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Cooley KV, Denning PW. A Nurse-Driven Protocol for Neonatal Enteral Access Device Placement Confirmation. Adv Neonatal Care 2024; 24:324-332. [PMID: 38975653 DOI: 10.1097/anc.0000000000001186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
BACKGROUND Preterm infants require the use of nasogastric and orogastric enteral access devices (EADs) to provide nutrition and medications. Confirmation of the location of the tip of the EAD is essential to minimize complications. At the study site, EAD location was limited to verifying the centimeter marking at the lip/nares and nonevidence-based methods of visual observation of aspirate and auscultation. PURPOSE Implement an evidenced-based EAD placement confirmation protocol, and by 90 days post-education and implementation, achieve adherence of 90%. METHODS This quality improvement project implemented a nurse-driven evidence-based protocol for EAD verification. The intervention was based on the New Opportunities for Verification of Enteral Tube Location best practice recommendations. Prior to implementation, education sessions focused on insertion measurement technique and gastric pH measurement. Radiographs, insertion measurement technique, centimeter marking, and gastric pH measurement were used for EAD location confirmation. To determine compliance with the protocol, audits were conducted and questionnaires assessing current practice regarding EAD confirmation were administered pre- and postimplementation. RESULTS The protocol increased nursing knowledge regarding evidence-based EAD insertion and verification procedures, incorporated pH measurement into practice, and reduced use of auscultation for confirmation. Nursing adherence to the protocol was 92%. IMPLICATIONS FOR PRACTICE AND RESEARCH This provides a model for how to successfully implement and achieve adherence to an evidence-based EAD placement confirmation nurse-driven protocol. Further research is needed to verify the effectiveness of the protocol and establish consensus on approaches specifically for the neonatal population.
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Affiliation(s)
- Kim V Cooley
- Neonatal Intensive Care Unit, Emory University Hospital Midtown (Dr Cooley); and Department of Pediatrics, Neonatal Intensive Care Unit, Emory University Hospital Midtown, and Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia (Dr Denning)
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Bradford JY, Camarda A, Gilmore L, Horigan AE, Kaiser J, MacPherson-Dias R, Perry A, Slifko A, Slivinski A, Van Dusen K, Bishop-Royse J, Delao AM. ENA Clinical Practice Guideline Synopsis: Family Presence During Resuscitation and Invasive Procedures. J Emerg Nurs 2024; 50:463-468. [PMID: 38705706 DOI: 10.1016/j.jen.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 05/07/2024]
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Perry A, Kaiser J, Kruger K, Horigan AE, Bradford JY, Camarda A, DeGroot D, Dixon C, MacPherson-Dias R, Slifko A, Slivinski A, Bishop-Royse J, Delao AM. ENA Clinical Practice Guideline Synopsis: Gastric Tube Placement Verification. J Emerg Nurs 2024; 50:301-304. [PMID: 38453344 DOI: 10.1016/j.jen.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 03/09/2024]
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Hahn M, Byham-Gray L, Samavat H, Roberts S, Brody R. Small-bore feeding tubes placed with an electromagnetic imaging device leads to cost avoidance and decreased time to initiation of enteral nutrition. Nutr Clin Pract 2023; 38:1324-1333. [PMID: 36942613 DOI: 10.1002/ncp.10979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/04/2023] [Accepted: 02/09/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND The Cortrak Enteral Access System (CEAS) was previously approved by the United States Food and Drug Administration (FDA) to be used in lieu of radiographic confirmation imaging for feeding tubes placed by trained clinicians. Following an institutional protocol change in 2016, our registered dietitians had the option to forgo radiographic confirmation imaging for tubes placed using the CEAS. Our research aimed to determine the difference in the number of radiographic confirmation images for feeding tubes placed using the CEAS between preprotocol and postprotocol environments and the associated cost avoidance after the institutional policy change. METHODS We retrospectively reviewed data from 506 tube placements (n = 253 per protocol environment) in adult patients with diverse diagnoses admitted to various in-patient care units. RESULTS There was a significant reduction in the mean number of radiographic images per tube placement (preprotocol = 1.10 [95% CI, 1.05-1.15]; postprotocol = 0.36 [95% CI, 0.30-0.41]; P < 0.001), leading to a cost avoidance of $67,282.80 for the 253 tube placements and a potential cost avoidance of $279,236 over the 5-year postprotocol environment. Additionally, the mean time to initiation of enteral nutrition was significantly reduced by 2.65 h in the postprotocol environment (P < 0.001). CONCLUSION Our findings suggest that using the CEAS can reduce the number of radiographic images, provide cost avoidance, and improve nutrition outcomes. However, updated 2022 FDA regulatory changes to the use of the CEAS for tube confirmation lead to an uncertain future for this practice because of safety concerns.
