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Zheng Z, Wang J, Shao Z, Cai H, Lu L, Tang S, Xu S, Gong F, Ye S, Yang X, Liu J. Multivariate analysis of factors associated with the successful prediction of initial blind placement of a nasointestinal tube in the stomach based on X-ray imaging: a retrospective, single-center study. BMC Gastroenterol 2024; 24:284. [PMID: 39179985 PMCID: PMC11342475 DOI: 10.1186/s12876-024-03363-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 08/08/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Patients in the intensive care unit (ICU) are highly susceptible to malnutrition, and while enteral nutrition via nasogastric tube is the preferred method, there is a risk of inadvertent reflux and aspiration. Therefore, clinicians have turned to nasointestinal tubes (NET) for enteral nutrition as an alternative option. But the precise localization of NET presents an ongoing challenge. We proposed an innovative approach to provide a valuable reference for clinicians involved in NET placement. METHOD Data were obtained retrospectively from the medical records of adult patients with a high risk of aspiration or gastric feeding intolerance who had a NET placed in the ICU of Zhejiang Provincial People's Hospital between October 1, 2017, and October 1, 2023. The collected data were subjected to statistical analysis using SPSS and R software. RESULT There were 494 patients who met the inclusion and exclusion criteria. The first-pass success rate was 81.4% (n = 402). The success of a patient's initial NET placement was found to be associated with Angle SPC and Distance CP, as determined by univariate analysis (25.6 ± 16.7° vs. 41.9 ± 18.0°, P < 0.001; 40.0 ± 26.2 mm vs. 62.0 ± 31.8 mm, P < 0.001, respectively). By conducting a multivariate regression analysis, we identified a significant association between pyloric types and the success rate of placing NET (OR 29.559, 95%CI 14.084-62.038, P < 0.001). CONCLUSION Angle SPC, Distance CP, and the type of pylorus are independently associated with successful initial placement of NET. Besides, patients with the outside type of pylorus (OP-type) exhibit a higher rate of initial placement success.
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Affiliation(s)
- Zihao Zheng
- Emergency and Critical Care Center, Intensive Care Unit, Affiliated People's Hospital, Zhejiang Provincial People's Hospital, Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou, 310014, Zhejiang Province, China
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang Province, China
| | - Jiangbo Wang
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang Province, China
| | - Ziqiang Shao
- Emergency and Critical Care Center, Intensive Care Unit, Affiliated People's Hospital, Zhejiang Provincial People's Hospital, Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou, 310014, Zhejiang Province, China
| | - Hanhui Cai
- Emergency and Critical Care Center, Intensive Care Unit, Affiliated People's Hospital, Zhejiang Provincial People's Hospital, Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou, 310014, Zhejiang Province, China
| | - Lihai Lu
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang Province, China
| | - Siyu Tang
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang Province, China
| | - Shuting Xu
- Emergency and Critical Care Center, Intensive Care Unit, Affiliated People's Hospital, Zhejiang Provincial People's Hospital, Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou, 310014, Zhejiang Province, China
| | - Fangxiao Gong
- Emergency and Critical Care Center, Intensive Care Unit, Affiliated People's Hospital, Zhejiang Provincial People's Hospital, Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou, 310014, Zhejiang Province, China
| | - Sen Ye
- Emergency and Critical Care Center, Intensive Care Unit, Affiliated People's Hospital, Zhejiang Provincial People's Hospital, Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou, 310014, Zhejiang Province, China
| | - Xianghong Yang
- Emergency and Critical Care Center, Intensive Care Unit, Affiliated People's Hospital, Zhejiang Provincial People's Hospital, Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou, 310014, Zhejiang Province, China
| | - Jingquan Liu
- Emergency and Critical Care Center, Intensive Care Unit, Affiliated People's Hospital, Zhejiang Provincial People's Hospital, Hangzhou Medical College, No. 158 Shangtang Road, Gongshu District, Hangzhou, 310014, Zhejiang Province, China.
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Li H, Tay KV, Liu J, Ong CYG, Khoo HW, Zhou A, Miyasaka M, Phee SJ. Feasibility of a low-cost magnet tracking device in confirming nasogastric tube placement at point of care, a clinical trial. Sci Rep 2024; 14:7068. [PMID: 38528059 PMCID: PMC10963729 DOI: 10.1038/s41598-024-57455-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/18/2024] [Indexed: 03/27/2024] Open
Abstract
An affordable and reliable way of confirming the placement of nasogastric tube (NGT) at point-of-care is an unmet need. Using a novel algorithm and few sensors, we developed a low-cost magnet tracking device and showed its potential to localize the NGT preclinically. Here, we embark on a first-in-human trial. Six male and 4 female patients with NGT from the general ward of an urban hospital were recruited. We used the device to localize the NGT and compared that against chest X-ray (CXR). In 5 patients, with the sensors placed on the sternal angle, the trajectory of the NGT was reproduced by the tracking device. The tracked location of the NGT deviated from CXR by 0.55 to 1.63 cm, and a downward tracking range of 17 to 22 cm from the sternal angle was achieved. Placing the sensors on the xiphisternum, however, resulted in overt discordance between the device's localization and that on CXR. Short distance between the sternal angle and the xiphisternum, and lower body weight were observed in patients in whom tracking was feasible. Tracking was quick and well tolerated. No adverse event occurred. This device feasibly localized the NGT in 50% of patients when appropriately placed. Further refinement is anticipated.ClinicalTrials.gov identifier: NCT05204901.
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Affiliation(s)
- Hao Li
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - Kon Voi Tay
- Department of General Surgery, Woodlands Health, Singapore, Singapore
| | - Jiajun Liu
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Chern Yue Glen Ong
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Hau Wei Khoo
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore, Singapore
| | - Aijin Zhou
- Department of Nursing, Tan Tock Seng Hospital, Singapore, Singapore
| | - Muneaki Miyasaka
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
| | - Soo Jay Phee
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Singapore
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Lyu Y, Yu H, Jia K, Chen G, He X, Muir R. Emergency nurse and physician perceptions of barriers and facilitators to optimal nutrition in the emergency department: A national cross-sectional survey. Int Emerg Nurs 2023; 70:101327. [PMID: 37597279 DOI: 10.1016/j.ienj.2023.101327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 05/12/2023] [Accepted: 07/07/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION Optimal nutritional support is becoming increasingly important in Emergency Departments (EDs) as over half of patients presenting to ED are reported to be malnourished or at risk of malnutrition. Few studies have examined the barriers and facilitators to nutritional support in ED. AIM To identify barriers and facilitators to providing optimal nutritional support in the ED from nurse and physician perspectives. METHODS A cross-sectional 31-item electronic survey was developed, validated, and distributed nationally in August 2021 in China. RESULTS A total of 1766 eligible respondents completed the survey, including 846 ED nurses and 920 ED physicians from 155 hospitals. Barriers to optimal nutrition were moderate (2.72/5 ± 0.88); the most common barrier was lack of multidisciplinary team-work support. Facilitators to support optimal nutrition were moderately high (3.58/5 ± 1.08); the most common facilitator was technical/professional support and organizational management. Respondents who received recent nutrition training and those with higher levels of nutrition knowledge (self-rated) perceived fewer barriers overall to optimal nutrition in ED (P < 0.01). CONCLUSION Context specific barriers and facilitators both hinder and support optimal nutrition in ED. Further research is required to develop tailored interventions to address specific barriers to optimal nutrition and enhance facilitators in the ED context.
