1
|
Yeganehjoo M, Johanek J. Role of registered dietitians in nasoenteric feeding tube placement. Nutr Clin Pract 2023; 38:1225-1234. [PMID: 37725386 DOI: 10.1002/ncp.11071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/07/2023] [Accepted: 08/20/2023] [Indexed: 09/21/2023] Open
Abstract
Provision of enteral nutrition (EN) in hospitalized patients is an integral part of clinical care. For various reasons, including but not limited to delayed enteral access placement and EN initiation, it is becoming more prevalent for registered dietitians (RDs) to place feeding tubes in various clinical settings. Although numerous RDs have expanded their practice by learning this skill, many remain hesitant about adding feeding tube placement to their scope of responsibilities. Feeding tube placement is within RDs' scope of practice. The recently updated Accreditation Council for Education in Nutrition and Dietetics (ACEND) standards is requiring dietetic interns to learn the process and assist in placing feeding tubes. This will help promote the inclusion of this practice and open doors for future advancement in the scope of practice for RDs. This review will provide an overview of feeding tube placement methods, evidence-based techniques, training, competencies, and barriers to accepting this practice in dietetics.
Collapse
Affiliation(s)
- Maryam Yeganehjoo
- Nutrition Services Department, Baylor Scott & White Health, Grapevine, Texas, USA
| | | |
Collapse
|
2
|
Watanabe J, Kakehi E, Okamoto M, Ishikawa S, Kataoka Y. Electromagnetic-guided versus endoscopic-guided postpyloric placement of nasoenteral feeding tubes. Cochrane Database Syst Rev 2022; 10:CD013865. [PMID: 36189639 PMCID: PMC9527636 DOI: 10.1002/14651858.cd013865.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND For people who are malnourished and unable to consume food by mouth, nasoenteral feeding tubes are commonly used for the administration of liquid food and drugs. Postpyloric placement is when the tip of the feeding tube is placed beyond the pylorus, in the small intestine. Endoscopic-guided placement of postpyloric feeding tubes is the most common approach. Usually, an endoscopist and two or more medical professionals perform this procedure using a guidewire technique. The position of the tube is then confirmed with fluoroscopy or radiography, which requires moving people undergoing the procedure to the radiology department. Alternatively, electromagnetic-guided placement of postpyloric nasoenteral feeding tubes can be performed by a single trained nurse, at the bedside and with less equipment than endoscopic-guided placement. Hence, electromagnetic-guided placement may represent a promising alternative to endoscopic-guided placement, especially in settings where endoscopy and radiographic facilities are unavailable or difficult to access. OBJECTIVES To assess the efficacy and safety of electromagnetic-guided placement of postpyloric nasoenteral feeding tubes compared to endoscopic-guided placement. SEARCH METHODS We searched the Cochrane Library, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform, and OpenGrey until February 2021. We screened the reference lists of relevant review articles and current treatment guidelines for further literature. We contacted the study authors for missing data. SELECTION CRITERIA We included randomised trials comparing electromagnetic-guided placement with endoscopic-guided placement of nasoenteral feeding tubes. We excluded prospective cohort studies, retrospective cohort studies, (nested) case-control studies, cross-sectional studies, and case series or case reports. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the methodological quality of potentially eligible trials and extracted data from the included trials. The primary outcomes were technical success in insertion and aspiration pneumonitis. The secondary outcomes were the time for postpyloric placement of nasoenteral feeding tubes, direct healthcare costs, and adverse events. We performed a random-effects meta-analysis. We calculated risk ratios (RRs) with 95% confidence intervals (CIs) for dichotomous outcomes and mean differences (MDs) with 95% CIs for continuous outcomes. We evaluated the certainty of evidence based on the GRADE approach. MAIN RESULTS We identified four randomised controlled trials with 541 participants which met our inclusion criteria. All trials had methodological limitations, and lack of blinding of participants and investigators was a major source of bias. We had 'some concerns' for the overall risk of bias in all trials. Electromagnetic-guided postpyloric placement of nasoenteral feeding tubes may result in little to no difference in technical success in insertion compared to endoscopic-guided placement (RR 1.09, 95% CI 0.88 to 1.35; I2 = 81%; low-certainty evidence). Electromagnetic-guided placement may result in a difference in the proportion of participants with aspiration pneumonitis compared to endoscopic-guided placement, but these results are unclear (RR 0.24, 95% CI 0.03 to 2.18; I2 = 0%; low-certainty evidence). Electromagnetic-guided placement may result in little to no difference in the time for postpyloric placement of nasoenteral feeding tubes compared to endoscopic-guided placement (MD 4.06 minutes, 95% CI -0.47 to 8.59; I2 = 97%; low-certainty evidence). Electromagnetic-guided placement likely reduces direct healthcare costs compared to endoscopic-guided placement (MD -127.69 US dollars, 95% CI -135.71 to -119.67; moderate-certainty evidence). Electromagnetic-guided placement likely results in little to no difference in adverse events compared with endoscopic-guided placement (RR 0.78, 95% CI 0.41 to 1.49; moderate-certainty evidence). AUTHORS' CONCLUSIONS We found low-certainty evidence that electromagnetic-guided placement at the bedside results in little to no difference in technical success in insertion and aspiration pneumonitis, compared to endoscopic-guided placement. The heterogeneity of the healthcare professionals who performed the procedures and the small sample sizes limited our confidence in the evidence. Future research should be based on large studies with well-defined endpoints to potentially elucidate the differences between these two procedures.
Collapse
Affiliation(s)
- Jun Watanabe
- Center for Community Medicine, Jichi Medical University, Tochigi, Japan
- Department of Surgery, Division of Gastroenterological, General and Transplant Surgery, Jichi Medical University, Tochigi, Japan
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
| | - Eiichi Kakehi
- Department of General Medicine, Tottori Municipal Hospital, Tottori, Japan
| | - Masaru Okamoto
- Department of General Internal Medicine, Tottori Prefectural Central Hospital, Tottori, Japan
| | | | - Yuki Kataoka
- Scientific Research WorkS Peer Support Group (SRWS-PSG), Osaka, Japan
- Department of Internal Medicine, Kyoto Min-iren Asukai Hospital, Kyoto, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| |
Collapse
|
3
|
Zhu XJ, Liu SX, Li QT, Jiang YJ. Bedside ultrasonic localization of the nasogastric tube in a patient with severe COVID-19: A case report. World J Clin Cases 2022; 10:4911-4916. [PMID: 35801030 PMCID: PMC9198854 DOI: 10.12998/wjcc.v10.i15.4911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/07/2021] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The indwelling nasogastric tube is commonly used for supplying enteral nutrition to patients who are unable to feed themselves, and accurate positioning is essential in the indwelling nasogastric tube in the body of the aforementioned patients. In clinical practice, abdominal radiography, auscultation, and clinical determination of the pH of the gastric juice are routinely used by medical personnel to determine the position of the tube; however, those treatments have proved limitations in specific cases. There are few case reports on the precise positioning of the nasogastric tube in patients with coronavirus disease 2019 (COVID-19), for whom a supply of necessary nutrition support is significant throughout the process of treatment.
