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Dehghani MH, Saghafi F, Bordbari Z, Zare-Kamali J, Jafari-Nedooshan J, Sahebnasagh A. Investigating the effect of oral synbiotic on enteral feeding tolerance in critically ill patients: A double-blinded controlled clinical trial of gut microbiota. Nutr Clin Pract 2023; 38:402-410. [PMID: 35809224 DOI: 10.1002/ncp.10895] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/28/2022] [Accepted: 05/14/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Probiotics are beneficial live microorganisms that can modify the gut microbiota. It is assumed that they help improve enteral feeding intolerance (EFI) and nosocomial infections in critically ill patients. The present clinical trial aimed to investigate the efficacy of synbiotics in improving EFI and oropharyngeal aspiration in patients admitted to the intensive care unit (ICU). METHODS This randomized clinical trial was conducted on 105 critically ill patients admitted to the ICU of a tertiary referral hospital affiliated with a medical university. The patients were randomly assigned to either a synbiotic or control group and underwent 7 days of investigation. The primary end point was reduced gastric residual volume, which is suggestive of an improvement in EFI. The secondary end point included requirement for prokinetics, frequency of aspiration, duration of mechanical ventilation, length of ICU stay, and level of consciousness. RESULTS The present clinical trial showed that synbiotic intervention has resulted in a significantly diminished requirement for prokinetics (P = 0.019), fewer oropharyngeal aspirations (P = 0.01), improved volume of bolus administration, and decreased gastric residual volume during the 7-day follow-up period. The patients who received synbiotic had an improved level of consciousness (P = 0.01). CONCLUSION This clinical trial showed that the prescription of synbiotic from the initial days of enteral feeding has resulted in a significantly diminished requirement for prokinetics, less oropharyngeal aspiration, decreased gastric residual volume, improved volume of bolus administration, and hence, better tolerance of enteral feeding.
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Affiliation(s)
- Mohammad Hossein Dehghani
- Department of Anesthesiology and Critical Care, Shahid Rahnemoun Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Fatemeh Saghafi
- Department of Clinical Pharmacy, Faculty of Pharmacy and Pharmaceutical Sciences Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Zeinab Bordbari
- Department of Clinical Pharmacy, Faculty of Pharmacy, Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Javad Zare-Kamali
- Department of Clinical Pharmacy, Faculty of Pharmacy, Student Research Committee, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Jamal Jafari-Nedooshan
- Department of Surgery, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Adeleh Sahebnasagh
- Clinical Research Center, Department of Internal Medicine, School of Medicine, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
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Wang J, Chen Y, Xue H, Chen Z, Wang Q, Zhu M, Yao J, Yuan H, Zhang X. Effect of abdominal massage on feeding intolerance in patients receiving enteral nutrition: A systematic review and meta‐analysis. Nurs Open 2022; 10:2720-2733. [PMID: 36517968 PMCID: PMC10077396 DOI: 10.1002/nop2.1537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 10/26/2022] [Accepted: 11/20/2022] [Indexed: 12/23/2022] Open
Abstract
AIM This study aimed to evaluate the effect of abdominal massage (AM) on feeding intolerance (FI) in patients receiving enteral nutrition (EN). DESIGN A systematic review and meta-analysis. METHODS We searched seven electronic databases to September 2021. STATA and RevMan were used to analyse the data. RESULTS Eleven studies were included. The results revealed that AM could significantly reduce gastric residual volume and abdominal circumference difference, and reduce the incidence of gastric retention, vomiting, abdominal distention (all p < 0.001), diarrhoea (p = 0.02) and constipation (p = 0.002) in the experimental group. One study reported the incidence of aspiration in the control group was higher, but this was not statistically significant (p = 0.07). The meta-regression analysis showed there was a statistically significant correlation between intervention personnel and gastric residual volume (p = 0.035). CONCLUSION AM could reduce the amount and incidence of gastric retention and the changes in abdominal circumference, and significantly reduce the incidence of gastrointestinal symptoms, without increasing the incidence of aspiration for EN patients. No Patient or Public Contribution.
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Affiliation(s)
- Jia Wang
- Department of Fundamental Nursing, School of Nursing Jilin University Changchun China
- Shenzhen hospital of Southern Medical University Shenzhen China
| | - Yahong Chen
- Interventional operating room China‐Japan Union Hospital of Jilin University, Jilin University Changchun China
| | - Hui Xue
- Department of Histology and Embryology, College of Basic Medical Sciences Jilin University Changchun China
| | - Zhiming Chen
- Department of Fundamental Nursing, School of Nursing Jilin University Changchun China
| | - Qiuchen Wang
- Department of Fundamental Nursing, School of Nursing Jilin University Changchun China
| | - Mingyue Zhu
- Department of Fundamental Nursing, School of Nursing Jilin University Changchun China
| | - Jiannan Yao
- Department of Fundamental Nursing, School of Nursing Jilin University Changchun China
| | - Hua Yuan
- Department of Fundamental Nursing, School of Nursing Jilin University Changchun China
| | - Xiuying Zhang
- Department of Fundamental Nursing, School of Nursing Jilin University Changchun China
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Nasogastric tube care and flushing in a Portuguese general medicine ward: a best practice implementation project. JBI Evid Implement 2022; 20:S76-S87. [PMID: 36372796 DOI: 10.1097/xeb.0000000000000328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To implement evidence-based practice related to care and flushing of nasogastric tubes inserted for feeding, in a general medicine ward. INTRODUCTION Nasogastric tube feeding is a widely used nutritional support form. Although performed by qualified professionals, it is not a harm-free intervention. Progression to the trachea during initial insertion, aspiration of gastric contents, improper position for patient feeding, and/or a blocked tube are examples of problems that can occur. METHODS The project used JBI's methodological approach of the Clinical Evidence System and Getting Research into Practice audit and feedback tool. A baseline audit focused on nursing procedures related to the maintenance of nasogastric tube feeding, based on 14 criteria informed by the JBI evidence summaries, was performed for a month. Education sessions and other engagement strategies and resources were used to increase nasogastric tube maintenance. This best-practice implementation was conducted in Portugal, between January 2020 and April 2021, in a 33-bed general medicine ward with a staff of 30 registered nurses. RESULTS Different samples, for each audited procedure, were obtained from a universe of 25 nurses and 14 episodes of patients with nasogastric tube in baseline and 10 in follow-up audit. At baseline, compliance with the criteria ranged from 0 to 88%. Ten of the 14 criteria were below 50%. The follow-up audit showed significant improvement in all compliance criteria (ranging from 44.4 to 100%). Criteria 1 and 2, which were aimed at preventing adverse consequences related to wrong placement or displacement of the nasogastric tube, showed a high postimplementation compliance level (89.3 and 90%). CONCLUSION With an integrated plan incorporating interventions, strategies, and resources, tailored for this context, we improved nurses' knowledge of nasogastric tube maintenance and achieved significantly increased compliance with nasogastric tube care best-practice. We suggest maintaining current strategies, and reinforcing clinical supervision and regular assessment.