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Affiliation(s)
- Yang Lyu
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Han Yu
- Department of Emergency Medicine, Beijing Chao-Yang Hospital, Beijing, China
| | - Kai Jia
- Department of Nutrition, Beijing Chao-Yang Hospital, Beijing, China
| | - Gang Chen
- Department of Pharmacy, Beijing Chao-Yang Hospital, Beijing, China
| | - Xinhua He
- Department of Emergency Medicine, Beijing Chao-Yang Hospital, Beijing, China
| | - Rachel Muir
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia; Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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Martinovic D, Tokic D, Puizina Mladinic E, Usljebrka M, Kadic S, Lesin A, Vilovic M, Lupi-Ferandin S, Ercegovic S, Kumric M, Bukic J, Bozic J. Nutritional Management of Patients with Head and Neck Cancer-A Comprehensive Review. Nutrients 2023; 15:nu15081864. [PMID: 37111081 PMCID: PMC10144914 DOI: 10.3390/nu15081864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/07/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
While surgical therapy for head and neck cancer (HNC) is showing improvement with the advancement of reconstruction techniques, the focus in these patients should also be shifting to supportive pre and aftercare. Due to the highly sensitive and anatomically complex region, these patients tend to exhibit malnutrition, which has a substantial impact on their recovery and quality of life. The complications and symptoms of both the disease and the therapy usually make these patients unable to orally intake food, hence, a strategy should be prepared for their nutritional management. Even though there are several possible nutritional modalities that can be administrated, these patients commonly have a functional gastrointestinal tract, and enteral nutrition is indicated over the parenteral option. However, after extensive research of the available literature, it seems that there is a limited number of studies that focus on this important issue. Furthermore, there are no recommendations or guidelines regarding the nutritional management of HNC patients, pre- or post-operatively. Henceforth, this narrative review summarizes the nutritional challenges and management modalities in this particular group of patients. Nonetheless, this issue should be addressed in future studies and an algorithm should be established for better nutritional care of these patients.
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Affiliation(s)
- Dinko Martinovic
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Daria Tokic
- Department of Anesthesiology and Intensive Care, University Hospital of Split, 21000 Split, Croatia
| | - Ema Puizina Mladinic
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Mislav Usljebrka
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Sanja Kadic
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Antonella Lesin
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Marino Vilovic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
| | - Slaven Lupi-Ferandin
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Sasa Ercegovic
- Department of Maxillofacial Surgery, University Hospital of Split, 21000 Split, Croatia
| | - Marko Kumric
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
| | - Josipa Bukic
- Department of Pharmacy, University of Split School of Medicine, 21000 Split, Croatia
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
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Streibert F, Bernhardt C, Simon P, Hilbert-Carius P, Wrigge H. [Safe position check of gastric tubes: an often underestimated topic to prevent possible severe complications]. DIE ANAESTHESIOLOGIE 2023; 72:57-62. [PMID: 36416892 DOI: 10.1007/s00101-022-01218-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/28/2022] [Indexed: 11/24/2022]
Abstract
The insertion of a gastric tube in the operating room (OR) or in an intensive care unit (ICU) is a routine procedure. Although the tube is often inserted by nursing staff, the indications and selection of the procedure for position control remain the physician's responsibility. For immediate position control, the injection of air through the inserted tube with simultaneous auscultation of the epigastrium is probably the most simple and common clinical method. A typical "bubbling" is often regarded as a sufficiently reliable sign of correct gastric tube position. This procedure can be described as a routine standard both in the OR and the ICU; however, numerous examples from clinical practice and quality reviews show gastric tube mispositioning in esophageal, bronchial, pulmonary or even pleural positions in individual cases. Since auscultation findings are misinterpreted as tracheal, bronchial, or pleural secretions, mispositioning may remain undetected. In addition, adequate documentation of the procedure is lacking. In the worst case, hyperosmolar tube feeding occurs via the malpositioned tube into the lungs or pleural space causing subsequent severe pneumonia or pleuritis, which is often fatal for the patient outcome. In contrast to many other similar procedures in intensive care medicine, such as the installation of central venous catheters or endotracheal intubation, to our knowledge there is no uniform standard for forensic verification of the correct position after gastric tube positioning. The present work provides an overview of existing practices and the scientific background for confirmation of gastric tube positioning without ionizing radiation.
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Affiliation(s)
- Fridolin Streibert
- Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, Schmerztherapie, BG Klinikum Bergmannstrost Halle gGmbH, Merseburger Str. 165, 06112, Halle/Saale, Deutschland.
| | - Claudia Bernhardt
- Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, Schmerztherapie, BG Klinikum Bergmannstrost Halle gGmbH, Merseburger Str. 165, 06112, Halle/Saale, Deutschland
| | - Philipp Simon
- Klinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Augsburg, Augsburg, Deutschland
| | - Peter Hilbert-Carius
- Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, Schmerztherapie, BG Klinikum Bergmannstrost Halle gGmbH, Merseburger Str. 165, 06112, Halle/Saale, Deutschland
| | - Hermann Wrigge
- Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, Schmerztherapie, BG Klinikum Bergmannstrost Halle gGmbH, Merseburger Str. 165, 06112, Halle/Saale, Deutschland
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Le JM, Ying YP, Seri C, Deatherage H, Bourne G, Morlandt AB. Does early oral intake after microvascular free flap reconstruction of the oral cavity lead to increased postoperative complications? J Oral Maxillofac Surg 2022; 80:1705-1715. [DOI: 10.1016/j.joms.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 02/07/2023]
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Xu J, Li S, Chen X, Tan B, Chen S, Hu B, Nie Z, Ye H, Sun C, Chi R, Chen C. A Two-Stage Bedside Intubation Method to Improve Success Rate of Post-pyloric Placement of Spiral Nasoenteric Tubes in Critically Ill Patients: A Multi-Center, Prospective Study. Front Med (Lausanne) 2022; 9:875298. [PMID: 35646990 PMCID: PMC9134184 DOI: 10.3389/fmed.2022.875298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 04/26/2022] [Indexed: 12/03/2022] Open
Abstract
Backgrounds Prokinetic agents could improve the success rate of post-pyloric placement of self-propelled spiral nasoenteric tubes (NETs), and bedside blind technique might apply as a rescue therapy subsequent to spontaneous transpyloric migration failure. The objective of this study was to investigated the validity and safety of these two bedside intubation methods as a sequential procedure for post-pyloric placement of spiral NETs in critically ill patients. Methods The multicenter, prospective study was conducted in intensive care units of four tertiary hospitals (June 2020 to January 2021). Eligible patients received self-propelled spiral NET placements, promoted by prokinetic agents (Stage 1). An abdominal X-ray performed 24 h post-intubation confirmed the position of the tube tip. Patients with a failed transpyloric migration entered Stage 2, where beside blind intubation was conducted (reconfirmed by X-ray). The primary end point was the overall success rate of post-pyloric placement. Results The overall success rate of post-pyloric placement of the spiral NET was 91.1% (73.4% in the third portion of the duodenum [D3] or beyond). The total adverse event rate was 21.0%, without any serious adverse events. In Stage 1, 55.6% of participants achieved transpyloric migration, of these, 44.4% migrated to D3 or beyond. The median time from decision to intubate to the initiation of enteral nutrition (EN) was 25 h. In Stage 2, 83.0% of patients had successful post-pyloric intubation (67.9% in D3 or beyond). The median time from decision to EN initiation after the two-stage process was 36 h. Conclusions Prokinetic agents-assisted self-propelled intubation and remedial bedside blind technique as a sequential procedure for post-pyloric placement of spiral NETs were effective and safe, and this two-stage process did not affect the implementation of early EN in critically ill patients. Trial Registration Chinese Clinical Trial Registry, ChiCTR1900026381. Registered on 6 October 2019.
