Segurança nos cuidados de enfermagem com medicamentos sedativos, analgésicos e vasoativos: Revisão de escopo

Autores

DOI:

https://doi.org/10.21527/2176-7114.2025.50.15644

Palavras-chave:

Segurança do Paciente, Sistemas de Medicação no Hospital, Medicamentos vasoativos, Analgesia, Hipnóticos e Sedativos

Resumo

O objetivo foi mapear as evidências disponíveis sobre a segurança nos cuidados de enfermagem no preparo e administração de medicamentos sedativos, analgésicos e vasoativos em pacientes críticos. Trata-se de uma scoping review com busca nas bases de dados: EMBASE, SCOPUS, PubMED/MEDLINE, Cochrane Library, CINAHL e Web of Science. Complementou-se a busca na literatura cinzenta. Foram selecionados 32 estudos: a maioria (12) era dos EUA e um brasileiro; 16 publicados nos últimos cinco anos; 18 abordaram os cuidados com vasoativos; 11 os cuidados com analgésicos e sedativos. Sobre sedativos e analgésicos, identificaram-se cuidados para realização de procedimentos invasivos/dolorosos e o papel do enfermeiro nessa prática. Sobre vasoativos, encontrou-se a administração em vias periféricas, cuidados com bombas de infusão, comunicação, incompatibilidades físico-químicas, benefícios dos medicamentos prontos ou pré manipulados e implementação de protocolos assistenciais. As publicações descrevem a complexidade e os diversos cuidados da equipe de enfermagem na segurança desses medicamentos.

Referências

1. World Patient Safety Day [Internet]. World Health Organization. 2022. Disponível em: https://www.who.int/campaigns/world-patient-safety-day/2022

2. Elasrag GAE, Abu-Snieneh HM. Nurses’ perception of factors contributing to medication administration errors. Int J Res Pharm Sci. 2020 Jan 6;11(1):44–56. DOI:10.26452/ijrps.v11i1.1781

3. Anaclet TA, Cândido RCF, Soares DB. Desafio global de segurança do paciente medicação sem danos. Inst para Práticas Seguras no Uso Medicam. 2018. Disponível em: www.ismp-brasil.org

4. Brasil. Assistência Segura: Uma reflexão Teórica Aplicada a Prática. Agência Nacional de Vigilância Sanitária (ANVISA). Brasília; 2017. 113–28 p.

5. Castro AF, Oliveira JP, Rodrigues MCS. Anti-infective medication administration errors by dose omission. ACTA Paul Enferm. 2019 Dec 2;32(6):667–73. DOI: https://doi.org/10.1590/1982-0194201900092

6. Sodré BMC, Andrade TNG, Cerqueira SS, Goes AS, Santos ADS, Lyra Júnior DP, et al. Harm Prevalence Due to Medication Errors Involving High-Alert Medications: A Systematic Review. J Patient Saf. 2021 Jan 1;17(1):e1–9. DOI: 10.1097/PTS.0000000000000649

7. Fagundes L do C, Almeida LF de, Camerini FG, Maciel R de O, Paula VG de, Henrique D de M, et al. Use of potentially dangerous drugs in an Intensive Care Unit. Res Soc Dev. 2020 Jul 15;9(8):e499985831–e499985831. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/5831

8. Cardoso SR, Marques Santos JD, Abreu IM de, Carvalho NAR de, Santos AMR dos, Madeira MZ de A, et al. Errors in parenteral medication administration: Nursing technicians’ perspective. ACTA Paul Enferm. 2020;33:1–8. DOI: 10.37689/acta-ape/2020AO02766

9. Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z (Editors). JBI Manual for Evidence Synthesis, JBI, 2020. Available from: https://doi.org/10.46658/JBIMES-20-12

10. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar 29;372. Disponível em: https://www.bmj.com/content/372/bmj.n71

11. Trim JC, Roe J. Practical considerations in the administration of intravenous vasoactive drugs in the critical care setting: the double pumping or piggyback technique–part one. Intensive Crit Care Nurs. 2004 Jun 1;20(3):153–60. Disponível em: https://www.sciencedirect.com/science/article/abs/pii/S0964339704000175

12. Morrice A, Jackson E, Farnell S. Practical considerations in the administration of intravenous vasoactive drugs in the critical care setting: Part II - How safe is our practice? Intensive Crit Care Nurs. 2004;20(4):183–9. Disponível em: https://pubmed.ncbi.nlm.nih.gov/15288871/

13. Argaud L, Cour M, Martin O, Saint-Denis M, Ferry T, Goyatton A, et al. Changeovers of vasoactive drug infusion pumps: impact of a quality improvement program. Crit Care. 2007 Dec 28;11(6). Disponível em: https://pubmed.ncbi.nlm.nih.gov/18163908/

