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Zhang Z, He F, Lin Z, Li Z, Xiang F, Cai W. Application of a downward tract adherence method in the manual bedside placement of post-pyloric tubes in the intensive care unit. Technol Health Care 2024; 32:2129-2139. [PMID: 38607773 DOI: 10.3233/thc-230824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
BACKGROUND At present, there are few studies on the technical requirements of manual bedside placement of post-pyloric tube in Intensive Care Unit patients. OBJECTIVE To investigate the application value of downward tract adherence method in the manual bedside placement of jejunal tubes. METHODS In the downward group, 160 patients underwent manual bedside placement of jejunal tubes by a downward tract adherence method. In the conventional group, 144 patients were treated with conventional gas injection during the placement. The success rate, average time, and adverse reactions of the placement in the two groups were investigated and compared. RESULTS The success rate of the placement in the downward group was significantly higher (95% vs. 75%, P< 0.001) and the average time for the successful placement was shortened (23 ± 5.91 min vs. 26 ± 5.49 min, P= 0.025) than that in the conventional group. No treatment-related adverse reactions occurred in either group, and there were also no significant differences in vital sign changes. CONCLUSIONS The use of the downward tract adherence method in the manual bedside placement of postpyloric tubes for the intensive care patients at the bedside has a higher success rate, effectivity and safety.
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Lavoie JA, Schindler C, Garnier-Villareal M, Bagli S, McCarthy DL, Goday PS. Nasogastric Bridles are Associated with Improved Tube-Related Outcomes in Children. JPEN J Parenter Enteral Nutr 2022; 46:1568-1577. [PMID: 35589402 DOI: 10.1002/jpen.2409] [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: 01/14/2022] [Revised: 03/29/2022] [Accepted: 04/27/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare tube-related outcomes in children with standard tape versus nasal bridle securement of nasogastric tubes (NGTs). STUDY DESIGN Single-center, retrospective, correlational study of outcomes from the time of NGT placement until full oral feeds or durable-tube placement. Outcomes of interest included NGT dislodgements, length of stay, emergency department (ED) encounters, radiographic exposures, and adverse skin outcomes. Negative binomial regression and logistic regression were used to analyze differences between groups. RESULTS 582 children had NGTs secured traditionally [43% female; age at therapy initiation 2.6 months (SD 8.1)] and 173 received nasal bridles [55.5% female; age at therapy initiation 8.4 months (SD 11.8)]. Children with bridled NGTs were 16.67 times less likely to experience ≥1 dislodgement (OR=0.06, 95% CI 0.04, 0.09); 2.5 times less likely to have one more ED visit (OR=0.4, 95% CI 0.19, 0.82), and 4.76 times less likely to require one more radiographic exposure (OR=0.21, 95% CI 0.14, 0.33) than their non-bridled NGT counterparts (all p values <0.02). The mean initial hospital length of stay was 28 and 54 days in the bridled and standard care group respectively (p<0.001). Overall, 62.4% children with bridled NGTs and 77.1% children with unbridled NGTs progressed to full oral feedings and required no further therapy (p<0.001). Adverse skin outcomes were rare in both groups. CONCLUSION Children with bridled NGTs experienced fewer dislodgements, days in the hospital, ED encounters, and radiographic exposures than children with traditionally secured NGTs. The majority of children in both groups progressed to full oral feedings. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Julie Ann Lavoie
- Pediatric Gastroenterology and Nutrition, Children's Hospital of Wisconsin, Milwaukee, WI
| | - Christine Schindler
- Marquette University, College of Nursing, Milwaukee, WI.,Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | | | - Sravya Bagli
- Herma Heart Institute, Cardiology, Children's Hospital of Wisconsin, Milwaukee, WI
| | | | - Praveen S Goday
- Pediatric Gastroenterology and Nutrition, Medical College of Wisconsin Milwaukee WI
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Evaluation of the use of nasal bridle in clinical practice. NUTR HOSP 2022; 39:962-970. [DOI: 10.20960/nh.03781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Taylor S, Manara AR. X-ray checks of NG tube position: a case for guided tube placement. Br J Radiol 2021; 94:20210432. [PMID: 34233513 PMCID: PMC8764929 DOI: 10.1259/bjr.20210432] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Checking nasogastric (NG) tube position by X-ray is too late to prevent 1.5% of blind tube placements entering the lung and results in delays to feeding and drugs. We audit the safety of the tube position and delay incurred by X-ray. METHODS From Radiology reports, we determined whether tube position was safe for feeding, factors associated with an X-ray request and