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Affiliation(s)
- Jing Xu
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Sinian Li
- Neurological Intensive Care Unit, Maoming People's Hospital, Maoming, China
| | - Xiangyin Chen
- Surgical Intensive Care Unit, Maoming People's Hospital, Maoming, China
| | - Bo Tan
- Department of Emergency, Maoming People's Hospital, Maoming, China
| | - Shenglong Chen
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Bei Hu
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhiqiang Nie
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Heng Ye
- Department of Critical Care Medicine, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Cheng Sun
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ruibin Chi
- Department of Critical Care Medicine, Xiaolan People's Hospital of Zhongshan, Zhongshan, China
| | - Chunbo Chen
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Department of Critical Care Medicine, Maoming People's Hospital, Maoming, China
- *Correspondence: Chunbo Chen
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Wathen B, McNeely HL, Peyton C, Pan Z, Thomas R, Callahan C, Fidanza S, Brown J, Neu M. Comparison of electromagnetic guided imagery to standard confirmatory methods for ascertaining nasogastric tube placement in children. J SPEC PEDIATR NURS 2021; 26:e12338. [PMID: 33974328 DOI: 10.1111/jspn.12338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 03/31/2021] [Accepted: 04/23/2021] [Indexed: 01/04/2023]
Abstract
PURPOSE Evaluate the accuracy of an electromagnetic device (EMD) guided nasogastric tube (NGT) placement compared with standard confirmation methods. A secondary aim was to determine if EMD guided NGT placement would avert potential pulmonary misplacements of the tube. DESIGN AND METHODS Pediatric Intensive Care Unit (PICU) patients were enrolled if they had an NGT order during the study period of April 2014 through December 2016. Patients were included if they were one through 18 years of age. An EMD trained nurse inserted the NGT using EMD guidance. An insertion questionnaire, confirming if the nurse determined the NGT to be gastric per EMD, was completed immediately after NGT placement and before confirmation via either pH testing or radiographic imaging. RESULTS Forty-five patients were enrolled in the study. Nurses reported, based on EMD, that 86.7% (n = 39) of placements were gastric. Overall agreement between EMD guided tube placement and pH testing was 58% (n = 26). The marginal distribution was significantly different between the two methods (p = .0029). When compared to radiographic confirmation, sensitivity of the pH method was 32% (95% confidence interval [CI]: 17%-51%) compared with 85% (95% CI 69%-95%) for the EMD method. CONCLUSIONS EMD guidance was superior to pH testing when compared with radiographic confirmation of nasogastric tube placement in children. PRACTICE IMPLICATIONS EMD guided NGT placement is a potentially viable method for confirming nasogastric tube placement in children when done by appropriately trained clinicians. More research on EMD guided NGT placement in children is needed before any practice recommendation can be made.
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Affiliation(s)
- Beth Wathen
- Children's Hospital Colorado, Pediatric Intensive Care Unit, Aurora, Colorado, USA
| | - Heidi L McNeely
- Children's Hospital Colorado, Pediatric Intensive Care Unit, Aurora, Colorado, USA
| | - Christine Peyton
- Children's Hospital Colorado, Pediatric Intensive Care Unit, Aurora, Colorado, USA
| | - Zhaoxing Pan
- University of Colorado School of Medicine, Biostatistics Core of Children's Hospital Colorado Research Institute, Aurora, Colorado, USA
| | - Robin Thomas
- Children's Hospital Colorado, Pediatric Intensive Care Unit, Aurora, Colorado, USA
| | - Cayla Callahan
- Children's Hospital Colorado, Pediatric Intensive Care Unit, Aurora, Colorado, USA
| | - Sara Fidanza
- Children's Hospital Colorado, Pediatric Intensive Care Unit, Aurora, Colorado, USA
| | - James Brown
- Children's Hospital Colorado, Pediatric Intensive Care Unit, Aurora, Colorado, USA
| | - Madalynn Neu
- Children's Hospital Colorado, Pediatric Intensive Care Unit, Aurora, Colorado, USA.,University of Colorado, College of Nursing, Aurora, Colorado, USA
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Miyasaka M, Li H, Tay KV, Phee SJ. A Low-Cost, Point-of-Care Test for Confirmation of Nasogastric Tube Placement via Magnetic Field Tracking. SENSORS 2021; 21:s21134491. [PMID: 34209176 PMCID: PMC8271631 DOI: 10.3390/s21134491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 11/16/2022]
Abstract
In this work, we aim to achieve low-cost real-time tracking for nasogastric tube (NGT) insertion by using a tracking method based on two magnetic sensors. Currently, some electromagnetic (EM) tracking systems used to detect the misinsertion of the NGT are commercially available. While the EM tracking systems can be advantageous over the other conventional methods to confirm the NGT position, their high costs are a factor hindering such systems from wider acceptance in the clinical community. In our approach, a pair of magnetic sensors are used to estimate the location of a permanent magnet embedded at the tip of the NGT. As the cost of the magnet and magnetic sensors is low, the total cost of the system can be less than one-tenth of that of the EM tracking systems. The experimental results exhibited that tracking can be achieved with a root mean square error (RMSE) of 2-5 mm and indicated a great potential for use as a point-of-care test for NGT insertion, to avoid misplacement into the lung and ensure correct placement in the stomach.
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Affiliation(s)
- Muneaki Miyasaka
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore 639798, Singapore;
- Correspondence:
| | - Hao Li
- Department of Otorhinolaryngology, Tan Tock Seng Hospital, Singapore 308433, Singapore;
| | - Kon Voi Tay
- Department of General Surgery, Woodlands Health Campus, Singapore 069112, Singapore;
| | - Soo Jay Phee
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore 639798, Singapore;
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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.
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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
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Ayhan H, Akcay K, Olmez YN, Simsek C, Abbasoglu O. Redetermining the cutoff point of peristomal infection scoring: Methodological research. JPEN J Parenter Enteral Nutr 2021; 46:462-468. [PMID: 33904189 DOI: 10.1002/jpen.2122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Peristomal infections are a frequently encountered problem in enteral nutrition that warrants prompt diagnosis and early antimicrobial treatment. Current practice lacks a consensus on an accepted measurement tool with acknowledged validity and reliability. The Peristomal Infection Scoring System is one such tool that shows promise, yet the optimal cutoff value remains to be determined. METHODS This methodological research was conducted with 54 adult participants to evaluate their peristomal areas in terms of infection by two nurse nutritionists and an expert physician in a simultaneous and independent manner, using peristomal infection scoring or the local signs and symptoms of infection. Performance was assessed by the receiver operating characteristic curve, interobserver reliability, and validity metrics. RESULTS According to the expert physician's opinion, the peristomal infection rate was 9.2%. The agreement between the observers using the Peristomal Infection Scoring System was κ = 1,000, P < .001. The peristomal infection scoring area under the receiver operating characteristic curve was 0.98 (P < .001), and the best cutoff value was found to be 6 points, which correlated positively with a 0.88 coefficient (P < .001) and an accuracy of 98.1% (CI, 90.11%-99.95%). CONCLUSION The Peristomal Infection Scoring System with a cutoff value of 6 points is a valid and reliable instrument to diagnose peristomal infections. It can be easily used by healthcare professionals in all settings as needed.
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Affiliation(s)
- Hatice Ayhan
- Department of Surgical Nursing, Gulhane Faculty of Nursing, University of Health Sciences Turkey, Ankara, Turkey
| | - Kezban Akcay
- Nutritional Support Unit, Hacettepe University Hospital, Ankara, Turkey
| | | | - Cem Simsek
- Division of Gastroenterology, Hacettepe University, Ankara, Turkey
| | - Osman Abbasoglu
- Department of General Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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12
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Kaltenmeier C, Littleton E, Carozza L, Kosko R, Althans A, Lawrence B, Hamad G. Efficacy of a Nasogastric Tube Educational Intervention for Nursing Staff. Am Surg 2020; 88:93-97. [PMID: 33342275 DOI: 10.1177/0003134820976080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM We performed a single-center teaching intervention with nursing providers on nasogastric tube (NG tube) clinical practice. The initial purpose of this study was the validation of whether the training was sufficient enough to be retained at a later time point. METHODS We performed a prospective pre-post study examining participants' knowledge before, immediately after, and 4 weeks after training in NG tube management. Training was delivered in face-to-face classroom sessions. Knowledge was assessed using a multiple-choice test (pretest, posttest #1and #2). RESULTS A total of 137 nursing providers participated in the training intervention. Immediately after training (posttest #1) and again 4 weeks later (posttest #2), participants overwhelmingly recalled and retained the knowledge of NG tube management as compared to pretest results. Paired t-tests showed each participant increased their test score from pretest to posttest #1, t (134) = 12.64, P = .0001. Similarly, participants who took posttest #2 significantly improved their scores from the pretest to posttest #2, t (71) = 10.629, P < .0001. Secondary analysis showed that the NG tube management comfort level and age of provider were not significant in predicting test results. However, years of professional experience and frequency of NG tube care were significant predictors for higher test scores. CONCLUSION To minimize the risk of NG tubes for patients, it is critical to follow clinical guidelines. This study shows that teaching interventions for providers to increase knowledge on NG tubes are beneficial. In addition, the knowledge is retained at later time points.