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Abu Hdaib N, Albsoul-Younes A, Wazaify M. Oral medications administration through enteral feeding tube: Clinical pharmacist-led educational intervention to improve knowledge of Intensive care units' nurses at Jordan University Hospital. Saudi Pharm J 2021; 29:134-142. [PMID: 33679176 PMCID: PMC7910138 DOI: 10.1016/j.jsps.2020.12.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/31/2020] [Indexed: 01/10/2023] Open
Abstract
Introduction Medication administration through enteral feeding tubes is a practice that is commonly encountered in hospital settings, particularly in critically ill patients. This study aims to evaluate the knowledge of intensive care unit nurses regarding enteral medication administration and evaluate the effect of an educational intervention led by a clinical pharmacist that would improve nurses’ knowledge regarding the subject. Methods A pre/post interventional study was conducted. Improvement in nurses’ knowledge regarding medication administration through an enteral feeding tube was assessed using a validated questionnaire. Results Data were coded, entered, and analyzed using the Statistical Package for Social Sciences (IBM SPSS statistics 22). Independent samples t-test and paired t-test were used to detect any statistically significant differences in the mean total knowledge scores both between and within each group respectively. A P-value of <0.05 was considered statistically significant. The mean total knowledge score for nurses in the intervention and control group at the pre-interventional phase of the study was inadequate. There was a statistically significant improvement in the mean total knowledge score for the interventional group at the post-interventional phase of the study, while that of the control group remained inadequate (Intervention group total mean knowledge score at baseline 12.11 ± 3.75, post-intervention 21.50 ± 2.36, p-value <0.001; Control group total mean knowledge score at baseline 12.05 ± 3.12, post-intervention 12.60 ± 3.76, p-value 0.96). Conclusion Incorrect drug preparation and administration for patients with feeding tubes can affect patients. The knowledge of nurses regarding the subject can be improved significantly via an educational intervention. The activation of clinical pharmacists’ role and collaboration between pharmacists, physicians, and nurses is highly recommended in this clinical setting.
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Affiliation(s)
- N. Abu Hdaib
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Jordan
- Department of Pharmacy, Faculty of Pharmacy, Middle East University, Amman, Jordan
| | - A. Albsoul-Younes
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Jordan
| | - M. Wazaify
- Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Jordan
- Corresponding author at: Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman 11942, Jordan.
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Dehghan M, Fatehi Poor A, Mehdipour-Rabori R, Ahmadinejad M. Effect of abdominal massage on prevention of aspiration in intubated and enterally fed patients: A randomized controlled trial. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2020; 17:jcim-2017-0124. [PMID: 31710593 DOI: 10.1515/jcim-2017-0124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 10/03/2019] [Indexed: 11/17/2022]
Abstract
Background Aspiration is a serious side effect of delayed gastric emptying and increased residual volume in intensive care patients. Aspiration can increase the risk of pneumonia and death. Currently, pharmaceutical methods are the most commonly used techniques for decreasing aspiration, but non-pharmaceutical methods may also be effective in reducing aspiration. One of these methods is an abdominal massage. The present study aimed to examine the effect of abdominal massage on aspiration incidence in intensive care patients with an endotracheal tube. Methods This study was a randomized controlled clinical trial. Seventy intensive care patients with an endotracheal tube were chosen by convenience sampling and allocated to an intervention or a control group by the minimization method. The intervention group was provided with a 15-min abdominal massage twice a day for 3 days, while the control group received only routine cares. The patients' respiratory secretion was suctioned before and after the intervention, and immediately after suctioning, the incidence of the aspiration was assessed using special strips which are sensitive to respiratory secretion pH and glucose. SPSS 18 was used to analyze data. Descriptive statistics were used. T independent, Mann-Whitney U, χ2, and Fisher exact tests were used to compare two groups. Results The incidence rates of the aspiration were 5.7% (confidence interval: 0.0-14.3%) and 20% (confidence interval: 8.6-34.3%) in the abdominal massage and the control groups, respectively. The incidence of aspiration differed between two groups, but it was not statistically significant (p=0.07). Conclusion Although the low rate of aspiration in the abdominal massage group did not differ significantly with that of the control group, it can be clinically important. It is suggested that further studies be conducted to confirm the effect of abdominal massage on the prevention of aspiration in intensive care patients with an endotracheal tube.
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Affiliation(s)
- Mahlagha Dehghan
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Haft Bagh Alavi road, Iran
| | - Amanollah Fatehi Poor
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Haft Bagh Alavi road, Iran
| | | | - Mehdi Ahmadinejad
- Fellow of Critical Care Medicine, Kerman University of Medical Sciences, Haft Bagh Alavi road, Kerman, Iran
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Wen Z, Xie A, Peng M, Bian L, Wei L, Li M. Is discard better than return gastric residual aspirates: a systematic review and meta-analysis. BMC Gastroenterol 2019; 19:113. [PMID: 31253100 PMCID: PMC6599274 DOI: 10.1186/s12876-019-1028-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 06/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The assessment of residual gastric volume is common practice in critical care units. However, the effects and safety of discarding or returning gastric aspirates remain uncertain. Therefore, we aimed to evaluate the role of discarding or returning gastric aspirates on the gastric residual volumes in critically ill patients. METHODS A comprehensive, systematic meta-analysis of randomized controlled trials (RCTs) on the efficacy and safety of discarding or returning gastric aspirates in critical ill patients was performed. Studies were identified by searching Pubmed and other databases (from inception to 31 Sept 2018). Summary odd ratios (ORs) or mean differences (MDs) with 95% confidence intervals were calculated using fixed- or random-effects model for outcome assessment. RESULTS Four RCTs, with a total number of 314 adult patients, were included in the analysis. No significant differences were found in the 48th hour residual volume (MD = 8.89, 95% CI: 11.97 to 29.74), the average potassium level (MD = 0.00, 95% CI: - 0.16 to 0.16), the episodes of gastric emptying delay (OR = 0.98, 95% CI: 0.35 to 2.80), the incidence of aspiration pneumonia (OR = 0.93, 95% CI: 0.14 to 6.17), the episodes of nausea or vomiting (OR = 0.53, 95% CI: 0.07 to 4.13) and diarrhea (OR = 0.99, 95% CI: 0.58 to 1.70). CONCLUSIONS No evidence confirms that returning residual gastric aspirates provides more benefits than discarding them without increasing potential complications. Rigorously designed, multi-center, large-sample randomized controlled trials must be further conducted to validate the role of discarding or returning residual gastric aspirates.