CASE SUMMARY A 79-year-old patient, diagnosed with COVID-19 at the stage of combined syndromes with severe bacterial lung infection, respiratory failure, multiple co-morbidities, and a poor nutritional status, was presented to us and required an indwelling nasogastric tube for enteral nutrition support. After pre-treatment assessments including observation of the patient’s nasal feeding status and examination of the nasal septal deviation, inflammation, obstruction, nasal leakage of cerebrospinal fluid, and other disorders that might render intubation inappropriate, we measured and marked the length of the nasogastric tube to be placed and delivered the tube to the intended length in the standard manner. Then further scrutiny was conducted to ensure that the tube was not coiled in the mouth, and gentle movements were made to avoid damage to the esophageal mucosa. However, back draw of the gastric juice using an empty needle failed, and the stethoscope could not be used for auscultation due to the specific condition presented by the internal organs of the patient, and the end of the tube was placed in saline with no bubbles spilling out. Therefore, it was not possible to determine whether the nasogastric tube was placed exactly in the stomach and no nutrient infusion was performed for the time being. Subsequently, the ultrasound probe was utilized to view the condition of the patient’s stomach, where the nasogastric tube was found to be translucent and running parallel to the esophagus shaped as “=”. The pre-conditions were achieved and 100 mL nutritional fluid was fed to the patient, who did not experience any discomfort throughout the procedure. His vital signs were stable with no adverse effects.
CONCLUSION We achieved successfully used ultrasound to position the nasogastric tube in a 79-year-old patient with COVID-19. The repeatable ultrasound application does not involve radiation and causes less disturbance in the neck, making it advantageous for rapid positioning of the nasogastric tube and worthy of clinical promotion and application.
Collapse
Affiliation(s)
- Xiao-Ju Zhu
- Cancer Center, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Shui-Xia Liu
- Cancer Center, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Qiu-Tang Li
- Department of Neurology, Daping Hospital, Army Medical University, Chongqing 400042, China
| | - Yuan-Jing Jiang
- Cancer Center, Daping Hospital, Army Medical University, Chongqing 400042, China
| |
Collapse
|
4
|
Slingerland-Boot R, Bouw-Ruiter M, van Manen C, Arbous S, van Zanten A. Video-assisted placement of enteral feeding tubes using the Integrated Real-Time Imaging System (IRIS)-technology in critically ill patients. Clin Nutr 2021; 40:5000-5007. [PMID: 34364239 DOI: 10.1016/j.clnu.2021.07.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/17/2021] [Accepted: 07/21/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION In critically ill patients, nasogastric (NG) and nasojejunal (NJ) feeding tube placements are standard procedures. However, about 1.9% of blind tube insertions are malpositioned in the tracheopulmonary system, whereas guided procedures may result in a significant delay in nutritional delivery. Guided methods, such as Cortrak and fluoroscopy, have success rates of 82.6-85% and 93% respectively. The current study aims to investigate the performance of video-assisted feeding tube placement in the post-pyloric position using Integrated Real Time Imaging System (IRIS-) technology. METHODS A prospective cohort study in patients requiring enteral feeding was conducted in a mixed medical-surgical intensive care unit (ICU). The primary outcome was the post-pyloric placement of IRIS feeding tubes, as confirmed by X-ray. Secondary study objectives included gastric placement, ease of use and adverse events. RESULTS Thirty-one feeding tubes were placed using IRIS-technology; one patient was excluded for analysis due to protocol violation. One procedure was terminated due to significant bleeding (epistaxis) and desaturation. Only eighteen (58%) feeding tubes were placed in post-pyloric position (including two past the ligament of Treitz). In subjects who needed post-pyloric placement due gastroparesis, IRIS was mostly unsuccessful (success rate of 25%). However, when gastric placement was the primary objective, 96.8% of tubes were correctly placed. During insertion, tracheal visualization occurred in 27% of cases, and the IRIS feeding tube was repositioned early in the procedure without causing patient harm. CONCLUSIONS Real-time video-assisted post-pyloric feeding tube placement in critically ill ICU patients was only successful in 58% of cases and therefore currently cannot be recommended for this indication. However, a high success rate (96.8%) for gastric placement was achieved. IRIS tube placement detected tracheal misplacement immediately and had few adverse events.
Collapse
Affiliation(s)
| | - Marianne Bouw-Ruiter
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Ede, the Netherlands
| | | | - Sesmu Arbous
- Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Arthur van Zanten
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Ede, the Netherlands; Wageningen University & Research, Division of Human Nutrition and Health, Chair group Nutritional Biology, HELIX (Building 124), Stippeneng 4, 6708 WE, Wageningen, the Netherlands.
| |
Collapse
|
5
|
McMullen CD, Anstey C, Garrett P, Moore J. Nasogastric tube placement under sonographic observation: A comparison study of ultrasound and chest radiography in mechanically ventilated patients. Aust Crit Care 2021; 35:181-185. [PMID: 34120804 DOI: 10.1016/j.aucc.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 03/26/2021] [Accepted: 03/28/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Nasogastric tube insertion in the intensive care setting is common. Placement verification is required to avoid complications of bronchotracheal misplacement that range from aspiration of infused contents to death from associated causes. The gold standard of practice is chest radiography. Ultrasound is a growing modality and is readily available in most intensive care units. OBJECTIVE The objective of this study was to examine the diagnostic accuracy of ultrasound imaging of nasogastric tube placements by nonradiologists compared with chest radiography in mechanically ventilated patients. METHODS This is a dual-centre prospective, single-blind study. Correct placement was captured with a hyperechoic ultrasound image of a nasogastric tube in the oesophagus and epigastrium, which was compared with chest radiography. Patient enrolment included general adult intensive care unit admissions who were mechanically ventilated and required a nasogastric tube for either the treatment or monitoring of their illness. RESULTS A total of 25 patients were enrolled (15 men, 10 women), and their mean age was 68.1 ± 13.8 years. Outcome measures were the percentage of correctly identified nasogastric tubes in the oesophagus and epigastrium. The sensitivity of oesophagus ultrasound was 88%, and the positive predictive value was 100%. The subxiphoid sensitivity was 64%, and the positive predictive value was 100%. Comparison sensitivity and specificity of oesophagus versus subxiphoid ultrasound was 64% and 33%, respectively. There was a positive predictive value of 88% and a negative predictive value of 11%. The results showed a variance in detection sensitivity in the ultrasound scans of the oesophagus (0.88) and subxiphoid (0.64) (N = 25, p = 0.012). CONCLUSION Nasogastric tube placement verification via ultrasound in critically ill mechanically ventilated patients conducted by nonradiologists with minimal training is associated with diagnostic accuracy. These results add to the limited evidence in the current literature; however, they should be considered with awareness that placement in the stomach in this study was detected in 64% of cases, alongside the missed captured evidence of the sonographer's ability to identify misplacement.