the time delay from X-ray request to that report. For tubes misplaced into the lung, the distance from the carina to tube tip was measured and compared with that from published records of guided tube placement. RESULTS From 1 July 2019 to 30 June 2020, 1934 X-rays were done to check NG tube position in 891 patients. Gastric placement was confirmed in 85% but, because of tube proximity to the oesophagus, only 73% were deemed safe to feed. The 2.2% of tubes reported to be in the lung were a median of 18 cm beyond the carina compared to 12 cm and 0 cm for electromagnetic and direct vision methods of guided placement. X-ray checks delayed feed and drug treatment by >2 h in 51% of placements and 33% of patients required >3 X-rays during their enteral episode. CONCLUSION X-ray checks are common and detect a high percentage of unsafe tube placements, leading to repeated X-ray and delayed delivery of drugs and nutrition. Interpretation can be difficult even when following standard national criteria and post-placement X-ray cannot prevent deep lung placement. Guided or combined methods of confirming tube placement should be investigated. ADVANCES IN KNOWLEDGE Reports included 27.5% of placements as unsafe, 2.2% in the lung at a median depth of 18 cm beyond the carina and too late to prevent 7 pneumothoraces. X-rays were repeated >3 times in 33% of patients over their enteral course and we are associated with clinically significant delays to drug treatment (and nutrition) in 51%; combined methods of tube confirmation or guided placement may be safer and more efficient.
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Affiliation(s)
- Stephen Taylor
- Department of Nutrition and Dietetics, Southmead Hospital Bristol, Bristol, United Kingdom
| | - Alex R Manara
- Department of Anaesthetics, Southmead Hospital Bristol, Bristol, United Kingdom
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Nasogastric Tube Feeding in Older Patients: A Review of Current Practice and Challenges Faced. Curr Gerontol Geriatr Res 2021; 2021:6650675. [PMID: 33936197 PMCID: PMC8056871 DOI: 10.1155/2021/6650675] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 01/05/2023] Open
Abstract
Nasogastric tube feeding is an essential way of delivering enteral nutrition when the oral route is insufficient or unsafe. Malnutrition is recognised as a reversible factor for sarcopenia and frailty. It is therefore crucial that malnutrition is treated in older inpatients who have dysphagia and require enteral nutrition. Despite five National Patient Safety Alerts since 2005, “Never Events” related to nasogastric feeding persist. In addition to placement errors, current practice often leads to delays in feeding, which subsequently result in worse patient outcomes. It is crucial that tube placement is confirmed accurately and in a timely way. Medical advancements in this area have been slow to find a solution which meets this need. In this paper, we provide an updated review on the current use of feeding nasogastric tubes in the older population, the issues associated with confirming correct placement, and innovative solutions for improving safety and outcomes in older patients.
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Taylor SJ. Methods of Estimating Nasogastric Tube Length: All, Including "NEX," Are Unsafe. Nutr Clin Pract 2020; 35:864-870. [PMID: 32406552 DOI: 10.1002/ncp.10497] [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] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Predominance of blind feeding tube placement makes esophageal tube misplacement and aspiration risk commonplace. Accurate estimation of nose-to-stomach length could reduce this risk. Standards for estimating this length were audited against the length measured from guided tube placement. METHODS This prospective, single-center observational study used electromagnet-guided tube placement to measure the length from nose to gastric body flexure as part of routine care. This measurement was used to audit standard equations used to estimate this length from external measures: xiphisternum-ear-nose + 10 cm (XEN+10), nose-ear-xiphisternum (NEX), and Hanson_A and Hanson_B. RESULTS From April 23, 2015, to March 2, 2020, measurements were obtained from 200 primary tube placements. Median length to the gastric body flexure (61 cm) was significantly different from that to the pre-gastroesophageal junction flexure (48 cm) or lengths predicted by NEX (51 cm) or Hanson_A (50.5 cm) and Hanson_B (56.1 cm) (all P < .00001) but similar to XEN+10 (61 cm). Esophageal placement was a potential risk for all methods (NEX: 96.3%, Hanson_A: 99.5%, Hanson_B: 86.9%, XEN+10: 43.2%) and a definite risk for most (NEX and Hanson_A: 14.9%, Hanson_B: 1%, XEN+10: 0%). CONCLUSIONS NEX and Hanson methods of predicting the length from nose to gastric body flexure are too short and risk esophageal misplacement. XEN+10 reduces but does not eliminate this risk. External measurement predictions are clinically unsafe as a guide blind tube placement. Guided placement is recommended.