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Affiliation(s)
- Zunjia Wen
- Children's Hospital of Nanjing Medical University, No.72 Guangzhou road, Gulou district, Nanjing, Jiangsu province, China
| | - Ailing Xie
- Children's Hospital of Nanjing Medical University, No.72 Guangzhou road, Gulou district, Nanjing, Jiangsu province, China
| | - Mingqi Peng
- Children's Hospital of Nanjing Medical University, No.72 Guangzhou road, Gulou district, Nanjing, Jiangsu province, China
| | - Lanzheng Bian
- Children's Hospital of Nanjing Medical University, No.72 Guangzhou road, Gulou district, Nanjing, Jiangsu province, China
| | - Li Wei
- Children's Hospital of Nanjing Medical University, No.72 Guangzhou road, Gulou district, Nanjing, Jiangsu province, China
| | - Mei Li
- Children's Hospital of Nanjing Medical University, No.72 Guangzhou road, Gulou district, Nanjing, Jiangsu province, China.
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Sari D, Kadifeli D, Akbiyik A, Taşkiran N. Intensive care unit nurses' knowledge of medication administration via enteral tubes. Nurs Crit Care 2018; 23:141-146. [PMID: 29424127 DOI: 10.1111/nicc.12335] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 12/06/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Medication administration via enteral tubes is a complex and key application for which nurses in intensive care units are responsible. AIM The aim of this study was to evaluate drug administrations via enteral tubes by nurses in intensive care units. METHODS This research was conducted using a descriptive and cross-sectional research design. The study was conducted with 289 nurses at intensive care units in hospitals in İzmir, Turkey. The data of the study were collected with the 'Sociodemographic Information Form' and the 'Enteral Medication Administrations Questionnaire', which was designed in accordance with the literature and consists of questions on interventions before, during and following medication administrations via enteral tubes. RESULTS It was found that more than half the nurses (62.3%) use nasogastric tubes for medication administrations and that all of them use the enteral way for the administration of medications in the form of tablets, while 58.8% use this method to administer the medications in the form of enteric-coated tablets. It was determined that approximately half the nurses (52.6%) apply more than one medication separately, and a majority (84.1%) use tap water to wash the enteral tube. CONCLUSIONS Enteral medication administration practices are inconsistent. Some nurses use unsafe practices and may therefore compromise patient care. RELEVANCE TO CLINICAL PRACTICE Conduction of education programmes on medication administration via enteral tubes for intensive care unit nurses is important in improving nurses' knowledge.
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Affiliation(s)
- Dilek Sari
- Ege University College of Nursing, Department of Fundamentals of Nursing, İzmir, Turkey
| | - Derya Kadifeli
- İzmir Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital, İzmir, Turkey
| | - Ayşe Akbiyik
- İzmir Katip Celebi University Faculty of Health Science, Department of Fundamentals of Nursing, İzmir, Turkey
| | - Nihal Taşkiran
- Adnan Menderes University College of Nursing, Department of Fundamentals of Nursing, Aydın, Turkey
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Rezae J, Kadivarian H, Abdi A, Rezae M, Karimpour K, Rezae S. The Effect of Body Position on Gavage Residual Volume of Gastric in Intensive Care Units Patients. ACTA ACUST UNITED AC 2018. [DOI: 10.29252/ijn.30.110.58] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Kalaldeh MA. The influence of implementing nurse-led enteral nutrition guidelines on care delivery in the critically ill: a cohort study. ACTA ACUST UNITED AC 2017. [DOI: 10.12968/gasn.2017.15.6.34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Mahmoud Al Kalaldeh
- Assistant Professor, Faculty of Nursing, Al-Zaytoonah University of Jordan, Jordan
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Bani Hani M, Ihim I, Harps J, Cunningham SC. A breath of fresh air: a quality-improvement study comparing an air-circulating technique versus conventional technique to prevent nasogastric tube dysfunction. BMC Nurs 2015; 14:63. [PMID: 26617465 PMCID: PMC4661948 DOI: 10.1186/s12912-015-0111-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 11/09/2015] [Indexed: 01/01/2023] Open
Abstract
Background Nasogastric tubes are an important component of care in patients with gastrointestinal obstructions. However, they are prone to malfunction despite conventional flushing techniques, with potentially severe consequences. There is no widely accepted, gold-standard way to ensure that a nasogastric tube succeeds in maintaining an empty stomach following flushing. Methods We have developed a flushing technique to better ensure successful tube function. We compared this technique to conventional flushing both in vitro (using a plastic stomach model) and in vivo (in a pig model), and we provide a didactic video. Results The mean gastric residual volume following our novel flushing technique is nearly 25-fold lower than following conventional flushing (13 mL vs. 330 mL). Conclusions Our simple technique is more effective than conventional techniques in maintaining nasogastric tube function and therefore should prevent dangerous vomiting and aspiration pneumonia better than conventional techniques.
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Affiliation(s)
- Murad Bani Hani
- The Department of Surgery, Saint Agnes Hospital, Baltimore, MD USA
| | - Ikenna Ihim
- The Department of Surgery, Saint Agnes Hospital, Baltimore, MD USA
| | - Joyce Harps
- The Department of Nursing, Saint Agnes Hospital, Baltimore, MD USA
| | - Steven C Cunningham
- The Department of Surgery, Saint Agnes Hospital, Baltimore, MD USA.,Pancreatic and Hepatobiliary Surgery, Saint Agnes Hospital, 900 Caton Avenue, MB 207, Baltimore, MD 21229 USA
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Kalaldeh MA, Watson R, Hayter M. Jordanian intensive care nurses' perspectives on evidence-based practice in nutritional care. ACTA ACUST UNITED AC 2015; 23:1023-9. [PMID: 25345451 DOI: 10.12968/bjon.2014.23.19.1023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
This study aimed to explore Jordanian nurses' perspectives on the implementation of evidence-based practice and team-working related to nutritional care in the critically ill. Poor adherence to evidence-based practice and poor collaboration may contribute to nutritional failure. Fourteen critical care nurses from three healthcare sectors in Jordan were selected purposively and interviewed using semi-structured interviews. The information obtained was subjected to a thematic analysis. Four themes emerged from the study: 'undertaking nutritional responsibilities', 'approaching evidence-based practice', 'multidisciplinary team working' and 'consequences of enteral nutrition care deficits'. Although evidence-based practice was emphasised by nurses, lack of evidence-based resources, and ineffective aspiration reduction measures were found to impede adherence to evidence-based practice. Multidisciplinary team working was introduced as means to improve practice. However, ineffective nursing involvement and poor interaction were obstacles to effective sharing.