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Affiliation(s)
| | | | - Lisa Carozza
- Magee-Womens Hospital, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Risa Kosko
- Magee-Womens Hospital, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Alison Althans
- Department of Surgery, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Barbara Lawrence
- Magee-Womens Hospital, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Giselle Hamad
- Department of Surgery, 6614University of Pittsburgh, Pittsburgh, PA, USA
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13
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Roch AM, Carr RA, Watkins JL, Lehman G, House MG, Nakeeb A, Schmidt CM, Ceppa EP, Zyromski NJ. Percutaneous Gastrostomy in Necrotizing Pancreatitis: Friend or Foe? J Gastrointest Surg 2020; 24:2800-2806. [PMID: 31792902 DOI: 10.1007/s11605-019-04469-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 11/06/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Enteral nutrition plays a central role in managing necrotizing pancreatitis (NP). Although the nasojejunal (NJ) route is widely used, percutaneous gastrostomy (PEG-J) is an alternative technique that is also applied commonly. We hypothesized that NJ and PEG-J had similar morbidity in the setting of NP. METHODS All patients receiving preoperative enteral nutrition before surgical debridement for NP (2005-2015) were segregated into NJ or PEG-J. RESULTS A total of 242 patients had complete data for analysis (155 men/87 women; median age 54 years; 47% biliary and 16% alcohol-related pancreatitis). NJ was used exclusively in 187 patients (77%); 25 patients (10%) were fed exclusively by PEG-J; the remaining 30 patients (13%) had NJ first, followed by PEG-J. Equal proportions of NJ and PEG-J patients reached enteral feeding goal (67% vs. 68%, p ≈ 1) and increased serum albumin (39% vs. 36%, p = 0.87). No difference was seen in rate of pancreatic necrosis infection (NJ 53% vs. PEG-J 49%, p = 0.64). NJ patients had significantly more complications compared to PEG-J (51%vs.27%,p = 0.0015). However, NJ patients had more grade I/II complication, compared to PEG-J patients, who had more grade III/IV complication (Grade I/II: NJ 51%vs. PEG-J 16%; Grade III/IV NJ 0%vs. PEG-J 11%, p < 0.0001). CONCLUSION In necrotizing pancreatitis, NJ and PEG-J both delivered enteral nutrition effectively. Patients with NJ feeding had significantly more complications than those with PEG-J; however, NJ complications were less severe.
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Affiliation(s)
- Alexandra M Roch
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rosalie A Carr
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - James L Watkins
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Glen Lehman
- Department of Medicine, Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael G House
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Attila Nakeeb
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - C Max Schmidt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Eugene P Ceppa
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nicholas J Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
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Dietrich CG, Schoppmeyer K. Percutaneous endoscopic gastrostomy – Too often? Too late? Who are the right patients for gastrostomy? World J Gastroenterol 2020; 26:2464-2471. [PMID: 32523304 PMCID: PMC7265142 DOI: 10.3748/wjg.v26.i20.2464] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 04/30/2020] [Accepted: 05/15/2020] [Indexed: 02/06/2023] Open
Abstract
Percutaneous endoscopic gastrostomy is an established method to provide nutrition to patients with restricted oral uptake of fluids and calories. Here, we review the methods, indications and complications of this procedure. While gastrostomy can be safely and easily performed during gastroscopy, the right patients and timing for this intervention are not always chosen. Especially in patients with dementia, the indication for and timing of gastrostomies are often improper. In this patient group, clear data for enteral nutrition are lacking; however, some evidence suggests that patients with advanced dementia do not benefit, whereas patients with mild to moderate dementia might benefit from early enteral nutrition. Additionally, other patient groups with temporary or permanent restriction of oral uptake might be a useful target population for early enteral nutrition to maintain mobilization and muscle strength. We plead for a coordinated study program for these patient groups to identify suitable patients and the best timing for tube implantation.
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Affiliation(s)
- Christoph G Dietrich
- Medical Clinic, Bethlehem-Gesundheitszentrum Stolberg/Rhld., Stolberg D-52222, Germany
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15
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Dias FDSB, Jales RM, Alvares BR, Caldas JPDS, Carmona EV. Randomized Clinical Trial Comparing Two Methods of Measuring Insertion Length of Nasogastric Tubes in Newborns. JPEN J Parenter Enteral Nutr 2020; 44:912-919. [PMID: 32026495 DOI: 10.1002/jpen.1786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 12/06/2019] [Accepted: 12/19/2019] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The selection of a method for measuring the insertion length of nasogastric tubes in newborns is an important factor in establishing the safe use of this device. OBJECTIVE The objective was to verify whether there is a difference in the proportion of correctly placed nasogastric tubes when using the nose, earlobe, mid-umbilicus (NEMU) method and the weight-based equation for measuring the insertion length. METHODS This study is a randomized, controlled, blinded study comparing 2 methods of nasogastric insertion at a neonatal unit, with intensive and intermediate care, on 162 randomized individuals. Radiological assessment and pH test were conducted to verify tube placement. Data were collected on sex, birth weight, gestational age, and days of life. A log-binomial model was used to verify whether there were placement differences between investigated methods. RESULTS Of the patients, 56.1% were male, who had a mean birth weight of 1886.8 g and gestational age of 32.9 weeks and were 10.8 days old. Radiological images demonstrated that tubes were properly placed in the gastric body in 67.5% of patients using the NEMU method and in 91.5% using the weight-based equation: the weight-based equation was superior to the NEMU method, with a prevalence ratio of 1.36 (95% CI, 1.15-1.44). There was no difference between the 2 methods, according to pH test (P-value: .7179). CONCLUSION Based on radiographic confirmation, the weight-based equation for measuring the insertion length of the nasogastric tube in newborns resulted in significantly more nasogastric tubes being placed in the correct intragastric location.
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Affiliation(s)
| | - Rodrigo Menezes Jales
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Beatriz Regina Alvares
- Department of Radiology, School of Medical Sciences, University of Campinas, São Paulo, Brazil
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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
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17
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Gimenes FRE, Pereira MCA, Prado PRD, Carvalho REFLD, Koepp J, Freitas LMD, Teixeira TCA, Miasso AI. Nasogastric/Nasoenteric tube-related incidents in hospitalised patients: a study protocol of a multicentre prospective cohort study. BMJ Open 2019; 9:e027967. [PMID: 31345968 PMCID: PMC6661907 DOI: 10.1136/bmjopen-2018-027967] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 06/26/2019] [Accepted: 07/01/2019] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Hospitalised patients with nasogastric/nasoenteric tube (NGT/NET) are at constant risk of incidents; therefore, healthcare professionals need to routinely monitor risks and adopt strategies for patient safety and quality of care. AIM This study aimed to evaluate the NGT/NET-related incidents in hospitalised patients and associated factors. METHODS This is a multicentre study, with a prospective cohort design. Data will be collected at the general medical ward of seven Brazilian hospitals in the north, northeast, southeast and south. The sample will consist of 391 patients that require an NGT/NET during hospitalisation. Three different methods will be used to identify the incidents: (1) healthcare professionals and patients/caregivers will be required to report any NGT/NET-related incidents; (2) researchers will visit the wards to get information about the incidents with healthcare professionals and patients/caregivers; (3) the researchers will review the medical records looking for information on the occurrence of any NGT/NET-related incidents. Demographic, clinical and therapeutic details will be obtained from the medical records and will be registered in an electronic data collection tool developed for the purposes of this study. The complexity of patients will be assessed by the Patient Classification System, and the severity of comorbid diseases will be assessed through the Charlson Comorbidity Index. IMPLICATION FOR PRACTICE The results may encourage the use of evidence effectively to influence the scientific foundation for clinical practice and the development of evidence-based policies that will prevent, manage and eliminate complications caused by NGT/NET-related incidents, and improve the quality and safety of care provided to hospitalised patients. ETHICS AND DISSEMINATION The study has been approved by the Research Ethics Committee. Detailed information about the study can be provided by the principal investigator. The findings will be reported through academic journals, seminar and conference presentations, social media, print media, the internet and community/stakeholder engagement activities.