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Affiliation(s)
- Stephen J Taylor
- Department of Nutrition and Dietetics, Southmead Hospital Bristol, Westbury on Trym, Avon, United Kingdom
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Allan K, Taylor S, Clemente R, Toher D. Observation of inadvertent tube loss in ICU: effect of nasal bridles. ACTA ACUST UNITED AC 2019; 28:1170-1174. [PMID: 31597070 DOI: 10.12968/bjon.2019.28.18.1170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: safe placement and securement of feeding tubes are essential to establishing early enteral nutrition. Nasogastric or nasojejunal feeding tubes are often inadvertently removed, and using a nasal bridle can reduce the number of tube replacements required. Aim: to review current nasal bridle practices on one intensive care unit. Over a 3-month period, nasal bridle use was recorded to measure unintentional tube loss and tube duration (the time a tube remained in situ). Method: an observational service evaluation. Findings: 109 patients were recruited; 205 tubes were passed and 77 bridles were inserted, with 42% (n=46) of the bridles placed on day 1. Tubes secured with tape were more likely to be dislodged than tubes secured with a bridle, P=0.0001. Duration of tubes remaining in situ was significantly longer in patients who had a bridle fitted on day 1, P=0.0001 compared with tubes secured with tape. Conclusion: securing a tube with a nasal bridle from day 1 is independently associated with reduced tube loss, increased duration of tube use, and likelihood that the tube would reach redundancy when it was no longer required.
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Affiliation(s)
- Kaylee Allan
- Nutrition Support Dietitian, Department of Nutrition and Dietetics, Southmead Hospital, Bristol
| | - Stephen Taylor
- Research Dietitian, Department of Nutrition and Dietetics, Southmead Hospital, Bristol
| | - Rowan Clemente
- Nutrition Support Dietitian, Department of Nutrition and Dietetics, Southmead Hospital, Bristol
| | - Deirdre Toher
- Statistician, Department of Engineering, Design and Mathematics, University of the West of England, Bristol
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Taylor SJ, Allan K, Clemente R, Marsh A, Toher D. Feeding tube securement in critical illness: implications for safety. ACTA ACUST UNITED AC 2019; 27:1036-1041. [PMID: 30281347 DOI: 10.12968/bjon.2018.27.18.1036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Over 50 % of tape-secured feeding tubes are inadvertently lost. The impact of nasal bridle securement on nasogastric (NG) and nasointestinal (NI) tube loss, outcome and duration of use was determined from 1 October 2014 (NG) and 1 January 2010 respectively to 31 December 2017. From this and published data, the potential impact of nasal bridles on major complications was determined. Use of nasal bridles was independently associated with: an 80% reduction in inadvertent NI tube loss (odds ratio (OR): 95% confidence interval (CI): 0.2: 0.12-0.33, p<0.0001); increased duration of tube use (2.2 days, 95% CI: 0.7-3.7, p= 0.004); and an almost threefold likelihood of tubes being used until no longer needed (OR: 2.8, 95%CI: 1.9-4.3, p<0.0001). In a single-room intensive care unit, inadvertent tube loss dropped from 53% to 9% and tube redundancy (tube no longer required) rose from 20% to 64%. UK-wide bridle securement, by reducing premature tube loss and the need for replacement by 40%, could be associated with 1422 fewer pneumonias or pneumothoraces and 768 fewer deaths.