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Rosini I, Salum NC. Care protocol for fine-needle aspiration biopsy of breast and thyroid. TEXTO & CONTEXTO ENFERMAGEM 2014. [DOI: 10.1590/0104-07072014003520012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study had the aim of building a care protocol for fine-needle aspiration biopsy of breast and thyroid. Using a convergent-care type qualitative approach, it was developed in a teaching hospital in southern Brazil, between September 2010 and April 2011. The study participants were 88 patients and 20 professionals who work in the Radiology Service. The protocol was built in three stages: development of educational activities in the waiting room with the patients for the identification of doubts and anxieties in relation to the examination; meetings held with the professionals for the evaluation and validation of the protocol; and search for scientific evidence in data sources. The organization of data allowed to elaborate the flowchart of patient care and the care protocol, which was organized in sequential activities and included the executor, the activity and the scientific justification. The professionals expressed the importance of the protocol, which brings advantages for patient care, such as agility, organization and the humanization of the service.
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Kahraman BB, Ozdemir L. The impact of abdominal massage administered to intubated and enterally fed patients on the development of ventilator-associated pneumonia: a randomized controlled study. Int J Nurs Stud 2014; 52:519-24. [PMID: 25498742 DOI: 10.1016/j.ijnurstu.2014.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 10/28/2014] [Accepted: 11/02/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND Enteral nutrition is one of the major risk factors for ventilator-associated pneumonia. Abdominal massage is assumed to prevent the development of ventilator-associated pneumonia by reducing residual gastric volume. OBJECTIVES To identify the effect of abdominal massage administered to critically ill patients with mechanical ventilation and continuous enteral feeding on the development of ventilator-associated pneumonia. DESIGN A randomized controlled design was used in this study. SETTING This study was performed in a critical care unit of a university hospital in Turkey. PARTICIPANTS The sample of the study consisted of a total of 32 patients, selected randomly to receive abdominal massage (n=16) and a control group (n=16). The stratified randomization was used in this study. Patients were stratified according to age and gender. METHODS A fifteen-minute abdominal massage was administered to the patients in the intervention group twice daily. No intervention was administered to the patients in the control group. RESULTS At the end of monitoring days a reduction, compared to the control patients, was identified. The amount of gastric residual volume and abdominal circumference measurement of the patients in the intervention group had decreased. This reduction was found to be significant in the statistical analysis (p<0.05). Also, although not reaching the statistical significance level, ventilator-associated pneumonia decreased in the intervention group with a ratio of 6.3% compared to the control group (31.3%) (p>0.05). CONCLUSION This study revealed that abdominal massage administered to intubated and enterally fed patients reduced gastric residual volume and abdominal distension. In addition, a decrease in the ratio of ventilator-associated pneumonia was determined.
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Xu Y, Ren X, Shi W, Jiang H. Implementation of the best practice in nasogastric tube feeding of critically ill patients in a neurosurgical intensive care unit. INT J EVID-BASED HEA 2014; 11:128-33. [PMID: 23750576 DOI: 10.1111/1744-1609.12020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This project was designed to implement the best practice in nasogastric tube feeding of critically ill patients in a neurosurgical intensive care unit. METHODS Clinical audit software programmes of the Joanna Briggs Institute (Practical Application of Clinical Evidence System and Getting Research Into Practice) were used in this project. A baseline audit, feedback, follow-up audit cycle was followed. The audit team analysed the results of the baseline audit, conducted a situational analysis and formulated and implemented a strategic plan to improve the nasogastric tube care. RESULTS Initially, the compliance with the criteria varied from 0% to 87%. The Getting Research Into Practice phase of the project identified several barriers of each criterion. After implementation of best practice, the following audit showed an improvement in all criteria, ranging from 33% to 95%. Marked improvement was achieved in the criteria that were not strictly required by local standards, such as rechecking the tube position, assessing the gastric residual volume and maintaining the airway cuff pressure. CONCLUSION The project had some success in improving the practice of nasogastric tube feeding. Collaboration, education, monitoring and a reward system were the key elements used to drive the project. Further actions and changes are expected to produce 100% compliance.
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Affiliation(s)
- Yan Xu
- Huashan Hospital affiliated to Fudan University, Shanghai, China
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Ellett MLC, Cohen MD, Croffie JMB, Lane KA, Austin JK, Perkins SM. Comparing bedside methods of determining placement of gastric tubes in children. J SPEC PEDIATR NURS 2014; 19:68-79. [PMID: 24393228 PMCID: PMC4096163 DOI: 10.1111/jspn.12054] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 09/19/2013] [Indexed: 11/30/2022]
Abstract
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.
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Al Kalaldeh M, Watson R, Hayter M. Jordanian nurses' knowledge and responsibility for enteral nutrition in the critically ill. Nurs Crit Care 2013; 20:229-41. [PMID: 24279734 DOI: 10.1111/nicc.12065] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 08/02/2013] [Accepted: 09/30/2013] [Indexed: 01/04/2023]
Abstract
BACKGROUND Poor nursing adherence to evidence-based guidelines has negative consequences leading to higher mortality rates, delayed recovery and longer length of stay. Evidence-based practice has the potential to minimize complications and discrepancies between nurses. AIM This study aimed to assess nurses' practice and perception of their knowledge and responsibility in relation to enteral nutrition (EN) in the critically ill. DESIGN AND METHODS This descriptive correlational design was applied to nurses working in intensive care units (ICUs) from three health care sectors in Jordan (Governmental, Military and Private sectors). Nurses were recruited using a stratified sampling technique. A pre-prepared questionnaire focusing on nurses' practice and perception towards EN was used. RESULTS A total of 253 ICU nurses completed the questionnaire. Nurses revealed a tendency to undertake nutritional care despite the recognition clinical nutrition is a secondary role. In terms of nursing processes, nurses showed greater levels of knowledge and responsibility for 'preventing complications' and 'evaluation' more than 'assessment' and 'identifying goals'. Nurses inadequately assess both gastric residuals and tube placement before feeding. Diarrhoea was the most frequent complication followed by abdominal pain, vomiting, tube dislodgment and weight loss. However, nurses realized that the incidences of complications is less likely when applying evidence-based protocol. CONCLUSION It is necessary to establish a preliminary assessment for patients' nutritional needs prior to using EN. Aspiration reduction measures are still deficient and need further attention. An evidence-based protocol for EN should be adopted in the critically ill. RELEVANCE TO CLINICAL PRACTICE This article provides insight into the current practice of Jordanian intensive care nurses in different health care sectors. The study can contribute to redirect the perception of nurses towards nutrition in the critically ill in addition to enhance positive adherence to evidence base.