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Affiliation(s)
- Fernanda Raphael Escobar Gimenes
- General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirao Preto, Sao Paulo, Brazil
| | - Marta Cristiane Alves Pereira
- General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirao Preto, Sao Paulo, Brazil
| | | | | | - Janine Koepp
- Nursing Department, University of Santa Cruz do Sul, Santa Cruz do Sul, Rio Grande do Sul, Brazil
| | - Ligia Menezes de Freitas
- Nursing Department, Faculty of Science and Technology of Campos Gerais, Campos Gerais, Minas Gerais, Brazil
| | | | - Adriana Inocenti Miasso
- Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
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18
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Abstract
BACKGROUND The use of gastric tubes in newborns admitted to a neonatal intensive care unit is fairly high, and there is a risk of serious complications related to this procedure. PURPOSE Considering the need to find a method that does not involve the patient's exposure to radiation, this study aimed to evaluate the diagnostic accuracy of ultrasonography for verifying gastric tube placement in newborns. METHODS This was a prospective, double-blind, observational study performed in a neonatal intensive care unit, in which 159 infants had gastric intubation using ultrasound examination and radiological imaging, to verify positioning. Results were analyzed in terms of diagnostic accuracy. RESULTS The tubes were correctly positioned in 157 cases (98.7%), according to radiological images, and in 156 cases (98.1%), according to ultrasound. The sensitivity analysis was 0.98 and the positive predictive value was 0.99. It was not possible to perform a specificity analysis, as there were not enough negative cases in the sample. IMPLICATIONS FOR PRACTICE The use of ultrasonography to identify correct positioning of gastric tubes in infants and newborns shows good sensitivity. IMPLICATIONS FOR RESEARCH It was not possible to evaluate the ultrasonography specificity; further studies with greater samples are probably necessary, so that this objective can be achieved.Video Abstract available at https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?videoId=29&autoPlay=true.
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19
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Sun C, Lv B, Zheng W, Hu L, Ouyang X, Hu B, Zhang Y, Wang H, Ye H, Zhang X, Lan H, Chen L, Chen C. The learning curve in blind bedside postpyloric placement of spiral tubes: data from a multicentre, prospective observational study. J Int Med Res 2019; 47:1884-1896. [PMID: 30747017 PMCID: PMC6567746 DOI: 10.1177/0300060519826830] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objective This study sought to quantify the learning curve for the blind bedside postpyloric placement of a spiral tube in critically ill patients. Methods We retrospectively analysed 127 consecutive experiences of three intensivists who performed comparable procedures of blind bedside postpyloric placement of a spiral tube subsequent to failed self-propelled transpyloric migration in a multicentre study. Each intensivist’s cases were divided chronologically into two groups for analysis. The assessment of the learning curve was based on efficiency and safety outcomes. Results All intensivists achieved postpyloric placement for over 80% of their patients. The junior intensivist showed major improvement in both efficiency and safety outcomes, and the learning curve for both outcomes was approximately 20 cases. The junior intensivist showed a significant increase in the success rate of proximal jejunum placement and demonstrated a substantial decrease in the major adverse tube-associated events rate. The time to insertion significantly decreased in each intensivist as case experience accumulated. Conclusions Blind bedside postpyloric placement of a spiral tube involves a significant learning curve, indicating that this technique could be readily acquired by intensivists with no previous experience using an adequate professional training programme.
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Affiliation(s)
- Cheng Sun
- 1 Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Bo Lv
- 1 Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Wei Zheng
- 3 Department of Emergency, Longgang District Central Hospital, Shenzhen, Guangdong Province, China
| | - Linhui Hu
- 4 Department of Critical Care Medicine, The People's Hospital of Gaozhou, Gaozhou, Guangdong Province, China.,5 School of Medicine, South China University of Technology, Guangzhou Higher Education Mega Center, Guangzhou, Guangdong Province, China
| | - Xin Ouyang
- 2 Department of Intensive Care Unit of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China.,5 School of Medicine, South China University of Technology, Guangzhou Higher Education Mega Center, Guangzhou, Guangdong Province, China
| | - Bei Hu
- 1 Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Yanlin Zhang
- 6 Department of Critical Care Medicine, Xinjiang Kashgar Region's First People's Hospital, Kashgar Region, Xinjiang Uygur Autonomous Region, China
| | - Hao Wang
- 6 Department of Critical Care Medicine, Xinjiang Kashgar Region's First People's Hospital, Kashgar Region, Xinjiang Uygur Autonomous Region, China
| | - Heng Ye
- 7 Department of Critical Care Medicine, Guangzhou Nansha Central Hospital, Guangzhou, Guangdong Province, China
| | - Xiunong Zhang
- 1 Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Huilan Lan
- 1 Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Lifang Chen
- 1 Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
| | - Chunbo Chen
- 1 Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China.,2 Department of Intensive Care Unit of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province, China
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20
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Omondi GB, Serem G, Abuya N, Gathara D, Stanton NA, Agedo D, English M, Murphy GAV. Neonatal nasogastric tube feeding in a low-resource African setting - using ergonomics methods to explore quality and safety issues in task sharing. BMC Nurs 2018; 17:46. [PMID: 30479560 PMCID: PMC6240229 DOI: 10.1186/s12912-018-0314-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 10/31/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Sharing tasks with lower cadre workers may help ease the burden of work on the constrained nursing workforce in low- and middle-income countries but the quality and safety issues associated with shifting tasks are rarely critically evaluated. This research explored this gap using a Human Factors and Ergonomics (HFE) method as a novel approach to address this gap and inform task sharing policies in neonatal care settings in Kenya. METHODS We used Hierarchical Task Analysis (HTA) and the Systematic Human Error Reduction and Prediction Approach (SHERPA) to analyse and identify the nature and significance of potential errors of nasogastric tube (NGT) feeding in a neonatal setting and to gain a preliminary understanding of informal task sharing. RESULTS A total of 47 end tasks were identified from the HTA. Sharing, supervision and risk levels of these tasks reported by subject matter experts (SMEs) varied broadly. More than half of the tasks (58.3%) were shared with mothers, of these, 31.7% (13/41) and 68.3% were assigned a medium and low level of risk by the majority (≥4) of SMEs respectively. Few tasks were reported as 'often missed' by the majority of SMEs. SHERPA analysis suggested omission was the commonest type of error, however, due to the low risk nature, omission would potentially result in minor consequences. Training and provision of checklists for NGT feeding were the key approaches for remedying most errors. By extension these strategies could support safer task shifting. CONCLUSION Inclusion of mothers and casual workers in care provided to sick infants is reported by SMEs in the Kenyan neonatal settings. Ergonomics methods proved useful in working with Kenyan SMEs to identify possible errors and the training and supervision needs for safer task-sharing.
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Affiliation(s)
| | - George Serem
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Nancy Abuya
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Nairobi City County Government, Nairobi, Kenya
| | - David Gathara
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Neville A. Stanton
- Faculty of Engineering and the Environment, University of Southampton, Southampton, UK
| | | | - Mike English
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Georgina A. V. Murphy
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
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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.
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Affiliation(s)
- Elizabeth Pash
- Division of Research, Scientific & Medical Affairs, Abbott Nutrition, Columbus, OH, USA
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22
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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.
