\u00f5es. 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