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Affiliation(s)
| | - Roger Watson
- Faculty of Health and Social Care, Professor of Nursing, University of Hull, Hull HU6 7RX, UK
| | - Mark Hayter
- Faculty of Health and Social Care, Professor of Nursing, University of Hull, Hull HU6 7RX, UK
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The role of nasogastric intubation on postoperative gastrointestinal function in patients with obstructive jaundice. Indian J Surg 2013; 74:376-80. [PMID: 24082589 DOI: 10.1007/s12262-011-0391-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2009] [Accepted: 12/21/2011] [Indexed: 01/03/2023] Open
Abstract
It is the practice of many surgeons to use the routine nasogastric tube after biliary operations, but its usefulness has been questioned. This study was designed to determine the effect of postoperative nasogastric intubation on gastrointestinal function in patients with obstructive jaundice. In this randomized clinical trial, 40 patients who underwent choledochoduodenostomy or hepaticojejunostomy were randomly divided into two groups. Patients in the experimental group did not have the nasogastric tube, and in the control group the nasogastric tube was routinely applied after surgery. Gastrointestinal function was compared in these two groups. Patients with no nasogastric intubation did not show any postoperative complications or prolonged hospital stay. On the contrary, nasogastric tube insertion postponed return of bowel function and increased the incidence of nausea and vomiting, while it did not affect the incidence of postoperative ileus. Routine use of the nasogastric tube after choledochoduodenostomy or hepaticojejunostomy can delay normal gastrointestinal function and increase postoperative discomfort.
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Malekzadeh J, Mazluom SR, Etezadi T, Tasseri A. A standardized shift handover protocol: improving nurses' safe practice in intensive care units. J Caring Sci 2013; 2:177-85. [PMID: 25276725 PMCID: PMC4134157 DOI: 10.5681/jcs.2013.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 11/29/2012] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION For maintaining the continuity of care and improving the quality of care, effective inter-shift information communication is necessary. Any handover error can endanger patient safety. Despite the importance of shift handover, there is no standard handover protocol in our healthcare settings. METHODS In this one-group pretest-posttest quasi-experimental study conducted in spring and summer of 2011, we recruited a convenience sample of 56 ICU nurses. The Nurses' Safe Practice Evaluation Checklist was used for data collection. The Content Validity Index and the inter-rater correlation coefficient of the checklist was 0.92 and 89, respectively. We employed the SPSS 11.5 software and the Mc Nemar and paired-samples t test for data analysis. RESULTS Study findings revealed that nurses' mean score on the Safe Practice Evaluation Checklist increased significantly from 11.6 (2.7) to 17.0 (1.8) (P < 0.001). CONCLUSION using a standard handover protocol for communicating patient's needs and information improves nurses' safe practice in the area of basic nursing care.
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Affiliation(s)
- Javad Malekzadeh
- Department of Nursing, Faculty of Nursing and Midwifery, Mashhad University of
Medical Sciences, Mashhad, Iran
| | - Seyed Reza Mazluom
- Department of Nursing, Faculty of Nursing and Midwifery, Mashhad University of
Medical Sciences, Mashhad, Iran
| | - Toktam Etezadi
- Department of Nursing, Faculty of Nursing and Midwifery, Mashhad University of
Medical Sciences, Mashhad, Iran
| | - Alireza Tasseri
- Department of Nursing, Javad-Al- Aemeh Hospital, Mashhad, Iran
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Williams TA, Leslie GD, Leen T, Mills L, Dobb GJ. Reducing interruptions to continuous enteral nutrition in the intensive care unit: a comparative study. J Clin Nurs 2013; 22:2838-48. [DOI: 10.1111/jocn.12068] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2012] [Indexed: 12/26/2022]
Affiliation(s)
- Teresa A Williams
- Discipline of Emergency Medicine (M516); School of Primary; Aboriginal and Rural Health Care (SPARHC); The University of Western Australia and Research Fellow; ICU Royal Perth Hospital; Perth WA Australia
| | - Gavin D Leslie
- School of Nursing & Midwifery; Curtin Health Innovation Research Institute; Faculty Health Science; Curtin University; Perth WA Australia
| | - Tim Leen
- Intensive Care Unit; Royal Perth Hospital; Perth WA Australia
| | - Lauren Mills
- Intensive Care Unit; Royal Perth Hospital; Perth WA Australia
| | - Geoff J Dobb
- Intensive Care Unit; Royal Perth Hospital; Perth WA Australia
- School of Medicine and Pharmacology ; The University of Western Australia; Perth WA Australia
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Pereira SRM, Coelho MJ, Mesquita AMFD, Teixeira AO, Graciano SDA. Causas da retirada não planejada da sonda de alimentação em terapia intensiva. ACTA PAUL ENFERM 2013. [DOI: 10.1590/s0103-21002013000400007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Descrever as principais causas da perda da sonda de alimentação e analisar as ações que tiveram impacto para a redução desta intercorrência. MÉTODOS: Trata-se de um estudo transversal com dados secundários provenientes de 4228 pacientes/dia com sonda de alimentação. RESULTADOS: As causas da perda da sonda foram: a retirada pelo paciente (50%) e obstrução da sonda (36%). Observadas a correlação da perda da sonda enteral com alterações da cognição dos pacientes (delirium e demência) e a incrustação de resíduos no lúmen da sonda. CONCLUSÃO: As principais causas de retirada da sonda de alimentação foram relacionadas ao paciente e à obstrução. As medidas proativas para evitar a obstrução da sonda foram impactantes no período em que foram aplicadas as demais medidas tiveram baixo impacto.