Collapse
Affiliation(s)
- Carena D McMullen
- Department of Intensive Care, Nambour General Hospital, 26 Hospital Road, Nambour, Sunshine Coast, Queensland, 4560, Australia; Department of Intensive Care, Sunshine Coast University Hospital, 6 Doherty Street, Birtinya, Sunshine Coast, Queensland, 4575, Australia.
| | - Chris Anstey
- Department of Intensive Care, Nambour General Hospital, 26 Hospital Road, Nambour, Sunshine Coast, Queensland, 4560, Australia; Department of Intensive Care, Sunshine Coast University Hospital, 6 Doherty Street, Birtinya, Sunshine Coast, Queensland, 4575, Australia; School of Medicine Griffith University, 170 Kessels Road, Brisbane, Queensland, 4111, Australia; Faculty of Medicine, University of Queensland, St Lucia, Queensland, 4072, Australia; Sunshine Coast Research Institute Research Activity Group, Sunshine Coast University Hospital, 6 Doherty Street, Birtinya, Sunshine Coast, Queensland, 4575, Australia.
| | - Peter Garrett
- Department of Intensive Care, Nambour General Hospital, 26 Hospital Road, Nambour, Sunshine Coast, Queensland, 4560, Australia; Department of Intensive Care, Sunshine Coast University Hospital, 6 Doherty Street, Birtinya, Sunshine Coast, Queensland, 4575, Australia.
| | - John Moore
- Department of Intensive Care, Nambour General Hospital, 26 Hospital Road, Nambour, Sunshine Coast, Queensland, 4560, Australia; Department of Intensive Care, Sunshine Coast University Hospital, 6 Doherty Street, Birtinya, Sunshine Coast, Queensland, 4575, Australia.
| |
Collapse
|
6
|
Powers J, Brown B, Lyman B, Escuro AA, Linford L, Gorsuch K, Mogensen KM, Engelbrecht J, Chaney A, McGinnis C, Quatrara BA, Leonard J, Guenter P. Development of a Competency Model for Placement and Verification of Nasogastric and Nasoenteric Feeding Tubes for Adult Hospitalized Patients. Nutr Clin Pract 2021; 36:517-533. [PMID: 34021623 DOI: 10.1002/ncp.10671] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/23/2021] [Accepted: 04/04/2021] [Indexed: 01/15/2023] Open
Abstract
Nasogastric/nasoenteric (NG/NE) feeding tube placements are associated with adverse events and, without proper training, can lead to devastating and significant patient harm related to misplacement. Safe feeding tube placement practices and verification are critical. There are many procedures and techniques for placement and verification; this paper provides an overview and update of techniques to guide practitioners in making clinical decisions. Regardless of placement technique and verification practices employed, it is essential that training and competency are maintained and documented for all clinicians placing NG/NE feeding tubes. This paper has been approved by the American Society for Parenteral and Enteral Nutrition (ASPEN) Board of Directors.
Collapse
Affiliation(s)
- Jan Powers
- Parkview Health System, Fort Wayne, Indiana, USA
| | - Britta Brown
- Nutrition Services Hennepin Healthcare Minneapolis, Minneapolis, Minnesota, USA
| | - Beth Lyman
- Nutrition Support Consultant, Smithville, Missouri, USA
| | - Arlene A Escuro
- Center for Human Nutrition, Digestive Disease and Surgery Institute Cleveland Clinic, Cleveland, Ohio, USA
| | - Lorraine Linford
- Nutrition Support/Vascular Team, Intermountain Healthcare Medical Center Murray, Salt Lake City, Utah, USA
| | - Kim Gorsuch
- Interventional GI and Pulmonology, Gastroenterology and Nutrition Support Clinic, Comprehensive Care and Research Center, Chicago, Zion, Illinois, USA
| | - Kris M Mogensen
- Department of Nutrition, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Amanda Chaney
- Department of Transplant, College of Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Carol McGinnis
- Sanford USD Medical Center, Sioux Falls, South Dakota, USA
| | - Beth A Quatrara
- Center of Interprofessional Collaborations School of Nursing, University of Virginia Charlottesville, Charlottesville, Virginia, USA
| | - Jennifer Leonard
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Peggi Guenter
- Clinical Practice, Quality, and Advocacy, American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| |
Collapse
|
7
|
Watanabe J, Kakehi E, Okamoto M, Ishikawa S, Kataoka Y. Electromagnetic guided versus endoscopic guided postpyloric placement of nasoenteral feeding tubes. Hippokratia 2021. [DOI: 10.1002/14651858.cd013865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Jun Watanabe
- Center for Community Medicine; Jichi Medical University; Tochigi Japan
| | - Eiichi Kakehi
- Department of General Medicine; Tottori Municipal Hospital; Tottori Japan
| | - Masaru Okamoto
- Department of General Internal Medicine; Tottori Prefectural Central Hospital; Tottori Japan
| | | | - Yuki Kataoka
- Department of Respiratory Medicine; Hyogo Prefectural Amagasaki General Medical Center; Hyogo Japan
| |
Collapse
|
8
|
Brown BD, Hoffman SR, Johnson SJ, Nielsen WR, Greenwaldt HJ. Developing and Maintaining an RDN-Led Bedside Feeding Tube Placement Program. Nutr Clin Pract 2019; 34:858-868. [DOI: 10.1002/ncp.10411] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
| | | | | | - Wendy R. Nielsen
- University of Minnesota Medical Center; Minneapolis Minnesota USA
| | | |
Collapse
|
9
|
Pediatric Nasogastric Tubes in the Home: Recommendations for Practice. Home Healthc Now 2018; 36:148-153. [PMID: 29722704 DOI: 10.1097/nhh.0000000000000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
One of the dilemmas facing home healthcare nurses is the placement of a nasogastric tube (NGT) in the home setting coupled with being assured and confident that the NGT tip is in the correct position, that is, the stomach. There are very limited data to address the issue of management of an NGT in the home care setting with even less guidance for the pediatric population. Therefore, home healthcare nurses must use agency policy and procedures coupled with their own education, knowledge, experience, and skills when performing this procedure. These may vary from agency to agency, thus providing inconsistencies in teaching and techniques.
Collapse
|
10
|
Abstract
The preferred method of nutrition support in the presence of a functional gastrointestinal tract is enteral nutrition (EN). Many factors contribute to the selection process for the type of enteral access device to be used. Short-term enteral access tubes are placed into the nares or, sometimes, orally, usually at bedside. The short-term access provides a means to meet patient nutrient needs and can provide a chance to assess tolerance of the tube feedings if more permanent long-term placement is determined to be required. Access for nutrition support does not come without a risk; it can be challenging, requiring an individualized approach for each patient. The selection type and access location can greatly impact the success of EN. The most advantageous tube choice must be determined carefully, taking into account the multiple considerations reviewed in this paper.