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23
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Lv B, Hu L, Chen L, Hu B, Zhang Y, Ye H, Sun C, Zhang X, Lan H, Chen C. Blind bedside postpyloric placement of spiral tube as rescue therapy in critically ill patients: a prospective, tricentric, observational study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:248. [PMID: 28950897 PMCID: PMC5615440 DOI: 10.1186/s13054-017-1839-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 09/08/2017] [Indexed: 02/07/2023]
Abstract
Background Various special techniques for blind bedside transpyloric tube placement have been introduced into clinical practice. However, transpyloric spiral tube placement facilitated by a blind bedside method has not yet been reported. The objective of this prospective study was to evaluate the safety and efficiency of blind bedside postpyloric placement of a spiral tube as a rescue therapy subsequent to failed spontaneous transpyloric migration in critically ill patients. Methods This prospective, tricentric, observational study was conducted in the intensive care units (ICUs) of three tertiary hospitals. A total of 127 consecutive patients with failed spontaneous transpyloric spiral tube migration despite using prokinetic agents and still required enteral nutrition for more than 3 days were included. The spiral tube was inserted postpylorically using the blind bedside technique. All patients received metoclopramide intravenously prior to tube insertion. The exact tube tip position was determined by radiography. The primary efficacy endpoint was the success rate of postpyloric spiral tube placement. Secondary efficacy endpoints were success rate of a spiral tube placed in the third portion of the duodenum (D3) or beyond, success rate of placement in the proximal jejunum, time to insertion, length of insertion, and number of attempts. Safety endpoints were metoclopramide-related and major adverse tube-associated events. Results In 81.9% of patients, the spiral feeding tubes were placed postpylorically; of these, 55.1% were placed in D3 or beyond and 33.9% were placed in the proximal jejunum, with a median time to insertion of 14 min and an average number of attempts of 1.4. The mean length of insertion was 95.6 cm. The adverse event incidence was 26.0%, and no serious adverse event was observed. Conclusions Blind bedside postpyloric placement of a spiral tube, as a rescue therapy subsequent to failed spontaneous transpyloric migration in critically ill patients, is safe and effective. This technique may facilitate the early initiation of postpyloric feeding in the ICU. Trial registration Chinese Clinical Trial Registry, ChiCTR-OPN-16008206. Registered on 1 April 2016.
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Affiliation(s)
- Bo Lv
- Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Linhui Hu
- Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China.,School of Medicine, South China University of Technology, Guangzhou Higher Education Mega Center, Guangzhou, 510006, Guangdong Province, People's Republic of China
| | - Lifang Chen
- Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Bei Hu
- Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Yanlin Zhang
- Department of Critical Care Medicine, Xinjiang Kashgar Region's First People's Hospital, 66 Airport Road, Kashgar Region, 844099, Xinjiang Uygur Autonomous Region, People's Republic of China
| | - Heng Ye
- Department of Critical Care Medicine, Guangzhou Nansha Central Hospital, 105 Fengzhedong Road, Guangzhou, 511457, Guangdong Province, People's Republic of China
| | - Cheng Sun
- Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Xiunong Zhang
- Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Huilan Lan
- Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Chunbo Chen
- Department of Critical Care Medicine, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China.
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Comparison of Complications Following Laparoscopic and Endoscopic Gastrostomy Placements. J Gastrointest Surg 2017; 21:1396-1403. [PMID: 28660520 DOI: 10.1007/s11605-017-3475-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 06/09/2017] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Percutaneous endoscopic gastrostomy (PEG) and laparoscopic gastrostomy (LG) placements provide enteral access to patients unable to tolerate oral feeds. Limited data comparing PEG and LG outcomes is available in adults. This study compares complications between PEG and LG placements. MATERIALS AND METHODS A retrospective chart review was completed for patients undergoing PEG or LG placement at a single academic center between 2007 and 2014. Patient demographics, comorbidities, and Charlson Comorbidity Index (CCI) were compared. Logistic regression was utilized to identify independent predictors for complication. RESULTS Two hundred and twenty-four patients (164 PEGs and 60 LGs) were evaluated. Patients undergoing LG had a higher incidence of prior surgery (42 vs 20%; P < 0.01) and age-adjusted CCI (5 vs 4; P = 0.01). Return to the OR was more common following PEG than LG (5.5 vs 0%) but did not achieve significance (P = 0.12). There were no differences in 30-day mortality; however, age-adjusted CCI was predictive of 30-day mortality (OR 1.3, 95% CI 1.1-1.6). CONCLUSION Despite increased comorbidities, LG tubes are at least as safe as PEGs. Research should focus on identifying predictive factors associated with post-operative complications to identify which patients would have superior outcomes with LG placement.
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Lim YJ. Outcomes and Safety Issues Related to Percutaneous Endoscopic Gastrostomy in Neurodegenerative Diseases. Clin Endosc 2017; 50:213-214. [PMID: 28609815 PMCID: PMC5475512 DOI: 10.5946/ce.2017.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 04/06/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Yun Jeong Lim
- Department of Internal Medicine, Dongguk University, College of Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
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Caron-Cantin M, Gagné T, Tampieri D, Cortés MD. Radiologist Contribution to Improved Nasogastric Tube Placement for Hospitalized Neurological Patients. J Am Coll Radiol 2017; 14:787-789. [PMID: 28089107 DOI: 10.1016/j.jacr.2016.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 10/25/2016] [Accepted: 10/31/2016] [Indexed: 11/24/2022]
Affiliation(s)
| | - Thierry Gagné
- Institut de Recherche en Santé Publique de l'Université de Montréal, Montreal, Quebec, Canada
| | - Donatella Tampieri
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Montreal Neurological Hospital and Institute, Montreal, Quebec, Canada; and the Department of Diagnostic Imaging, McGill University, Montreal, Quebec, Canada
| | - Maria delPilar Cortés
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada; Montreal Neurological Hospital and Institute, Montreal, Quebec, Canada; and the Department of Diagnostic Imaging, McGill University, Montreal, Quebec, Canada.
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Fluoroscopy-guided placement of nasoenteral tubes in children using intermittent digital pulse fluoroscopy and last image save/grab technique. Clin Radiol 2016; 71:939.e9-939.e13. [DOI: 10.1016/j.crad.2016.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/14/2016] [Accepted: 03/24/2016] [Indexed: 11/21/2022]
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Matuschek C, Bölke E, Geigis C, Kammers K, Ganswindt U, Scheckenbach K, Gripp S, Simiantonakis J, Hoffmann TK, Greve J, Gerber PA, Orth K, Roeder H, Hautmann MG, Budach W. Influence of dosimetric and clinical criteria on the requirement of artificial nutrition during radiotherapy of head and neck cancer patients. Radiother Oncol 2016; 120:28-35. [PMID: 27296411 DOI: 10.1016/j.radonc.2016.05.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 05/02/2016] [Accepted: 05/10/2016] [Indexed: 01/08/2023]
Abstract
PURPOSE/OBJECTIVE(S) Intensification of radiotherapy and chemotherapy for head-and-neck cancer (HNC) may lead to increased rates of long term dysphagia as a severe side effect. Mucositis and consequent swallowing problems require artificial nutrition in many HNC patients undergoing radiotherapy or chemoradiation. It is unknown, which predict factors for prophylactic PEG tube insertion appear useful. MATERIALS/METHODS From an institutional database, 101 patients (72 male, 29 female, mean age 59.5years) were identified who underwent radiotherapy or chemoradiation for HNC. Primary end point of the investigation was the need for artificial nutrition for more than 4days during radiotherapy. Dose volume parameters of defined normal tissue structures potentially of relevance for swallowing ability as well as clinical factors were used to develop a predictive model using a binary multiple logistic regression model. RESULTS Whereas several dosimetric and clinical factors were significant predictors for the need of artificial nutrition on univariate analysis, on multivariate analysis only three factors remained independently significant: mean dose to the oropharynx+1cm circumferential margin, ECOG performance state (0-1 vs. 2-4), and the use of chemotherapy (yes vs. no). CONCLUSIONS Using a 3 parameter model we could distinguish HNC-patients with different risks for the need of artificial nutrition during radiotherapy. After independent validation, the model could be helpful to decision on prophylactic PEG tube insertion.