14. Coons JC, Seidl E. Cardiovascular pharmacotherapy update for the intensive care unit. Crit Care Nurs Q. 2007;30(1):44–57. Disponível em: https://pubmed.ncbi.nlm.nih.gov/17198036/

15. Ricard JD, Martin Y, Botcherby C, Villard S, Kalinowski H, Blivet A, et al. Changeover of vasopressors in the intensive care unit. Médecine Intensive Réanimation. 2011 Feb 16;20(2):138–42. Disponível em: https://revue-mir.srlf.org/index.php/mir/article/view/117

16. Smally AJ, Nowicki TA, Simelton BH. Procedural sedation and analgesia in the emergency department. Curr Opin Crit Care. 2011 Aug;17(4):317–22. Disponível em: https://pubmed.ncbi.nlm.nih.gov/21677578/

17. Kastrup M, Balzer F, Volk T, Spies C. Analysis of event logs from syringe pumps: a retrospective pilot study to assess possible effects of syringe pumps on safety in a university hospital critical care unit in Germany. Drug Saf. 2012 Jul 1;35(7):563–74. Disponível em: https://pubmed.ncbi.nlm.nih.gov/22671864/

18. Adapa RM, Mani V, Murray LJ, Degnan BA, Ercole A, Cadman B, et al. Errors during the preparation of drug infusions: a randomized controlled trial. Br J Anaesth [Internet]. 2012;109(5):729–34. Disponível em: https://pubmed.ncbi.nlm.nih.gov/22850220/

19. Valentin A. Approaches to decreasing medication and other care errors in the ICU. Curr Opin Crit Care. 2013 Oct;19(5):474–9. Disponível em: https://pubmed.ncbi.nlm.nih.gov/23995119/

20. Sistema Español de Notificación en Seguridad en Anestesia y Reanimación (SENSAR). Phenylephrine dosing error in Intensive Care Unit. Case of the trimester. Rev Esp Anestesiol Reanim. 2013 Aug-Sep;60(7):e19-21. DOI: 10.1016/j.redar.2013.05.011.

21. Paparella SF. EPINEPHrine: a potpourri of potential medication safety risks. J Emerg Nurs. 2013 Mar;39(2):151–3. Disponível em : https://pubmed.ncbi.nlm.nih.gov/23369771/

22. Koczmara C, St-Arnaud C, Quiroz Martinez H, Adhikari N, Meade M, Bérard D, et al. Vasopressor stewardship: a case report and lesson shared . ISMP Canadá. 2014 Apr;26–9. Disponível em: https://www.ismpcanada.org/download/caccn/CACCN-Spring14.pdf

23. Cardenas-Garcia J, Schaub KF, Belchikov YG, Narasimhan M, Koenig SJ, Mayo PH. Safety of peripheral intravenous administration of vasoactive medication. J Hosp Med. 2015 Sep 1;10(9):581–5. Disponível em: https://pubmed.ncbi.nlm.nih.gov/26014852/

24. Corrigan M, Wilson SS, Hampton J. Safety and efficacy of intranasally administered medications in the emergency department and prehospital settings. Am J Health Syst Pharm. 2015 Sep 15;72(18):1544–54. Disponível em: https://pubmed.ncbi.nlm.nih.gov/26346210/

25. Cuesta López I, Sánchez Cuervo M, Candela Toha, Benedí González J, Bermejo Vicedo T. Impact of the implementation of vasoactive drug protocols on safety and efficacy in the treatment of critically ill patients. J Clin Pharm Ther. 2016 Dec 1;41(6):703–10. Disponível em: https://pubmed.ncbi.nlm.nih.gov/27699815/

26. Häggström M, Bergsman AC, Månsson U, Holmström MR. Learning to manage vasoactive drugs-A qualitative interview study with critical care nurses. Intensive Crit care Nurs. 2017 Apr 1;39:1–8. Disponível em: https://pubmed.ncbi.nlm.nih.gov/28108169/

27. Furniss SS, Sneyd JR. Safe sedation in modern cardiological practice. Heart. 2015 Oct 1;101(19):1526–30. Disponível em: https://pubmed.ncbi.nlm.nih.gov/26085525/

28. Medlej K, Kazzi AA, El Hajj Chehade A, Saad Eldine M, Chami A, Bachir R, et al. Complications from Administration of Vasopressors Through Peripheral Venous Catheters: An Observational Study. J Emerg Med. 2018 Jan 1;54(1):47–53. Disponível em: https://pubmed.ncbi.nlm.nih.gov/29110979/

29. Lewis T, Merchan C, Altshuler D, Papadopoulos J. Safety of the Peripheral Administration of Vasopressor Agents. 2017 Jan 11;34(1):26–33. Disponível em: https://journals.sagepub.com/doi/10.1177/0885066616686035?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed

30. Datar S, Gutierrez E, Schertz A, Vachharajani V. Safety of Phenylephrine Infusion Through Peripheral Intravenous Catheter in the Neurological Intensive Care Unit. J Intensive Care Med. 2018 Oct 1;33(10):589–92. Disponível em: https://pubmed.ncbi.nlm.nih.gov/28569131/

31. Chawla N, Boateng A, Deshpande R. Procedural sedation in the ICU and emergency department. Curr Opin Anaesthesiol. 2017 Aug 1;30(4):507–12. Disponível em: https://pubmed.ncbi.nlm.nih.gov/28562388/

32. Strout TD, Kendrick DB. Nursing considerations in emergency department procedural sedation and analgesia. Emergency Sedation and Pain Management. Cambridge University Press; 2008.

33. Miller KA, Andolfatto G, Miner JR, Burton JH, Krauss BS. Clinical Practice Guideline for Emergency Department Procedural Sedation With Propofol: 2018 Update. Ann Emerg Med. 2019 May 1;73(5):470–80. Disponível em: https://pubmed.ncbi.nlm.nih.gov/30732981/

34. De E, Henrique B, Oliveira S, Maria De Sousa V, Jessik K, De S, et al. Errors in medication dosage in the urgency unit of a hospital. Rev Enferm UFPE line. 2019 Jun 3;13(0). Disponível em: https://periodicos.ufpe.br/revistas/revistaenfermagem/article/view/239792

35. Oduyale MS, Patel N, Borthwick M, Claus S. Co-administration of multiple intravenous medicines: Intensive care nurses’ views and perspectives. Nurs Crit Care. 2020 May 1;25(3):156–64. Disponível em: https://onlinelibrary.wiley.com/doi/full/10.1111/nicc.12497

36. Hunter S, Considine J, Manias E. Nurse management of vasoactive medications in intensive care: A systematic review. J Clin Nurs. 2020 Feb 1;29(3–4):381–92. Disponível em: https://pubmed.ncbi.nlm.nih.gov/31715043/

37. Tian DH, Smyth C, Keijzers G, Macdonald SPJ, Peake S, Udy A, et al. Safety of peripheral administration of vasopressor medications: A systematic review. Emerg Med Australas. 2020 Apr 1;32(2):220–7. Disponível em: https://pubmed.ncbi.nlm.nih.gov/31698544/

38. Prasanna N, Yamane D, Haridasa N, Davison D, Sparks A, Hawkins K. Safety and efficacy of vasopressor administration through midline catheters. J Crit Care. 2021 Feb 1;61:1–4. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33049486/

39. Hansel J, Ármannsson GS. Cardiac arrest due to accidental overdose with norepinephrine dissolved in crystalloid. BMJ Case Rep. 2020 Dec 9;13(12):237643. Disponível em: /pmc/articles/PMC7733087/

40. Bilhimer M, Hommer K, Johnson B. Comments on Medication Safety in the Emergency Department After a Trip to the K-Hole. J Emerg Med. 2020 Aug 1;59(2):312–3. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32948284/

41. Tran QK, Mester G, Bzhilyanskaya V, Afridi LZ, Andhavarapu S, Alam Z, et al. Complication of vasopressor infusion through peripheral venous catheter: A systematic review and meta-analysis. Am J Emerg Med. 2020 Nov 1;38(11):2434–43. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33039229/

42. Messina A, Milani A, Morenghi E, Costantini E, Brusa S, Negri K, et al. Norepinephrine Infusion in the Emergency Department in Septic Shock Patients: A Retrospective 2-Years Safety Report and Outcome Analysis. Int J Environ Res Public Health. 2021 Jan 2;18(2):1–9. Disponível em: /pmc/articles/PMC7835753/

43. American Society of Anesthesiologists. Diretrizes de prática para sedação moderada e analgesia procedimental 2018. Anesthesiology. 2018;128(3):437. Disponível em: http://links.lww.com/ALN/B594.

44. Rech MA, Barbas B, Chaney W, Greenhalgh E, Turck C. When to Pick the Nose: Out-of-Hospital and Emergency Department Intranasal Administration of Medications. Ann Emerg Med. 2017 Aug 1;70(2):203–11. Disponível em: https://www.sciencedaily.com/releases/2017/04/170418151320.htm

45. Loubani OM, Green RS. A systematic review of extravasation and local tissue injury from administration of vasopressors through peripheral intravenous catheters and central venous catheters. J Crit Care. 2015 Jun 1;30(3):653.e9-653.e17. Disponível em: https://pubmed.ncbi.nlm.nih.gov/25669592/

46. Le A, Patel S. Extravasation of noncytotoxic drugs: A review of the literature. Ann Pharmacother. 2014 Jul 1;48(7):870–86. DOI: 10.1177/1060028014527820