Collapse
Affiliation(s)
- Elizabeth Pash
- Division of Research, Scientific & Medical Affairs, Abbott Nutrition, Columbus, OH, USA
| |
Collapse
|
11
|
McCutcheon KP, Whittet WL, Kirsten JL, Fuchs JL. Feeding Tube Insertion and Placement Confirmation Using Electromagnetic Guidance: A Team Review. JPEN J Parenter Enteral Nutr 2017; 42:247-254. [DOI: 10.1002/jpen.1015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 08/24/2017] [Indexed: 12/15/2022]
|
12
|
Li G, Pan Y, Zhou J, Tong Z, Ke L, Li W. Enteral nutrition tube placement assisted by ultrasonography in patients with severe acute pancreatitis: A novel method for quality improvement. Medicine (Baltimore) 2017; 96:e8482. [PMID: 29137035 PMCID: PMC5690728 DOI: 10.1097/md.0000000000008482] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
To evaluate the effect of a novel procedure using real-time ultrasonography to assist nasojejunal tube placement at bedside in patients with severe acute pancreatitis (SAP).Single center, prospective descriptive study in a 15-bed surgery intensive care unit of a university hospital. Thirty SAP patients were enrolled. The whole procedure of placing nasojejunal tube was performed by a single physician, who places nasojejunal tube at the bedside and performs ultrasonography to guide the tube positioning. The final nasojejunal tube position was confirmed by abdominal radiograph. The successful rate of the procedure as well as the time it took, the time from the decision of enteral feeding to commencement of feeding, and complications were recorded.Thirty-six intubations were performed in 30 patients by using ultrasonography-assisted method at bedside. Nasojejunal tubes were successful placed in 28 of 30 patients (93.3%). The average time of successful placement was 22.07 ± 5.78 minutes. The median time between physician's decision for tube placement and feeding initiation was 5.5 (2, 24) hours. No adverse events occurred in all of patients.This novel method of nasojejunal tube placement under ultrasound guidance is practical, less time consuming and reliable.
Collapse
|
13
|
Kim J, Shin JH. Placement of feeding tubes using fluoroscopy guidance and over-the-wire technique: A technical review. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2017. [DOI: 10.18528/gii160022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jinoo Kim
- Department of Radiology, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea
| | - Ji Hoon Shin
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| |
Collapse
|
14
|
Park J, Krzeminski S, Tan J, Bandlamuri M, Carlson RW. Electromagnetic Tube-Placement Device: The Replacement for the Radiographic Gold Standard? Am J Crit Care 2017; 26:162-163. [PMID: 28249870 DOI: 10.4037/ajcc2017680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Julia Park
- Julia Park, Joshua Tan, and Sylvia Krzeminski are residents at the Maricopa Medical Center in Phoenix, Arizona. Meghana Bandlamuri is a student at the Maricopa Medical Center. Richard W. Carlson is a faculty member at the Maricopa Medical Center, and is affiliated with the University of Arizona College of Medicine, and the Mayo Clinic College of Medicine, Scottsdale, Arizona
| | - Sylvia Krzeminski
- Julia Park, Joshua Tan, and Sylvia Krzeminski are residents at the Maricopa Medical Center in Phoenix, Arizona. Meghana Bandlamuri is a student at the Maricopa Medical Center. Richard W. Carlson is a faculty member at the Maricopa Medical Center, and is affiliated with the University of Arizona College of Medicine, and the Mayo Clinic College of Medicine, Scottsdale, Arizona
| | - Joshua Tan
- Julia Park, Joshua Tan, and Sylvia Krzeminski are residents at the Maricopa Medical Center in Phoenix, Arizona. Meghana Bandlamuri is a student at the Maricopa Medical Center. Richard W. Carlson is a faculty member at the Maricopa Medical Center, and is affiliated with the University of Arizona College of Medicine, and the Mayo Clinic College of Medicine, Scottsdale, Arizona
| | - Meghana Bandlamuri
- Julia Park, Joshua Tan, and Sylvia Krzeminski are residents at the Maricopa Medical Center in Phoenix, Arizona. Meghana Bandlamuri is a student at the Maricopa Medical Center. Richard W. Carlson is a faculty member at the Maricopa Medical Center, and is affiliated with the University of Arizona College of Medicine, and the Mayo Clinic College of Medicine, Scottsdale, Arizona
| | - Richard W Carlson
- Julia Park, Joshua Tan, and Sylvia Krzeminski are residents at the Maricopa Medical Center in Phoenix, Arizona. Meghana Bandlamuri is a student at the Maricopa Medical Center. Richard W. Carlson is a faculty member at the Maricopa Medical Center, and is affiliated with the University of Arizona College of Medicine, and the Mayo Clinic College of Medicine, Scottsdale, Arizona.
| |
Collapse
|
15
|
Confirming nasogastric tube placement: Is the colorimeter as sensitive and specific as X-ray? A diagnostic accuracy study. Int J Nurs Stud 2016; 61:248-57. [PMID: 27415975 DOI: 10.1016/j.ijnurstu.2016.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 06/09/2016] [Accepted: 06/17/2016] [Indexed: 12/27/2022]
Abstract
BACKGROUND The effect of delivering enteral nutrition or medications via a nasogastric tube that is inadvertently located in the tracheobronchial tract can cause respiratory complications. Although radiographic examination is accepted as the gold standard for confirming the position of patients' enteral tubes, it is costly, involves risks of radiation, and is not failsafe. Studies using carbon dioxide sensors to detect inadvertent nasogastric tube placements have been conducted in intensive care settings. However, none involved patients in general wards. OBJECTIVE The objective of this study was to ascertain the diagnostic measure of colorimeter, with radiographic examination as the reference standard, to confirm the location of nasogastric tubes in patients. DESIGN A prospective observational study of a diagnostic test. SETTING This study was conducted in the general wards of an approximately 1100-bed acute care tertiary hospital of an Academic Medical Center in Singapore. PARTICIPANTS Adult patients with nasogastric tubes admitted to the general wards were recruited into the study. METHODS The colorimeter was attached to the nasogastric tube to detect for the presence of carbon dioxide, suggestive of a tracheobronchial placement. The exact location of the nasogastric tube was subsequently confirmed by a radiographic examination. RESULTS A total of 192 tests were undertaken. The colorimeter detected carbon dioxide in 29 tested nasogastric tubes, of which radiographic examination confirmed that four tubes were located in the tracheobronchial tract. The colorimeter failed to detect carbon dioxide in one nasogastric tube that was located in the tracheobronchial tract, thus, demonstrating a sensitivity of 0.80 [95% CI (0.376, 0.964)]. The colorimeter detected absence of carbon dioxide in 163 tested nasogastric tubes in which radiographic examination confirmed 160 gastrointestinal and one tracheobronchial placements, demonstrating a specificity of 0.865 [95% CI (0.808, 0.907)]. The colorimeter detected one tracheobronchial nasogastric tube placement that the radiographic examination was misinterpreted. CONCLUSION The study found that the use of the colorimeter in the general ward setting was not 100% sensitive or specific in ascertaining the location of a nasogastric tube as previously reported by many studies undertaken in intensive care settings. This is the first study on the use of a colorimeter to confirm the placement of a nasogastric tube in adult patients in the general ward setting. More research on the use of a colorimeter in the general ward setting and its potential use in certain processes for confirming the placement of a nasogastric tube is warranted.