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Phillips NM, Nay R. Nursing administration of medication via enteral tubes in adults: a systematic review. INT J EVID-BASED HEA 2012; 5:324-53. [PMID: 21631795 DOI: 10.1111/j.1479-6988.2007.00072.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Enteral tubes are frequently inserted as part of medical treatment in a wide range of patient situations. Patients with an enteral tube are cared for by nurses in a variety of settings, including general and specialised acute care areas, aged care facilities and at home. Regardless of the setting, nurses have the primary responsibility for administering medication through enteral tubes. Medication administration via an enteral tube is a reasonably common nursing intervention that entails a number of skills, including preparing the medication, verifying the tube position, flushing the tube and assessing for potential complications. If medications are not given effectively through an enteral tube, harmful consequences may result leading to increased morbidity, for example, tube occlusion, diarrhoea and aspiration pneumonia. There are resultant costs for the health-care system related to possible increased length of stay and increased use of equipment. Presently what is considered to be best practice to give medications through enteral tubes is unknown. Objectives The objective of this systematic review was to determine the best available evidence on which nursing interventions are effective in minimising the complications associated with the administration of medications via enteral tubes in adults. Nursing interventions and considerations related to medication administration included form of medication, verifying tube placement before administration, methods used to give medication, methods used to flush tubes, maintenance of tube patency and specific practices to prevent possible complications related to the administration of enteral medications. Search strategy The following databases were searched for literature reported in English only: CINAHL, MEDLINE, The Cochrane Library, Current Contents/All Editions, EMBASE, Australasian Medical Index and PsychINFO. There was no date restriction applied. In addition, the reference lists of all included studies were scrutinised for other potentially relevant studies. Selection criteria Systematic reviews of randomised controlled trials (RCTs) and RCTs that compared the effectiveness of nursing interventions and considerations used in the administration of medications via enteral tubes. Other research methods, such as non-randomised controlled trials, longitudinal studies, cohort and case control studies, were also included. Exclusion criteria included studies investigating drug-nutrient interactions or the bioavailability of specific medications. Data collection and analysis Initial consideration of potential relevance to the review was carried out by the primary author (NP). Two reviewers independently assessed study eligibility for inclusion. A meta-analysis could not be undertaken, as there were no comparable RCTs identified. All data were presented in a narrative summary. Results There is very limited evidence regarding the effectiveness of nursing interventions in minimising the complications associated with enteral tube medication administration in adults. The review highlights a lack of high quality research on many important nursing issues relating to enteral medication administration. There is huge scope for further research. Some of the evidence that was identified included that nurses should consider the use of liquid form medications as there may be fewer tube occlusions than with solid forms in nasoenteral tubes and silicone percutaneous endoscopic gastronomy tubes. Nurses may need to consider the sorbitol content of some liquid medications, for example, elixirs, as diarrhoea has been attributed to the sorbitol content of the elixir, not the drug itself. In addition, the use of 30 mL of water for irrigation when administering medications or flushing small-diameter nasoenteral tubes may reduce the number of tube occlusions.
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Affiliation(s)
- Nicole M Phillips
- Division of Nursing and Midwifery and Gerontic Nursing Clinical School, Australian Centre for Evidence Based Aged Care, La Trobe University, Bundoora, Victonia, Australia
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Chan EY, Ng IHL, Tan SLH, Jabin K, Lee LN, Ang CC. Nasogastric feeding practices: A survey using clinical scenarios. Int J Nurs Stud 2012; 49:310-9. [DOI: 10.1016/j.ijnurstu.2011.09.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Revised: 09/14/2011] [Accepted: 09/16/2011] [Indexed: 11/29/2022]
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Tan M, Zhu JC, Yin HH. Enteral nutrition in patients with severe traumatic brain injury: reasons for intolerance and medical management. Br J Neurosurg 2011; 25:2-8. [PMID: 21323401 DOI: 10.3109/02688697.2010.522745] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Approximately, 50% of patients with severe traumatic brain injury (TBI) exhibit intolerance to enteral nutrition (EN). This intolerance hampers the survival and rehabilitation of this subpopulation to a great extent, and poses various difficulties for clinicians due to its complex underlying mechanisms. This review discusses the possible reasons for intolerance to EN following severe TBI, current trends in medical management, as well as other related issues that are experienced by many clinicians.
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Affiliation(s)
- Min Tan
- School of Nursing, Third Military Medical University, Chongqing 400038, China
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Jack L, Coyer F, Courtney M, Venkatesh B. Probiotics and diarrhoea management in enterally tube fed critically ill patients—What is the evidence? Intensive Crit Care Nurs 2010; 26:314-26. [DOI: 10.1016/j.iccn.2010.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Revised: 06/25/2010] [Accepted: 07/07/2010] [Indexed: 01/18/2023]
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Juvé-Udina ME, Valls-Miró C, Carreño-Granero A, Martinez-Estalella G, Monterde-Prat D, Domingo-Felici CM, Llusa-Finestres J, Asensio-Malo G. To return or to discard? Randomised trial on gastric residual volume management. Intensive Crit Care Nurs 2009; 25:258-67. [PMID: 19615907 DOI: 10.1016/j.iccn.2009.06.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Revised: 06/12/2009] [Accepted: 06/15/2009] [Indexed: 01/15/2023]
Abstract
BACKGROUND The control of gastric residual volume (GRV) is a common nursing intervention in intensive care; however the literature shows a wide variation in clinical practice regarding the management of GRV, potentially affecting patients' clinical outcomes. The aim of this study is to determine the effect of returning or discarding GRV, on gastric emptying delays and feeding, electrolyte and comfort outcomes in critically ill patients. METHOD A randomised, prospective, clinical trial design was used to study 125 critically ill patients, assigned to the return or the discard group. Main outcome measure was delayed gastric emptying. Feeding outcomes were determined measuring intolerance indicators, feeding delays and feeding potential complications. Fluid and electrolyte measures included serum potassium, glycaemia control and fluid balance. Discomfort was identified by significant changes in vital signs. RESULTS Patients in both groups presented similar mean GRV with no significant differences found (p=0.111), but participants in the intervention arm showed a lower incidence and severity of delayed gastric emptying episodes (p=0.001). No significant differences were found for the rest of outcome measurements, except for hyperglycaemia. CONCLUSIONS The results of this study support the recommendation to reintroduce gastric content aspirated to improve GRV management without increasing the risk for potential complications.
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Affiliation(s)
- Maria-Eulàlia Juvé-Udina
- IDIBELL, Catalan Institute of Health, Gran Via de les Corts Catalanes, 587, Barcelona 08007, Spain.