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Affiliation(s)
- Stephen J Taylor
- Research Dietitian, Department of Nutrition & Dietetics, Southmead Hospital, Bristol
| | - Kaylee Allan
- Nutrition Support Dietitian, Department of Nutrition & Dietetics, Southmead Hospital, Bristol
| | - Rowan Clemente
- Nutrition Support Dietitian, Department of Nutrition & Dietetics, Southmead Hospital, Bristol
| | - Aidan Marsh
- Consultant Anaesthetist and in Intensive Care Medicine, Department of Anaesthetics, Southmead Hospital, Bristol
| | - Deirdre Toher
- Statistician, Department of Engineering Design and Mathematics, University of the West of England, Bristol
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Usability study of pH strips for nasogastric tube placement. PLoS One 2017; 12:e0189013. [PMID: 29190683 PMCID: PMC5708821 DOI: 10.1371/journal.pone.0189013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 11/16/2017] [Indexed: 12/28/2022] Open
Abstract
AIMS (1) To model the process of use and usability of pH strips (2) to identify, through simulation studies, the likelihood of misreading pH strips, and to assess professional's acceptance, trust and perceived usability of pH strips. METHODS This study was undertaken in four phases and used a mixed method approach (an audit, a semi-structured interview, a survey and simulation study). The three months audit was of 24 patients, the semi-structured interview was performed with 19 health professionals and informed the process of use of pH strips. A survey of 134 professionals and novices explored the likelihood of misinterpreting pH strips. Standardised questionnaires were used to assess professionals perceived usability, trust and acceptance of pH strip use in a simulated study. RESULTS The audit found that in 45.7% of the cases aspiration could not be achieved, and that 54% of the NG-tube insertions required x-ray confirmation. None of those interviewed had received formal training on pH strips use. In the simulated study, participants made up to 11.15% errors in reading the strips with important implications for decision making regarding NG tube placement. No difference was identified between professionals and novices in their likelihood of misinterpreting the pH value of the strips. Whilst the overall experience of usage is poor (47.3%), health professionals gave a positive level of trust in both the interview (62.6%) and the survey (68.7%) and acceptance (interview group 65.1%, survey group 74.7%). They also reported anxiety in the use of strips (interview group 29.7%, survey group 49.7%). CONCLUSIONS Significant errors occur when using pH strips in a simulated study. Manufacturers should consider developing new pH strips, specifically designed for bedside use, that are more usable and less likely to be misread.
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Brazier S, Taylor SJ, Allan K, Clemente R, Toher D. Stroke: ineffective tube securement reduces nutrition and drug treatment. ACTA ACUST UNITED AC 2017. [PMID: 28640722 DOI: 10.12968/bjon.2017.26.12.656] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sophie Brazier
- Department of Nutrition and Dietetics, Southmead Hospital, Bristol
| | - Stephen J Taylor
- Department of Nutrition and Dietetics, Southmead Hospital, Bristol
| | - Kaylee Allan
- Department of Nutrition and Dietetics, Southmead Hospital, Bristol
| | - Rowan Clemente
- Department of Nutrition and Dietetics, Southmead Hospital, Bristol
| | - Deirdre Toher
- Applied Statistics Group, Department of Engineering Design and Mathematics, University of the West of England, Bristol
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Puiggròs C, Molinos R, Ortiz MD, Ribas M, Romero C, Vázquez C, Segurola H, Burgos R. Experience in Bedside Placement, Clinical Validity, and Cost-Efficacy of a Self-Propelled Nasojejunal Feeding Tube. Nutr Clin Pract 2015; 30:815-23. [PMID: 26214512 PMCID: PMC4708005 DOI: 10.1177/0884533615592954] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The procedures needed to insert nasojejunal tubes (NJTs) are often invasive or uncomfortable for the patient and require hospital resources. The objectives of this study were to describe our experience in inserting a self-propelling NJT with distal pigtail end and evaluate clinical validity and cost efficacy of this enteral nutrition (EN) approach compared with parenteral nutrition (PN). MATERIALS AND METHODS Prospective study from July 2009 to December 2010, including hospitalized noncritical patients who required short-term jejunal EN. The tubes were inserted at bedside, using intravenous erythromycin as a prokinetic drug. Positioning was considered correct when the distal end was beyond the ligament of Treitz. Migration failure was considered when the tube was not positioned into the jejunum within 48 hours postinsertion. RESULTS Fifty-six insertions were recorded in 47 patients, most frequently in severe acute pancreatitis (69.6%). The migration rates at 18 and 48 hours postinsertion were 73.2% and 82.1%, respectively. There was migration failure in 8.9% of cases, and 8.9% were classified null (the tube was no longer in the gastrointestinal tract at 18 hours). There were no reported or observed complications. The mean duration of the EN was 12 ± 10.8 days. Five different types of EN formula were used. The total study cost was 53.9% lower compared with using PN in all patients. CONCLUSIONS Our study demonstrated that bedside insertion of a self-propelling NJT is a safe, cost-effective, and successful technique for postpyloric enteral feeding in at least 73% of the patients, and only 18% of patients could eventually need other placement techniques. It can avoid the need for more aggressive or expensive placement techniques or even PN if we cannot achieve enteral access.
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Affiliation(s)
- Carolina Puiggròs
- Nutritional Support Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Rosa Molinos
- Nutritional Support Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - M Dolors Ortiz
- Nutritional Support Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Montserrat Ribas
- Nutritional Support Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Carlos Romero
- Nutritional Support Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Concepcion Vázquez
- Nutritional Support Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Hegoi Segurola
- Nutritional Support Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Rosa Burgos
- Nutritional Support Unit, Vall d'Hebron University Hospital, Barcelona, Spain
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