Collapse
|
16
|
Milsom SA, Sweeting JA, Sheahan H, Haemmerle E, Windsor JA. Naso-enteric Tube Placement: A Review of Methods to Confirm Tip Location, Global Applicability and Requirements. World J Surg 2016; 39:2243-52. [PMID: 25900711 DOI: 10.1007/s00268-015-3077-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The insertion of a tube through the nose and into the stomach or beyond is a common clinical procedure for feeding and decompression. The safety, accuracy and reliability of tube insertion and methods used to confirm the location of the naso-enteric tube (NET) tip have not been systematically reviewed. The aim of this study is to review and compare these methods and determine their global applicability by end-user engagement. METHODS A systematic literature review of four major databases was performed to identify all relevant studies. The methods for NET tip localization were then compared for their accuracy with reference to a gold standard method (radiography or endoscopy). The global applicability of the different methods was analysed using a house of quality matrix. RESULTS After applying the inclusion and exclusion criteria, 76 articles were selected. Limitations were found to be associated with the 20 different methods described for NET tip localization. The method with the best combined sensitivity and specificity (where n > 1) was ultrasound/sonography, followed by external magnetic guidance, electromagnetic methods and then capnography/capnometry. The top three performance criteria that were considered most important for global applicability were cost per tube/disposable, success rate and cost for non-disposable components. CONCLUSION There is no ideal method for confirming NET tip localisation. While radiography (the gold standard used for comparison) and ultrasound were the most accurate methods, they are costly and not universally available. There remains the need to develop a low-cost, easy-use, accurate and reliable method for NET tip localization.
Collapse
Affiliation(s)
- S A Milsom
- Department of Biomedical Engineering, University of Auckland, Auckland, New Zealand
| | | | | | | | | |
Collapse
|
17
|
Stewart ML. Interruptions in enteral nutrition delivery in critically ill patients and recommendations for clinical practice. Crit Care Nurse 2015; 34:14-21; quiz 22. [PMID: 25086090 DOI: 10.4037/ccn2014243] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Malnutrition is common in critically ill patients and is associated with poor outcomes for patients and increased health care spending. Enteral nutrition is the method of choice for nutrition delivery. Enteral nutrition delivery practices vary widely, and underfeeding is widespread in critical care. Interruptions in enteral nutrition due to performance of procedures, positioning, technical issues with feeding accesses, and gastrointestinal intolerance contribute to underfeeding. Strategies such as head-of-bed positioning, use of prokinetic agents, tolerance of higher gastric residual volumes, consideration of postpyloric feeding access, and use of a nutrition support protocol may decrease time spent without nutrition.
Collapse
Affiliation(s)
- Melissa L Stewart
- Melissa Stewart is a staff nurse in the medical intensive care unit at the University of Kentucky Chandler Medical Center in Lexington.
| |
Collapse
|
18
|
Capriati T, Cardile S, Chiusolo F, Torroni F, Schingo P, Elia D, Diamanti A. Clinical management of post-pyloric enteral feeding in children. Expert Rev Gastroenterol Hepatol 2015; 9:929-41. [PMID: 25926033 DOI: 10.1586/17474124.2015.1041506] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Post-pyloric feeding (PF) allows the administration of enteral nutrition beyond the pylorus, either into the duodenum or, ideally, into the jejunum. The main indications of PF are: upper gastrointestinal tract obstructions, pancreatic rest (e.g., acute pancreatitis), gastric dysmotility (e.g., critically ill patients and chronic intestinal pseudo-obstruction) or severe gastroesophageal reflux with risk of aspiration (e.g., neurological disability). Physiological and clinical evidence derives from adults, but can also be pertinent to children. This review will discuss the practical management and potential clinical applications of PF in pediatric patients. Some key studies pertaining to the physiological changes during PF will also be considered because they support the strategy of PF management.
Collapse
Affiliation(s)
- Teresa Capriati
- Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù Children's Hospital, Piazza S. Onofrio 4, 00165 Rome, Italy
| | | | | | | | | | | | | |
Collapse
|
19
|
Smithard D, Barrett NA, Hargroves D, Elliot S. Electromagnetic Sensor-Guided Enteral Access Systems: A Literature Review. Dysphagia 2015; 30:275-85. [PMID: 25943295 PMCID: PMC4469250 DOI: 10.1007/s00455-015-9607-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 03/05/2015] [Indexed: 02/06/2023]
Abstract
Enteral feeding is the nutritional support of choice for acutely ill patients with functional gastrointestinal tracts who are unable to swallow. Several benefits including reduced mortality and length of hospital stay have been associated with early initiation of enteral feeding. However, misplacement of conventional nasoenteric tubes is relatively common and can result in complications including pneumothorax. In addition, the need to confirm the position by X-ray can delay the start of using the tube. Eliminating these delays can help patients start feeding, and minimise the adverse impact on initiating hydration and medication. The purpose of this review was to critically examine whether electromagnetic sensor-guided enteral access systems (EMS-EAS) can help overcome the challenges of conventional nasoenteric feeding tube placement and confirmation. The Royal Society of Medicine's library performed two searches on Medline (1946-March 2014) and Embase (1947-March 2014) covering all papers on Cortrak or electromagnetic or magnetic guidance systems for feeding tubes in adults. Results from the literature search found an agreement between the radiographic and EMS-EAS confirmation of placement. EMS-EAS virtually eliminated the risk of misplacement and pneumothorax was not reported. In addition, studies showed a small decrease in the number of X-rays with EMS-EAS and a reduced average time to start feeding compared with blind placement. This review suggests that EMS-EAS reduces several complications associated with the misplacement of nasoenteric feeding tubes, and that there could be considerable improvements in mortality, morbidity, patient experience and cost if EMS-EAS is used instead of conventional methods.
Collapse
|
20
|
Irving SY, Lyman B, Northington L, Bartlett JA, Kemper C. Nasogastric tube placement and verification in children: review of the current literature. Nutr Clin Pract 2014; 29:267-76. [PMID: 24737681 DOI: 10.1177/0884533614531456] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Placement of a nasogastric enteral access device (NG-EAD), often referred to as a nasogastric tube, is a common practice and largely in the domain of nursing care. Most often an NG-EAD is placed at the bedside without radiographic assistance. Correct initial placement and ongoing location verification are the primary challenges surrounding NG-EAD use and have implications for patient safety. Although considered an innocuous procedure, placement of an NG-EAD carries risk of serious and potentially lethal complications. Despite acknowledgment that an abdominal radiograph is the gold standard, other methods of verifying placement location are widely used and have success rates from 80% to 85%. The long-standing challenges surrounding bedside placement of NG-EADs and a practice alert issued by the Child Health Patient Safety Organization on this issue were the stimuli for the conception of The New Opportunities for Verification of Enteral Tube Location Project sponsored by the American Society for Parenteral and Enteral Nutrition. Its mission is to identify and promote best practices with the potential of technology development that will enable accurate determination of NG-EAD placement for both the inpatient and outpatient pediatric populations. This article presents the challenges of bedside NG-EAD placement and ongoing location verification in children through an overview of the current state of the science. It is important for all healthcare professionals to be knowledgeable about the current literature, to be vigilant for possible complications, and to avoid complacency with NG-EAD placement and ongoing verification of tube location.