47. Gorski LA, Hadaway L, Hagle ME, Broadhurst D, Clare S, Kleidon T, et al. Infusion Therapy Standards of Practice, 8th Edition. J Infus Nurs. 2021 Jan 1;44(1S Suppl 1):S1–224. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33394637/

48. Araiza A, Duran M, Varon J. Administration of vasopressors through peripheral venous catheters. CMAJ. 2022 May 30;194(21):E739. Disponível em: /pmc/articles/PMC9259422/

49. Plum M, Moukhachen O. Alternative Pharmacological Management of Vasopressor Extravasation in the Absence of Phentolamine. Pharm Ther. 2017;42(9):581. Disponível em: /pmc/articles/PMC5565133/

50. Shrestha N, Acharya U, Shrestha PS, Acharya SP, Karki B, Dhakal SS. Topical nitroglycerin for management of peripheral extravasation of vasopressors: a case report. Oxford Med Case Reports. 2020 Aug 1;2020(8):289–91. Disponível em: /pmc/articles/PMC7416830/

51. Chen X, Liang M. A Meta-Analysis of Incidence of Catheter-Related Bloodstream Infection with Midline Catheters and Peripherally Inserted Central Catheters. J Healthc Eng. 2022. Disponível em: /pmc/articles/PMC8934223/

52. Carr A, Green JR, Benish E, Lanham R. Midline venous catheters as an alternative to central line catheter placement: a product evaluation. https://doi.org/1012968/bjon2021308S10 2021 Apr 20;30(8):S10–8. Disponível em: https://www.magonlinelibrary.com/doi/10.12968/bjon.2021.30.8.S10

53. Barros E, Santos L dos, Torriani MS. Medicamentos de A a Z : 2016/2018. Ltda AE, editor. São Paulo; 2016. 1432 p.

54. Garcia JH, Crespo JCL, Handa AY, Padilha KG, Secoli SR. In(compatibility) of intravenous drugs in critical units: adult cohort. Rev Bras Enferm. 2021;74(2):e20200501. Disponível em: https://doi.org/10.1590/0034-7167-2020-0501

55. Maison O, Tardy C, Cabelguenne D, Parat S, Ducastelle S, Piriou V, et al. Drug incompatibilities in intravenous therapy: evaluation and proposition of preventive tools in intensive care and hematology units. Eur J Clin Pharmacol. 2019 Feb 6;75(2):179–87. Disponível em: https://pubmed.ncbi.nlm.nih.gov/30543036/

56. Machotka O, Manak J, Kubena A, Vlcek J. Incidence of intravenous drug incompatibilities in intensive care units. Biomed Pap. 2015 Dec;159(4):652–6. Disponível em: https://pubmed.ncbi.nlm.nih.gov/25482735/

57. Paim AE, Nascimento ERP do, Bertoncello KCG, Sifroni KG, Salum NC, Nascimento KC do. Validation of an instrument regarding nursing intervention in patients in vasoactive therapy. Rev Bras Enferm. 2017 May 1;70(3):453–60. Disponível em: http://www.scielo.br/j/reben/a/dhzNnPdffJxrtPtsHQcyQ7L/?lang=en

58. El-Shafy IA, Delgado J, Akerman M, Bullaro F, Christopherson NAM, Prince JM. Closed-Loop Communication Improves Task Completion in Pediatric Trauma Resuscitation. J Surg Educ. 2018 Jan 1;75(1):58–64. DOI: 10.1016/j.jsurg.2017.06.025

59. Salik I, Ashurst J V. Closed Loop Communication Training in Medical Simulation. StatPearls. 2022 Jul 25. Disponível em: https://www.ncbi.nlm.nih.gov/books/NBK549899/

60. Júnior O de JR, Gasparino RC. Drogas vasoativas: conhecimento da equipe de enfermagem. Rev Baiana Enfermagem. 2017 Jun 12;31(2). Disponível em: https://periodicos.ufba.br/index.php/enfermagem/article/view/16566

61. Sanguino GZ, Furtado MC de C, de Godoy S, Vicente JB, da Silva JR. Management of cardiopulmonary arrest in an educational video: contributions to education in pediatric nursing. Rev Lat Am Enfermagem. 2021 Apr 12;29. Disponível em: http://www.scielo.br/j/rlae/a/bL79DY5d837Xwrg5k6vNMnH/?lang=en

Publicado

2025-02-17

Como Citar

Carleti, M., Wachter, D. A., Giordani, J. N., Caregnato, R. C. A., & Blatt, C. R. (2025). Segurança nos cuidados de enfermagem com medicamentos sedativos, analgésicos e vasoativos: Revisão de escopo. Revista Contexto & Saúde, 25(50), e15644. https://doi.org/10.21527/2176-7114.2025.50.15644

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Artigo de Revisão