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To have and to hold nutritional control: balancing between individual and routine care. A grounded theory study. Intensive Crit Care Nurs 2009; 25:155-62. [PMID: 19395264 DOI: 10.1016/j.iccn.2009.03.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Revised: 03/16/2009] [Accepted: 03/17/2009] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Gaining insight into nutritional processes can help nurses and other staff in their work. The aim was to provide a theoretical understanding of the concerns and strategies of nutritional nursing care for patients with enteral nutrition in intensive care units. DESIGN A grounded theory approach was used. Observations of patient's nutritional care and twelve interviews with eight registered nurses and four enrolled nurses were conducted. SETTING The study was carried out in one intensive care unit at a medium sized hospital in Sweden. RESULTS The substantive theory developed included the core category "To have and to hold nutritional control - balancing between individual care and routine care". The core category was reflected in and related to the categories "knowing the patient", "facilitating the patient's involvement", "being a nurse in a team", "having professional confidence" and "having a supportive organisation". Finding a balance between individual care and routine care was a way of enhancing the patient's well-being, security and quality of care. CONCLUSION To have and to hold nutritional control over the patient's nutrition was found to be a balancing act between individual care and routine care. Organisation and teamwork are both challenging and supporting the provision, maintenance and development of nutritional care.
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Manojlovich M, Antonakos CL, Ronis DL. Intensive care units, communication between nurses and physicians, and patients' outcomes. Am J Crit Care 2009; 18:21-30. [PMID: 19116401 DOI: 10.4037/ajcc2009353] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Various factors in hospitals can adversely affect patients' outcomes, including faulty communication between nurses and physicians. Whether specific communication elements (timeliness, accuracy, openness, understanding) can influence adverse outcomes is unknown. OBJECTIVES To determine the relationships between patients' outcomes and (1) nurses' perceptions of elements of communication between nurses and physicians and (2) characteristics of the practice environment. METHODS A cross-sectional survey design was used. Information on ventilator-associated pneumonia, bloodstream infection associated with a central catheter, and pressure ulcers was collected from 25 intensive care units in southeastern Michigan. Simultaneously, 462 nurses in those units (response rate, 53.3%) were anonymously surveyed. The Conditions for Work Effectiveness Questionnaire-II and the Practice Environment Scale of the Nursing Work Index were used to measure characteristics of the practice environment. The Intensive Care Unit Nurse-Physician Questionnaire was used to measure communication between nurses and physicians. Statistical tests included correlation and multiple regression. Analyses were conducted at the unit level. RESULTS Unit response rates varied from 6% to 100%. Together, variability in understanding communication and capacity utilization were predictive of 27% of the variance in ventilator-associated pneumonia. Timeliness of communication was inversely related to pressure ulcers (r= -0.38; P=.06), and workplace empowerment and scores on the Acute Physiology and Chronic Health Evaluation III were positive predictors of ventilator-associated pneumonia (R(2)=0.36; P=.005). CONCLUSIONS Not all elements of communication were related to the selected adverse outcomes. The connection between characteristics of the practice environment at the unit level and adverse outcomes remains elusive.
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Affiliation(s)
- Milisa Manojlovich
- Milisa Manojlovich is an assistant professor and Cathy L. Antonakos is a statistical consultant at the University of Michigan School of Nursing, Ann Arbor. David L. Ronis is an associate research scientist and director of the statistical consulting team at the University of Michigan School of Nursing and is a statistical consultant within the US Department of Veterans Affairs
| | - Cathy L. Antonakos
- Milisa Manojlovich is an assistant professor and Cathy L. Antonakos is a statistical consultant at the University of Michigan School of Nursing, Ann Arbor. David L. Ronis is an associate research scientist and director of the statistical consulting team at the University of Michigan School of Nursing and is a statistical consultant within the US Department of Veterans Affairs
| | - David L. Ronis
- Milisa Manojlovich is an assistant professor and Cathy L. Antonakos is a statistical consultant at the University of Michigan School of Nursing, Ann Arbor. David L. Ronis is an associate research scientist and director of the statistical consulting team at the University of Michigan School of Nursing and is a statistical consultant within the US Department of Veterans Affairs
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Phillips NM, Nay R. A systematic review of nursing administration of medication via enteral tubes in adults. J Clin Nurs 2008; 17:2257-65. [PMID: 18705702 DOI: 10.1111/j.1365-2702.2008.02407.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
AIM This systematic review aimed to determine the best available evidence regarding the effectiveness of nursing interventions in minimising the complications associated with administering medication via enteral tubes in adults. BACKGROUND Giving enteral medication is a fairly common nursing intervention entailing several skills: verifying tube position, preparing medication, flushing the tube and assessing for potential complications. If not carried out effectively harmful consequences may result leading to increased morbidity and even mortality. Until now, what was considered to be best practice in this area was unknown. DESIGN Systematic review. METHODS CINAHL, MEDLINE, The Cochrane Library, Current Contents/All Editions, EMBASE, Australasian Medical Index and PsychINFO databases were searched up to September 2005. Reference lists of included studies were appraised. Two reviewers independently assessed study eligibility for inclusion. There were no comparable randomised-controlled trials; data were presented in a narrative summary. RESULTS Identified evidence included using 30 ml of water for irrigation when giving medication or flushing small-diameter nasoenteral tubes may reduce tube occlusion. Using liquid medication should be considered as there may be less tube occlusions than with solid forms in nasoenteral tubes and silicone percutaneous endoscopic gastrostomy tubes. In addition, nurses may need to consider the sorbitol content of some liquid medications, for example elixirs, as diarrhoea has been attributed to the sorbitol content of the elixir, not the drug itself. CONCLUSION The evidence was limited. There was a lack of high-quality research on many important issues relating to giving enteral medication. RELEVANCE TO CLINICAL PRACTICE Nurses have the primary responsibility for giving medication through enteral tubes and need knowledge of the best available evidence. Some of the nursing considerations and interventions relating to this skill have been researched in the clinical area and have implications for practice. There is a need for further studies to strengthen these findings.
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Affiliation(s)
- Nicole M Phillips
- Division of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia.