Collapse
Affiliation(s)
- Sharon Y Irving
- Children's Hospital of Philadelphia, University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania
| | | | | | | | | | | |
Collapse
|
21
|
Irving SY, Lyman B, Northington L, Bartlett JA, Kemper C. Nasogastric tube placement and verification in children: review of the current literature. Crit Care Nurse 2014; 34:67-78. [PMID: 24735587 DOI: 10.4037/ccn2014606] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Placement of a nasogastric enteral access device (NG-EAD), often referred to as a nasogastric tube, is common practice and largely in the domain of nursing care. Most often an NG-EAD is placed at the bedside without radiographic assistance. Correct initial placement and ongoing location verification are the primary challenges surrounding NG-EAD use and have implications for patient safety. Although considered an innocuous procedure, placement of an NG-EAD carries risk of serious and potentially lethal complications. Despite acknowledgment that an abdominal radiograph is the gold standard, other methods of verifying placement location are widely used and have success rates from 80% to 85%. The long-standing challenges surrounding bedside placement of NG-EADs and a practice alert issued by the Child Health Patient Safety Organization on this issue were the stimuli for the conception of The New Opportunities for Verification of Enteral Tube Location Project sponsored by the American Society for Parenteral and Enteral Nutrition. Its mission is to identify and promote best practices with the potential of technology development that will enable accurate determination of NG-EAD placement for both the inpatient and outpatient pediatric populations. This article presents the challenges of bedside NG-EAD placement and ongoing location verification in children through an overview of the current state of the science. It is important for all health care professionals to be knowledgeable about the current literature, to be vigilant for possible complications, and to avoid complacency with NG-EAD placement and ongoing verification of tube location.
Collapse
Affiliation(s)
- Sharon Y Irving
- Sharon Y. Irving is a pediatric critical care nurse practitioner at The Children's Hospital of Philadelphia and an assistant professor at the University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania. She is the AACN liaison for the New Opportunities for Verification of Enteral Tube Location (NOVEL) project sponsored by the American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.).Beth Lyman is a senior program coordinator for the nutrition support team at Children's Mercy Hospital in Kansas City, Missouri, and is the chair of the NOVEL project sponsored by A.S.P.E.N.LaDonna Northington is director of the traditional undergraduate program at the University of Mississippi, School of Nursing, in Jackson, and a member of the Society of Pediatric Nursing.Jacqueline A. Bartlett is director of evidence-based practice at Children's Mercy Hospital in Kansas City, Missouri.Carol Kemper is vice president of quality and safety at Children's Mercy Hospital in Kansas City, Missouri and a steering committee member for the Children Health Patient Safety Organization/Children's Hospital Association.
| | - Beth Lyman
- Sharon Y. Irving is a pediatric critical care nurse practitioner at The Children's Hospital of Philadelphia and an assistant professor at the University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania. She is the AACN liaison for the New Opportunities for Verification of Enteral Tube Location (NOVEL) project sponsored by the American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.).Beth Lyman is a senior program coordinator for the nutrition support team at Children's Mercy Hospital in Kansas City, Missouri, and is the chair of the NOVEL project sponsored by A.S.P.E.N.LaDonna Northington is director of the traditional undergraduate program at the University of Mississippi, School of Nursing, in Jackson, and a member of the Society of Pediatric Nursing.Jacqueline A. Bartlett is director of evidence-based practice at Children's Mercy Hospital in Kansas City, Missouri.Carol Kemper is vice president of quality and safety at Children's Mercy Hospital in Kansas City, Missouri and a steering committee member for the Children Health Patient Safety Organization/Children's Hospital Association
| | - LaDonna Northington
- Sharon Y. Irving is a pediatric critical care nurse practitioner at The Children's Hospital of Philadelphia and an assistant professor at the University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania. She is the AACN liaison for the New Opportunities for Verification of Enteral Tube Location (NOVEL) project sponsored by the American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.).Beth Lyman is a senior program coordinator for the nutrition support team at Children's Mercy Hospital in Kansas City, Missouri, and is the chair of the NOVEL project sponsored by A.S.P.E.N.LaDonna Northington is director of the traditional undergraduate program at the University of Mississippi, School of Nursing, in Jackson, and a member of the Society of Pediatric Nursing.Jacqueline A. Bartlett is director of evidence-based practice at Children's Mercy Hospital in Kansas City, Missouri.Carol Kemper is vice president of quality and safety at Children's Mercy Hospital in Kansas City, Missouri and a steering committee member for the Children Health Patient Safety Organization/Children's Hospital Association
| | - Jacqueline A Bartlett
- Sharon Y. Irving is a pediatric critical care nurse practitioner at The Children's Hospital of Philadelphia and an assistant professor at the University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania. She is the AACN liaison for the New Opportunities for Verification of Enteral Tube Location (NOVEL) project sponsored by the American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.).Beth Lyman is a senior program coordinator for the nutrition support team at Children's Mercy Hospital in Kansas City, Missouri, and is the chair of the NOVEL project sponsored by A.S.P.E.N.LaDonna Northington is director of the traditional undergraduate program at the University of Mississippi, School of Nursing, in Jackson, and a member of the Society of Pediatric Nursing.Jacqueline A. Bartlett is director of evidence-based practice at Children's Mercy Hospital in Kansas City, Missouri.Carol Kemper is vice president of quality and safety at Children's Mercy Hospital in Kansas City, Missouri and a steering committee member for the Children Health Patient Safety Organization/Children's Hospital Association
| | - Carol Kemper
- Sharon Y. Irving is a pediatric critical care nurse practitioner at The Children's Hospital of Philadelphia and an assistant professor at the University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania. She is the AACN liaison for the New Opportunities for Verification of Enteral Tube Location (NOVEL) project sponsored by the American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.).Beth Lyman is a senior program coordinator for the nutrition support team at Children's Mercy Hospital in Kansas City, Missouri, and is the chair of the NOVEL project sponsored by A.S.P.E.N.LaDonna Northington is director of the traditional undergraduate program at the University of Mississippi, School of Nursing, in Jackson, and a member of the Society of Pediatric Nursing.Jacqueline A. Bartlett is director of evidence-based practice at Children's Mercy Hospital in Kansas City, Missouri.Carol Kemper is vice president of quality and safety at Children's Mercy Hospital in Kansas City, Missouri and a steering committee member for the Children Health Patient Safety Organization/Children's Hospital Association
| | | |
Collapse
|
22
|
Abstract
Nutrition intervention plays a significant role in changing patient clinical outcomes in the intensive care unit. Identifying patients at nutrition risk with a validated tool is essential. The decision to use enteral or parenteral nutrition is patient dependent and should include an assessment of the patient's gastrointestinal function. Protein is a critical component of the nutrition prescription, and prescribed levels may need to be higher than current guidelines recommend. Alternative lipids, such as olive oil and fish oil, are still being evaluated for their potential clinical impact. Avoiding nutrition therapy-associated complications, such as catheter infection and hyperglycemia, are important factors in being able to maximize the effectiveness of a nutritional intervention.