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Affiliation(s)
- Christiane Matuschek
- Department of Radiation Oncology, Medical Faculty Heinrich Heine University Hospital Duesseldorf, Germany.
| | - Edwin Bölke
- Department of Radiation Oncology, Medical Faculty Heinrich Heine University Hospital Duesseldorf, Germany
| | - Caroline Geigis
- Department of Radiation Oncology, Medical Faculty Heinrich Heine University Hospital Duesseldorf, Germany
| | - Kai Kammers
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Ute Ganswindt
- Department of Radiation Oncology, Ludwig Maximilians University Hospital, Großhadern and Campus, Germany
| | - Kathrin Scheckenbach
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty Heinrich Heine University Hospital Duesseldorf, Germany
| | - Stephan Gripp
- Department of Radiation Oncology, Medical Faculty Heinrich Heine University Hospital Duesseldorf, Germany
| | - Jannis Simiantonakis
- Department of Radiation Oncology, Medical Faculty Heinrich Heine University Hospital Duesseldorf, Germany
| | - Thomas K Hoffmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Germany
| | - Jens Greve
- Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Germany
| | - Peter Arne Gerber
- Department of Dermatology, Medical Faculty Heinrich Heine University Duesseldorf, Germany
| | - Klaus Orth
- Department of General, Visceral and Thoracic Surgery, Harzkliniken Goslar, Germany
| | - Henning Roeder
- Department of Radiation Oncology, Medical Faculty Heinrich Heine University Hospital Duesseldorf, Germany
| | | | - Wilfried Budach
- Department of Radiation Oncology, Medical Faculty Heinrich Heine University Hospital Duesseldorf, Germany
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Antibacterial gauzes are effective in preventing infections after percutaneous endoscopic gastrostomy placement: a retrospective analysis. Eur J Gastroenterol Hepatol 2016; 28:297-304. [PMID: 26735159 DOI: 10.1097/meg.0000000000000561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVES The most common complication after percutaneous endoscopic gastrostomy (PEG) placement is peristomal wound infection (up to 40% without antibiotic prophylaxis). Single-dose parenteral prophylactic antibiotics as advised by current guidelines decrease the infection rate to 9-15%. We assume a prolonged effect of local antibiotic treatment with antibacterial gauzes. This study is the first to describe the effect of antibacterial gauzes in preventing infections in PEG without the use of antibiotics. METHODS A retrospective data analysis was carried out of all patients with PEG insertion between January 2009 and October 2014 in the Catharina Hospital Eindhoven. Data include placement and the period of the first 2 weeks after PEG placement, and long-term follow-up. All patients received a locally applied antibacterial gauze polyhexamethylene biguanide immediately following PEG insertion for 3 days. No other antibiotics were administered. The main outcomes were wound infection, peritonitis, and necrotizing fasciitis; secondary outcomes included other complications. RESULTS A total of 331 patients with only antibacterial gauzes were analyzed. The total number of infections 2 weeks after PEG insertion was 9.4%, including 8.2% minor and 1.2% major infections (peritonitis). No wound infection-related mortality or bacterial resistance was found. Costs are five times lower than antibiotics, and gauzes are more practical and patient friendly for use. CONCLUSION Retrospectively, antibacterial gauzes are at least comparable with literature data on parenteral antibiotics in preventing peristomal wound infection after PEG placement, with an infection rate of 9.4%. Rates of other complications found in this study were comparable with current literature data.
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Abstract
Critically ill patients often require enteral feedings as a primary supply of nutrition. Whether enteral nutrition (EN) should be delivered as a gastric versus small bowel feeding in the critically ill patient population remains a contentious topic. The Society of Critical Care Medicine (SCCM)/American Society for Parenteral and Enteral Nutrition (ASPEN), the European Society for Parenteral and Enteral Nutrition (ESPEN), and the Canadian Clinical Practice Guidelines (CCPG) are not in consensus on this topic. No research to date demonstrates a significant difference between the two feeding routes in terms of patient mortality, ventilator days, or length of stay in the intensive care unit (ICU); however, studies provide some evidence that there may be other benefits to using a small bowel feeding route in critically ill patients. The purpose of this paper is to examine both sides of this debate and review advantages and disadvantages of both small bowel and gastric routes of EN. Practical issues and challenges to small bowel feeding tube placement are also addressed. Finally, recommendations are provided to help guide the clinician when selecting a feeding route, and suggestions are made for future research.
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Beghetto MG, Anziliero F, Leães DM, de Mello ED. [Feeding tube placement: auscultatory method and x-ray agreement]. ACTA ACUST UNITED AC 2016; 36:98-103. [PMID: 26735765 DOI: 10.1590/1983-1447.2015.04.54700] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 08/31/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE to evaluate the correlation between the auscultation test and X-ray when detecting the position of an enteral feeding tube. METHODS cross-sectional study in an intensive care unit in southern Brazil, in 2011. Clinical nurse and nurse researcher performed auscultation test recording the impressions regarding the placement of an enteral feeding tube in 80 patients. A doctor evaluated the X-ray. Kappa coefficient and PABAK reviewed the agreements. RESULTS The X-ray showed that 70% of the enteral tubes were in the stomach, 27.4% in the duodenum, 1.3% in the esophagus, and 1.3% in the right lung. There was a weak correlation between clinical nurses and nurse researchers (PABAK=0.054; P=0.103), clinical nurses and X-rays (PABAK=0.188; P=0.111) and nurse researchers and X-rays (PABAK=0.128; P=0.107) . The auscultation test did not detect two risk conditions, enteral feeding tube in the esophagus and the bronchus. CONCLUSION the auscultation test showed little agreement with the X-ray on the enteral feeding tube location.
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Affiliation(s)
- Mariur Gomes Beghetto
- Departamento de Assistência e Orientação Profissional, Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil
| | - Franciele Anziliero
- Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil
| | - Dória Migotto Leães
- Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil
| | - Elza Daniel de Mello
- Departamento de Pediatria, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brasil
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Brown AM, Carpenter D, Keller G, Morgan S, Irving SY. Enteral Nutrition in the PICU: Current Status and Ongoing Challenges. J Pediatr Intensive Care 2015; 4:111-120. [PMID: 31110860 DOI: 10.1055/s-0035-1559806] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Malnutrition in the critically ill or injured child is associated with increased morbidities and mortality in the pediatric intensive care unit (PICU), whether present upon admission or acquired during the PICU stay. Particular subpopulations such as those with congenital heart disease or severe thermal injury are at highest risk for malnutrition which can worsen with illness progression. A growing body of evidence suggests the presence of a positive association between nutrition support during critical illness and patient outcomes. Enteral nutrition (EN), the preferred route of nutrient delivery, may be a crucial component of care provided in the PICU which modifies the response to critical illness or injury, resulting in improved outcomes. Numerous challenges exist in the delivery of the EN goal in critically ill children. These include accurate assessment of nutrient requirements, hemodynamic instability, feeding intolerance, feeding interruptions, and the lack of a standardized approach to nutrition support. This article describes the current state of the science and challenges related to EN prescription and delivery in the critically ill child. Suggestions for improving EN practice are then presented, in addition to a platform for further research inquiry.
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Affiliation(s)
- Ann-Marie Brown
- School of Nursing, The University of Akron, Akron, Ohio, United States.,Division of Critical Care, Akron Children's Hospital, Akron, Ohio, United States
| | - Debbie Carpenter
- Department of Food Service and Nutrition, Akron Children's Hospital, Akron, Ohio, United States
| | - Gerri Keller
- Department of Food Service and Nutrition, Akron Children's Hospital, Akron, Ohio, United States
| | - Sherry Morgan
- Biomedical Library, The University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Sharon Y Irving
- Department of Nursing, Critical Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.,School of Nursing, The University of Pennsylvania, Philadelphia, Pennsylvania, United States
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Affiliation(s)
- Mary S McCarthy
- Mary S. McCarthy is a senior nurse scientist at the Center for Nursing Science and Clinical Inquiry at Madigan Army Medical Center in Tacoma, Wash. Robert G. Martindale is a professor of surgery and the chief of the Division of Surgery at Oregon Health and Sciences University Medical Center in Portland, Ore
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Abstract
In patients unable to tolerate oral intake, multiple options of nutrient delivery are available to the clinician. Administration of enteral nutrition (EN) has long been considered the standard of care for nutrition support among patients unable to meet energy and protein requirements orally. Healthcare practitioners must make careful decisions related to ordering, administering, and monitoring EN therapy. In the hospital setting, the registered dietitian is a key resource in enteral formula selection and method of administration, monitoring for and troubleshooting EN-related complications, and transitioning to oral feeding. The hospital setting also presents many unique challenges in providing optimal nutrition to the enterally fed patient.
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Affiliation(s)
| | - Rebecca Fritzshall
- Department of Nutrition Services, Froedtert Hospital, Milwaukee, Wisconsin
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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.