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Complications of percutaneous endoscopic and fluoroscopic gastrostomy tube insertion procedures in 378 patients. Gastroenterol Nurs 2008; 30:337-41. [PMID: 18049202 DOI: 10.1097/01.sga.0000296252.70834.19] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Gastrostomy tubes are used for primary and supplemental feeding and gastric decompression. The purpose of the study was to compare the complication rate of gastrostomy tube placement by either endoscopic or fluoroscopic technique. Between 1996 and 2004, the surgical and radiological services at a Level I trauma hospital placed gastrostomy tubes in 378 patients (endoscopy=268, fluoroscopy=110). The percutaneous gastrostomy group comprised 71% of the cohort with a mean age of 51+/-21 (range: 1-93 years of age), and the percutaneous radiographic gastrostomy group comprised the remaining cohort (29%) with a mean age of 57+/-19 (range: 17-95 years of age). Fifty-eight percent of the percutaneous gastrostomy group were female (n=155) and 42% were male (n=113), whereas the gender distribution for the percutaneous radiographic gastrostomy group was 33% female (n=36) and 67% male (n=74). There was an overall complication rate of 36% (22% and 70% for the endoscopic and fluoroscopic methods, respectively). The most frequent complication in both types of techniques was tube dislodgement (endoscopic=32% [19/268]; fluoroscopic=27% [21/110]). There were very few serious complications. Women had a higher rate of postprocedure complications than did men, at 35% versus 27%. We conclude that gastrostomy tube placement by either endoscopic or fluoroscopic methods results in a number of complications, though most of them are minor. Patients must therefore be informed that this is not a complication-free procedure.
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Fulbrook P, Bongers A, Albarran JW. A European survey of enteral nutrition practices and procedures in adult intensive care units. J Clin Nurs 2007; 16:2132-41. [PMID: 17331100 DOI: 10.1111/j.1365-2702.2006.01841.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AIMS The aim of this survey was to gain an overview of enteral nutrition practices and procedures of European adult intensive care units and to describe current trends. BACKGROUND Currently, little is known about nutritional practices in European intensive care units and whether they match existing guidelines. DESIGN Survey. METHODS A 51-item questionnaire about nutritional assessment and enteral feeding was distributed to 383 intensive care units in 20 countries. RESULTS A total of 380 (99.2%) questionnaires were returned. Most intensive care units (86.5%, n = 320/370) did not use a nutritional risk score and 35.8% (n = 133/371) conducted daily assessments of nutritional status; body weight and serum albumin were the commonest measures. Checking the position of the feeding tube using auscultation of injected air was widespread (72.6%, n = 275/373). Most units used a clinical protocol and under half were supported by a nutritional support team. CONCLUSION There are some variations in enteral nutrition practices across European intensive care units. Involvement of nurses in performing nutritional assessments or developing clinical protocols was minimal. The use of outdated procedures for checking feeding tube placement is a concern. There is scope for further development of nutrition guidelines in European units. RELEVANCE TO CLINICAL PRACTICE This study is relevant to all nurses working in critical care areas. The findings suggest that when an intensive care unit is supported by a nutritional support team it is more likely that a nutritional score will be used and nutritional assessments will be made daily. Many intensive care practices do not conform to international guidelines for enteral feeding. Nutritional assessment and the use of nutritional risk scores are areas that would benefit from further application in intensive care. This study may provide an impetus for intensive care units to review their nutrition assessment practices and to advance evidence-based guidelines, developed by multi-professional teams, which ensure the safe and effective management of patients receiving enteral nutrition.
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Affiliation(s)
- Paul Fulbrook
- School of Nursing & Midwifery, Australian Catholic University, McAuley at Banyo Campus, Brisbane, QLD, Australia.
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Phillips NM, Nay R. Nursing administration of medication via enteral tubes in adults: a systematic review. JBI LIBRARY OF SYSTEMATIC REVIEWS 2007; 5:344-406. [PMID: 27820220 DOI: 10.11124/01938924-200705060-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Enteral tubes are frequently inserted as part of medical treatment in a wide range of patient situations. Patients with an enteral tube are cared for by nurses in a variety of settings, including general and specialised acute care areas, aged care facilities and at home. Regardless of the setting, nurses have the primary responsibility for administering medication through enteral tubes. Medication administration via an enteral tube is a reasonably common nursing intervention that entails a number of skills, including preparing the medication, verifying the tube position, flushing the tube and assessing for potential complications. If medications are not given effectively through an enteral tube, harmful consequences may result leading to increased morbidity, for example, tube occlusion, diarrhoea and aspiration pneumonia. There are resultant costs for the health-care system related to possible increased length of stay and increased use of equipment. Presently what is considered to be best practice to give medications through enteral tubes is unknown. OBJECTIVES The objective of this systematic review was to determine the best available evidence on which nursing interventions are effective in minimising the complications associated with the administration of medications via enteral tubes in adults. Nursing interventions and considerations related to medication administration included form of medication, verifying tube placement before administration, methods used to give medication, methods used to flush tubes, maintenance of tube patency and specific practices to prevent possible complications related to the administration of enteral medications. SEARCH STRATEGY The following databases were searched for literature reported in English only: CINAHL, MEDLINE, The Cochrane Library, Current Contents/All Editions, EMBASE, Australasian Medical Index and PsychINFO. There was no date restriction applied. In addition, the reference lists of all included studies were scrutinised for other potentially relevant studies. SELECTION CRITERIA Systematic reviews of randomised controlled trials (RCTs) and RCTs that compared the effectiveness of nursing interventions and considerations used in the administration of medications via enteral tubes. Other research methods, such as non-randomised controlled trials, longitudinal studies, cohort and case control studies, were also included. Exclusion criteria included studies investigating drug-nutrient interactions or the bioavailability of specific medications. DATA COLLECTION AND ANALYSIS Initial consideration of potential relevance to the review was carried out by the primary author (NP). Two reviewers independently assessed study eligibility for inclusion. A meta-analysis could not be undertaken, as there were no comparable RCTs identified. All data were presented in a narrative summary. RESULTS There is very limited evidence regarding the effectiveness of nursing interventions in minimising the complications associated with enteral tube medication administration in adults. The review highlights a lack of high quality research on many important nursing issues relating to enteral medication administration. There is huge scope for further research. Some of the evidence that was identified included that nurses should consider the use of liquid form medications as there may be fewer tube occlusions than with solid forms in nasoenteral tubes and silicone percutaneous endoscopic gastronomy tubes. Nurses may need to consider the sorbitol content of some liquid medications, for example, elixirs, as diarrhoea has been attributed to the sorbitol content of the elixir, not the drug itself. In addition, the use of 30 mL of water for irrigation when administering medications or flushing small-diameter nasoenteral tubes may reduce the number of tube occlusions.
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Affiliation(s)
- Nicole M Phillips
- 1 Division of Nursing and Midwifery and 2 Gerontic Nursing Clinical School, Australian Centre for Evidence Based Aged Care, La Trobe University, Bundoora, Victonia, Australia
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Ball C. Practice is individual, research is local, knowledge is international. Intensive Crit Care Nurs 2006; 23:1-3. [PMID: 17140795 DOI: 10.1016/j.iccn.2006.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Carol Ball
- Pond Street, London NW3 2QG, United Kingdom
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