Collapse
|
23
|
Holland A, Smith F, Penny K. Carbon dioxide detection for testing nasogastric tube placement in adults. Hippokratia 2013. [DOI: 10.1002/14651858.cd010773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Agi Holland
- Faculty of Health, Life & Social Sciences, Edinburgh Napier University; School of Nursing, Midwifery and Social Care; Sighthill Campus Sighthill Court Edinburgh UK EH11 4BN
| | - Fiona Smith
- Faculty of Health, Life & Social Sciences, Edinburgh Napier University; School of Nursing, Midwifery and Social Care; Sighthill Campus Sighthill Court Edinburgh UK EH11 4BN
| | - Kay Penny
- Edinburgh Napier University; School of Management; Craiglockhart Campus Edinburgh UK EH14 1DJ
| |
Collapse
|
24
|
Stayner JL, Bhatnagar A, McGinn AN, Fang JC. Feeding tube placement: errors and complications. Nutr Clin Pract 2012; 27:738-48. [PMID: 23064019 DOI: 10.1177/0884533612462239] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Feeding tube placement for enteral nutrition (EN) support is widely used in both critically ill and stable chronically ill patients who are unable to meet their nutrition needs orally. Nasal or oral feeding tubes can be performed blindly at the bedside or with fluoroscopic or endoscopic guidance into the stomach or small bowel. Percutaneous feeding tubes are used when EN support is required for longer periods (>4-6 weeks) and are most commonly placed endoscopically or radiographically. Although generally safe and effective, there is a wide spectrum of known complications associated with feeding tube placement. Errors made at the time of feeding tube placement can result in a number of these procedural and postprocedural complications. In many cases, a single error at the time of placement can result in numerous complications. A thorough knowledge of these errors and avoiding them in practice will decrease iatrogenic complications in a vulnerable population. In addition, early recognition and management of complications will further minimize morbidity and even mortality in enteral feeding tube placement. This article reviews the common errors leading to complications of enteral feeding tube placement and their prevention and management.
Collapse
Affiliation(s)
- James L Stayner
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah 84132, USA
| | | | | | | |
Collapse
|
25
|
Lee JM, Fernandez F, Staff I, Mah JW. Web-based teaching module improves success rates of postpyloric positioning of nasoenteric feeding tubes. JPEN J Parenter Enteral Nutr 2012; 36:323-9. [PMID: 22245760 DOI: 10.1177/0148607111416246] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Bedside protocols improve success rates of postpyloric nasoenteric tube (NET) placement by nutrition teams and experienced individuals. However, many hospitals require novice practitioners to perform these procedures and often choose fluoroscopy, endoscopy, or newer alternative devices to achieve success. Little is known about the ability to train inexperienced practitioners or the effectiveness of the methods used to implement these protocols. Web-based learning is a potential tool to improve knowledge and procedural skills. The authors created a self-directed Web-based teaching module (WBTM) to educate and standardize placement of postpyloric NETs. METHODS Forty-three first-, second-, or third-year residents or medical or physician assistant students took pretests for knowledge and confidence surveys, viewed the WBTM, placed NET at the bedside, then took a posttest and confidence survey while awaiting confirmation of tube position by abdominal radiograph. Success was acknowledged if the tip of the NET was beyond the pylorus. A retrospective chart review was used to determine a historical success rate, which was used as a control. RESULTS Knowledge and confidence significantly improved. Overall success rate of postpyloric NET placement for all participants on first attempt was 74.4% vs 46.7% in the control (P = .005). Improvement occurred in all subgroups, including those with no prior experience, who were successful 70.4% of the time (P = .009). CONCLUSIONS This WBTM is simple to implement, inexpensive, and resource efficient. The improvement in postpyloric NET placement, especially among novice practitioners, demonstrates the benefit and applicability of this method of standardized education.
Collapse
Affiliation(s)
- Jessica M Lee
- Department of Surgery/Critical Care, Hartford Hospital, Hartford, Connecticut, USA.
| | | | | | | |
Collapse
|
26
|
Powers J, Luebbehusen M, Spitzer T, Coddington A, Beeson T, Brown J, Jones D. Verification of an electromagnetic placement device compared with abdominal radiograph to predict accuracy of feeding tube placement. JPEN J Parenter Enteral Nutr 2011; 35:535-9. [PMID: 21700968 DOI: 10.1177/0148607110387436] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Use of an electromagnetic placement device (EMPD) facilitates placement of feeding tubes at the bedside. Standard practice for verification of feeding tube placement is via radiographic confirmation. The purpose of this research study was to assess the accuracy of placement of small-bore feeding tubes (SBFTs) as determined by EMPD interpretation compared with that of abdominal radiograph verification by a radiologist. METHODS This multicenter prospective study enrolled patients requiring bedside feeding tube placement. SBFTs were placed by an experienced investigator using the EMPD. Two abdominal radiographs were then obtained: one after initial SBFT placement and an additional radiograph after injection of contrast. Documentation of location based on clinician interpretation using the EMPD was then compared with radiologist interpretation. RESULTS The final sample size was 194 patients, including 18 pediatric patients. Patient age ranged from 12 days to 102 years. Median time for tube placement was 12 minutes. Of the 194 patients, only 1 patient had data showing discrepancies between the original EMPD verification and the final abdominal radiograph interpretation, providing a 99.5% agreement. No patient experienced complications during SBFT placement, and 15 patients had inadvertent airway placement that was avoided with the use of the EMPD. CONCLUSIONS There was a high percentage of agreement between EMPD and radiologic interpretation after contrast injection. The EMPD aided in avoiding inadvertent airway placement, with no patient complications. This device can be used safely at the bedside to facilitate placement of feeding tubes, leading to the delivery of early enteral nutrition.
Collapse
Affiliation(s)
- Jan Powers
- St Vincent Hospital, Indianapolis, Indiana, USA.
| | | | | | | | | | | | | |
Collapse
|
27
|
Braun J, Bein T, Wiese CHR, Graf BM, Zausig YA. [Enteral feeding tubes for critically ill patients]. Anaesthesist 2011; 60:352-65. [PMID: 21136033 DOI: 10.1007/s00101-010-1800-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The use of enteral feeding tubes is an important part of early enteral feeding in intensive care medicine. In other faculties with non-critically ill patients, such as (oncologic) surgery, neurology, paediatrics or even in palliative care medicine feeding tubes are used under various circumstances as a temporary or definite solution. The advantage of enteral feeding tubes is the almost physiologic administration of nutrition, liquids and medication. Enteral nutrition is thought to be associated with a reduced infection rate, increased mucosal function, improved immunologic function, reduced length of hospital stay and reduced costs. However, the insertion and use of feeding tubes is potentially dangerous and may be associated with life-threatening complications (bleeding, perforation, peritonitis, etc.). Therefore, the following article will give a summary of the different types of enteral feeding tubes and their range of application. Additionally, a critical look on indication and contraindication is given as well as how to insert an enteral feeding tube.
