Terapia infusional convencional e hipodermóclise em pacientes paliativos: comparação entre hospital geral e oncológico

Abstract

The study aims to compare the clinical and therapeutic characteristics of cancer patients in palliative care undergoing conventional therapy and hypodermoclysis admitted to a general hospital and an oncology hospital. This is a quantitative approach, prospective cohort study, which was developed in two reference oncology services with exclusive services from the Unified Health System in the state of Rio Grande do Norte. The study population consisted of cancer patients in palliative care who were hospitalized. Thus, to calculate the sample for this research, a power of 80% and a significance level of 0.05 were evident. Thus, the overall sample was 84 participants. This research included cancer patients admitted to hospitals that presented palliative care procedures or were beyond therapeutic possibilities. Participants whose own patient and/or companion did not have knowledge about palliative care were excluded. To collect data, an instrument with sociodemographic and clinical data was used, in addition to the hypodermoclysis eligibility algorithm, the Edmonton Symptom Assessment Scale and the Palliative Performance Scale. Data were collected from September 2023 to January 2024, and analyzed using the statistical software Statistical Package for the Social Sciences version 22.0. Statistical tests were carried out to analyze the data, with a significance level of 0.05 adopted. The study obtained a favorable opinion from the Research Ethics Committee of the Federal University of Rio Grande do Norte, the Onofre Lopes University Hospital and the Liga Norte Riograndense contra o Câncer. Given the data, it was observed that the sociodemographic profile of patients in both hospitals prevailed among women with a median age of 60-63 years, low level of education and income. Furthermore, the majority of patients lived in the interior of the state. The clinical profile showed a prevalence of patients with cancer primarily located in the gastrointestinal tract. The average length of stay was six days in the general hospital and four in the specialized hospital. The main symptoms recorded on the Edmonton scale during hospitalization were drowsiness (α=0.019), lack of appetite (α<0.001) and pain (α=0.004). As a result, patients presented low functional performance, showing a prevalence of hospital outcome of death. To characterize the infusion profile, the length of stay for the peripheral venous catheter had a median of one day, the central venous catheter had a median of 15 days, and hypodermoclysis had a median of 1.5 days. Thus, in relation to its suitability, in both hospitals the central venous catheter and hypodermoclysis proved to be adequate, however the peripheral venous catheter prevailed and was suitable only in the specialized hospital. Regarding the use of hypodermoclysis, eligible patients according to the algorithm prevailed (13.6%-86.4%). As a result, the study showed that the patients' hospitalization is related to conventional infusion therapy, due to its prevalence in the peripheral route. In this way, patients are exposed to multiple punctures, which result in changes and predispose them to possible adverse events, which could be avoided with the use of devices related to palliative care, such as hypodermoclysis.