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Affiliation(s)
- Anne Rowat
- Lecturer, School of Nursing, Midwifery and Social Care, Edinburgh Napier University
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Snaith B, Flintham K. Radiology responsibilities post NPSA guidelines for nasogastric tube insertion: A single centre review. Radiography (Lond) 2015. [DOI: 10.1016/j.radi.2014.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Gok F, Kilicaslan A, Yosunkaya A. Ultrasound-guided nasogastric feeding tube placement in critical care patients. Nutr Clin Pract 2015; 30:257-60. [PMID: 25616518 DOI: 10.1177/0884533614567714] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Nasogastric feeding tube (NGT) placement is a common practice performed in intensive care units (ICUs). Complications due to the improper placement of NGT are well known. In this prospective descriptive study, the effectiveness of ultrasound (US)-guided NGT placement was investigated. MATERIALS AND METHODS Fifty-six mechanically ventilated patients monitored in the ICU were included. A linear US probe was transversely placed just cranial to the suprasternal notch, and the concentric layers of the esophagus were attempted to be viewed on the posterolateral side of the trachea (generally left) by shifting the probe. If the esophagus can be seen, an attempt was made to insert the NGT under real-time visualization of ultrasonography. Furthermore, gastric placement of the NGT tip was confirmed with abdominal radiograph. RESULTS A total of 56 patients were included in the study. For 52 (92.8%), the NGT image was obtained during placement within the esophagus. For 3 (5.3%), the esophagus could not be seen by US, and NGT was placed blindly. For 1 patient, we could not detect passing of the NGT into the stomach despite the successful visualization of esophagus. In this patient, NGT was radiographically detected in the trachea after the procedure. CONCLUSION This study revealed that passing of the NGT through the esophagus could be visualized at a high rate in real-time US among ICU patients. These data suggest that ultrasonographic visualization of the upper esophagus during NGT insertion can be used as an adjuvant method for confirmation of correct placement.
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Affiliation(s)
- Funda Gok
- Department of Anesthesiology and Reanimation, Necmettin Erbakan University, Meram Faculty of Medicine, Turkey
| | - Alper Kilicaslan
- Department of Anesthesiology and Reanimation, Necmettin Erbakan University, Meram Faculty of Medicine, Turkey
| | - Alper Yosunkaya
- Department of Anesthesiology and Reanimation, Necmettin Erbakan University, Meram Faculty of Medicine, Turkey
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Fischer S, Kueckelhaus M, Pauzenberger R, Bueno EM, Pomahac B. Functional outcomes of face transplantation. Am J Transplant 2015; 15:220-33. [PMID: 25359281 DOI: 10.1111/ajt.12956] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 07/29/2014] [Accepted: 07/30/2014] [Indexed: 01/25/2023]
Abstract
In this study we provide a compilation of functional impairments before and improvements after face transplantation (FT) of five FT recipients of our institution and all FTs reported in current literature. Functional outcome included the ability to smell, breath, eat, speak, grimace and facial sensation. Before FT, all our patients revealed compromised ability to breath, eat, speak, grimace and experience facial sensation. The ability to smell was compromised in two of our five patients. Two patients were dependent on tracheostomy and one on gastrostomy tubes. After FT, all abilities were significantly improved and all patients were independent from artificial air airways and feeding tubes. Including data given in current literature about the other 24 FT recipients in the world, the abilities to smell, eat and feel were enhanced in 100% of cases, while the abilities of breathing, speaking and facial expressions were ameliorated in 93%, 71% and 76% of cases, respectively. All patients that required gastrostomy and 91% of patients depending on tracheostomy were decannulated after FT. Unfortunately, outcomes remain unreported in all other cases and therefore we are unable to comment on improvements.
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Affiliation(s)
- S Fischer
- Department of Surgery, Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Department of Hand-, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Ludwigshafen, Germany
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Malta MA, Carvalho-Junior AFD, Andreollo NA, Freitas MIPD. [Anthropometric measures for the introduction of the nasogastric tube for enteral nutrition employing the esophagogastroduodenoscopy]. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2014; 26:107-11. [PMID: 24000021 DOI: 10.1590/s0102-67202013000200007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 02/26/2013] [Indexed: 01/18/2023]
Abstract
BACKGROUND The correct placement of a nasogastric tube for enteral nutrition is subject of several investigations, demonstrating the controversy of the procedure. AIM To establish an external measure that can correspond to the internal measurement which determines the insertion length of nasogastric feeding tube up to the stomach. METHODS External measures were obtained between points: nose tip vs earlobe vs xiphoid appendix vs umbilicus and height correlated with the standard measures obtained from patients undergoing diagnostic esophagogastroduodenoscopy. RESULTS It was found a significative statistical correlation between esophagogastric junction, identified during the esophagogastroduodenoscopy, with the distance measured between the anatomic points of the earlobe and xiphoid appendix (r= 0.75) and from this line with the orthostatic height (r=0.72). CONCLUSION The distance between the earlobe to the xiphoid appendix (0.75) and the distance between the earlobe to the xiphoid appendix to the midpoint of the umbilicus, subtracting the distance from tip of nose to earlobe, were safe anatomical parameters to reach the esophagogastric junction. The height in the standing position (r= 0.72) also can be used as an indicator of the length necessary to insert the tube into the stomach. The height in the standing position (r= 0.72) also can be used as an indicator of the length necessary to insert the tube into the stomach.
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Affiliation(s)
- Monica Alexandre Malta
- Departamentos de Enfermagem e Cirurgia e Gastrocentro, Faculdade de Ciências Médicas da Universidade Estadual de Campinas, Unicamp, Campinas, São Paulo, SP, Brasil
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Kemper C, Northington L, Wilder K, Visscher D. A call to action: the development of enteral access safety teams. Nutr Clin Pract 2014; 29:264-6. [PMID: 24757061 DOI: 10.1177/0884533614531626] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Safety concerns regarding the verification of nasogastric feeding tube placement prompted the American Society for Parenteral and Enteral Nutrition to call for an interdisciplinary, interorganizational group to work on best practices and new technologies to address this issue in pediatric patients. This commentary calls for the development of specialized teams within hospitals to improve the quality of care provided to children and infants who require nasogastric feeding tubes. It is expands on the information presented in an article in the issue by Irving et al regarding the current status of nasogastric tube placement and verification methods.
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Affiliation(s)
- Carol Kemper
- Childrens Mercy Kansas City, Kansas City, Missouri
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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.
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Affiliation(s)
- Sharon Y Irving
- Children's Hospital of Philadelphia, University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania
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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.
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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
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Boyer N, McCarthy MS, Mount CA. Analysis of an electromagnetic tube placement device versus a self-advancing nasal jejunal device for postpyloric feeding tube placement. J Hosp Med 2014; 9:23-8. [PMID: 24288360 DOI: 10.1002/jhm.2122] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 10/24/2013] [Accepted: 10/31/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND Initiation of enteral feeding is an important part of the best practice model for critically ill patients. Although nasogastric feeding is appropriate for the majority of patients requiring short-term nutrition support, certain patients benefit greatly from postpyloric feeding. OBJECTIVE To determine which of 2 specialized enteral tube systems achieved postpyloric placement on initial insertion attempt most efficiently. DESIGN Retrospective study comparing the Tiger 2 tube (T2T) and Cortrak Enteral Access System (C-EAS). SETTING Academic medical center, mixed intensive care unit (ICU). PATIENTS All patients admitted to the ICU between 2009 and 2013 who had either a C-EAS or T2T placed. MEASUREMENTS Success rate for postpyloric placement, congruency of real-time tube placement with x-ray confirmation for C-EAS, and complication rates. RESULTS Seventy-one T2T and 74 C-EAS patients were included. The T2T was postpyloric 62% (44/71) of attempted placements. C-EAS was postpyloric 43% (32/74) of attempted placements (P = 0.03). C-EAS tracings accurately reflected chest x-ray findings 83% and 82% for postpyloric and non-postpyloric insertion, respectively. During the entire study period, no adverse events were recorded. CONCLUSION Our institution evaluated 2 different systems designed to ensure postpyloric placement of a small bore feeding tube. No literature exists directly comparing the 2 systems. Our retrospective review, although limited, showed that the T2T was more effective at postpyloric placement on first attempt. Although 1 benefit of the C-EAS system may be real-time visualization, our practice showed this system to be user dependent, which likely led to less success with postpyloric placement.
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Affiliation(s)
- Nathan Boyer
- Department of Medicine, Madigan Army Medical Center, Tacoma, Washington
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