Collapse
Affiliation(s)
- J Braun
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, Germany
| | | | | | | | | |
Collapse
|
28
|
Rivera R, Campana J, Hamilton C, Lopez R, Seidner D. Small Bowel Feeding Tube Placement Using an Electromagnetic Tube Placement Device. JPEN J Parenter Enteral Nutr 2011; 35:636-42. [DOI: 10.1177/0148607110386047] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Rene Rivera
- Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Strong Memorial Hospital, Rochester, New York
| | | | | | - Rocio Lopez
- Quantitative Health Sciences Cleveland Clinic, Cleveland, Ohio
| | - Douglas Seidner
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
29
|
Smith S, Fedyszen K. Providing nutrition to critically ill obese adults: use of the nursing process. Crit Care Nurs Clin North Am 2011; 21:353-67, vi. [PMID: 19840714 DOI: 10.1016/j.ccell.2009.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Caring for obese critically ill patients is not always the same as caring for critically ill patients who are not obese. Fortunately, nurses have many resources available to them to guide them in this process. However, research that specifically addresses the needs of obese critically ill patients is still lacking in many areas and should be considered as potential areas to develop evidence-based practices.
Collapse
Affiliation(s)
- Susan Smith
- Critical Care Unit, Texas Health Presbyterian Hospital Plano, 6200 West Parker Road, Plano, TX 75093-7914, USA.
| | | |
Collapse
|
30
|
Tho PC, Mordiffi S, Ang E, Chen H. Implementation of the evidence review on best practice for confirming the correct placement of nasogastric tube in patients in an acute care hospital. INT J EVID-BASED HEA 2011; 9:51-60. [PMID: 21332663 DOI: 10.1111/j.1744-1609.2010.00200.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Nasogastric (NG) tube is a device passed through the gastrointestinal tract of patients for the purpose of feeding, gastric decompression and medication administration. However, a small risk involved in the process is that the tube may be misplaced into the trachea during insertion or may get displaced at a later stage, leading to disastrous results. Recent adverse incidences arising out of the misplacement of NG tube raised concerns among the nursing and medical community and the Patient Safety Officer of the hospital. The Evidence Based Nursing Unit, in collaboration with some of the key nursing leaders in nursing administration, was tasked to explore and institute the current best practice in confirming the correct placement of NG tube. AIM The aim of this project was to institute the best practice to confirm the correct placement of NG tube in patients in an acute care hospital setting. METHOD The project comprised of a few stages. The first stage involved reviewing the existing recommendations and guidelines on the methods for checking correct NG tube placement. The second stage involved incorporation of the change of practice into the clinical setting. The final stage was to monitor and evaluate the impact of the new practice on the patients, nurses and other healthcare professionals. RESULTS Evidence search from guidelines and journals supported the test that used pH indicator instead of the litmus test. There is no evidence that supports the method of auscultation and bubbling to confirm correct NG tube placement in the absence of aspirate. Radiology remains the 'gold standard' for checking correct NG tube placement. The revised method of NG tube placement and workflow was incorporated in the revised Standard Operating Procedures. A total of 17 roadshows were conducted to create awareness regarding the new method amongst the nurses, and the implementation of the revised method and workflow was commenced on 3 November 2008. The initial audit conducted 1 month after the practice change was implemented reported 26 (50%) observations of NG tube feeding in 26 audit wards. The key areas of practice change in feeding when tube placement was confirmed (84.6%) and proper testing of aspirate (76.9%) showed good compliance. CONCLUSION The implementation of the change in the practice of confirming the correct placement of the NG tube in patients requires good coordination and a multidisciplinary team approach.
Collapse
Affiliation(s)
- Poh Chi Tho
- Evidence Based Nursing Unit, National University Hospital, Singapore.
| | | | | | | |
Collapse
|
31
|
Silk DBA. The Evolving Role of Post–Ligament of Trietz Nasojejunal Feeding in Enteral Nutrition and the Need for Improved Feeding Tube Design and Placement Methods. JPEN J Parenter Enteral Nutr 2011; 35:303-7. [DOI: 10.1177/0148607110387799] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- D. B. A. Silk
- Department of Biosurgery and Surgical Technology, Department of Academic Surgery, Imperial College London, London, United Kingdom
| |
Collapse
|
32
|
The use of the Cortrak Enteral Access System™ for post-pyloric (PP) feeding tube placement in a Burns Intensive Care Unit. Burns 2011; 37:277-80. [DOI: 10.1016/j.burns.2010.07.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 06/23/2010] [Accepted: 07/19/2010] [Indexed: 12/19/2022]
|
33
|
Abstract
Some advanced practice nutrition support dietitians have added small bowel feeding tube placement to their scope of responsibility. This is due, in part, to the challenges of gaining early enteral access in patients with functioning GI tracts. Emerging literature supports the practice of skilled practitioners placing feeding tubes at bedside. A variety of methods can be used to place tubes at the bedside. The nutrition support dietitian must understand licensure and liability considerations to perform this invasive procedure. This article will review literature reports of dietitians placing feeding tubes and provide information on the methods used, training and competencies required, and legal issues involved.
Collapse
Affiliation(s)
- Cheryl Marsland
- University of Medicine and Dentistry School of Health Related Professions, 65 Bergen Street, Newark, NJ 07107-3001, USA.
| |
Collapse
|
34
|
Munera-Seeley V, Ochoa JB, Brown N, Bayless A, Correia MITD, Bryk J, Zenati M. Use of a Colorimetric Carbon Dioxide Sensor for Nasoenteric Feeding Tube Placement in Critical Care Patients Compared With Clinical Methods and Radiography. Nutr Clin Pract 2008; 23:318-21. [DOI: 10.1177/0884533608318105] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Verónica Munera-Seeley
- From Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; State University of New York—SUNY, Downstate Medical Center, Brooklyn, New York; Unit Director Intravenous Therapy and Enteral Access Team, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, Brazil; and School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Juan B. Ochoa
- From Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; State University of New York—SUNY, Downstate Medical Center, Brooklyn, New York; Unit Director Intravenous Therapy and Enteral Access Team, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, Brazil; and School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nefertiti Brown
- From Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; State University of New York—SUNY, Downstate Medical Center, Brooklyn, New York; Unit Director Intravenous Therapy and Enteral Access Team, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, Brazil; and School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Angela Bayless
- From Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; State University of New York—SUNY, Downstate Medical Center, Brooklyn, New York; Unit Director Intravenous Therapy and Enteral Access Team, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, Brazil; and School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - M. Isabel T. D. Correia
- From Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; State University of New York—SUNY, Downstate Medical Center, Brooklyn, New York; Unit Director Intravenous Therapy and Enteral Access Team, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, Brazil; and School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jodie Bryk
- From Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; State University of New York—SUNY, Downstate Medical Center, Brooklyn, New York; Unit Director Intravenous Therapy and Enteral Access Team, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, Brazil; and School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Mazen Zenati
- From Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; State University of New York—SUNY, Downstate Medical Center, Brooklyn, New York; Unit Director Intravenous Therapy and Enteral Access Team, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, Brazil; and School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
35
|
Wesley JR. Technology: managing the genie. Nutr Clin Pract 2007; 22:375-6. [PMID: 17644691 DOI: 10.1177/0115426507022004375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- John R Wesley
- Feinberg School of Medicine, Northwestern University, Chicago, Illiniois, USA.
| |
Collapse
|