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Affiliation(s)
- Michaelann Hahn
- Baylor Simmons Transplant Institute, Baylor University Medical Center, Dallas, Texas, USA
- Departement of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, Rutgers University, Newark, New Jersey, USA
| | - Laura Byham-Gray
- Departement of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, Rutgers University, Newark, New Jersey, USA
| | - Hamed Samavat
- Departement of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, Rutgers University, Newark, New Jersey, USA
| | - Susan Roberts
- Nutrition and Dietetics Education Program, Keiser University, Florida, USA
| | - Rebecca Brody
- Departement of Clinical and Preventive Nutrition Sciences, Rutgers School of Health Professions, Rutgers University, Newark, New Jersey, USA
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Nurses' Knowledge and Practice of Nasogastric Tube Placement: A Descriptive Research Study. Gastroenterol Nurs 2023; 46:47-53. [PMID: 36706142 DOI: 10.1097/sga.0000000000000699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 08/06/2022] [Indexed: 01/28/2023] Open
Abstract
The aim of this study is to examine nurses' knowledge and behaviors about nasogastric tube placement according to current standards. This descriptive study was conducted in a private hospital in Turkey with the participation of 184 nurses. Data were collected through a questionnaire consisting of two parts: "Personal Information Form" and "NGT Placement Information Form." About half of the nurses (45.6%) did not read current information about nasogastric tubes, though 36.5% were aware of the auscultation method as the best method for nasogastric tube placement confirmation and approximately half (48.9%) of them used this method. Nurses who participated in our study did not use a pH test, capnography, or radiography methods to confirm nasogastric tube placement. As a result, it is recommended that nurses follow current evidence about nasogastric tube placement and maintain or improve their education on this topic.
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Li J, Sun X, Wu X. Effects of implementation strategies aimed at improving high-value verification methods of nasogastric tube placement: A systematic review. Front Nutr 2022; 9:1009666. [DOI: 10.3389/fnut.2022.1009666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/18/2022] [Indexed: 12/04/2022] Open
Abstract
BackgroundX-ray and pH testing, which clinical practice guidelines have proven to be effective in determining nasogastric tube (NGT) placement, were named the high-value methods. Implementation strategies can help to integrate high-value methods into particular contexts. The aim of this systematic review was to summarize the evidence of implementation strategies aimed at improving high-value verification methods of NGT placement.MethodsPubMed, ProQuest, and CINAHL were searched until June 2022. The Cochrane Effective Practice and Organization of Care (EPOC) taxonomy was used to categorize implementation strategies.ResultsThe initial search identified 1,623 records. Of these, 64 full-text studies were reviewed. Finally, 12 studies were included and used for qualitative synthesis. Eleven studies used an education component as an implementation strategy. Only one study based their implementation strategy on a barriers and facilitators assessment. None of the studies reported enough detail of the implementation strategy used in their studies. Seven studies were eligible for inclusion in the meta-analysis. Three of these seven studies revealed a significant improvement of the high-value method after strategy implementation. As heterogeneity was present in the high level, the pooled effect estimated was not calculated.ConclusionMost studies used an implementation strategy with an educational component. Unfortunately, no conclusion can be drawn about which strategy is most effective for improving high-value verification methods of NGT placement due to a high level of heterogeneity and a lack of studies. We recommend that future studies fully connect their implementation strategies to influencing factors and better report the details of implementation strategies.Systematic review registration[www.crd.york.ac.uk/PROSPERO/], identifier [CRD42022349997].
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Halm MA. On Low-Value Nursing Care: Part 1, Why De-implementation Matters for Quality Care. Am J Crit Care 2022; 31:338-342. [PMID: 35773189 DOI: 10.4037/ajcc2022857] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Margo A Halm
- Margo A. Halm is associate chief nurse executive, nursing research and evidence-based practice, VA Portland HealthCare System, Portland, Oregon
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McGinnis C, Marroquin S, Reed V. Assessment of the effect of colored beverage on gastric returns after gastric tube replacement to enhance placement verification. Nutr Clin Pract 2021; 37:413-424. [PMID: 34751966 DOI: 10.1002/ncp.10796] [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: 11/07/2022] Open
Abstract
BACKGROUND Verification of appropriate placement of newly replaced gastrostomy tubes is essential prior to use to avoid potentially serious adverse events. PROBLEM A lack of standardized guidance regarding effective and practical means to verify placement exists. Aspiration or drainage of gastric-like contents is one mean suggested to help determine placement, yet when returns are minimal, this becomes challenging. MATERIALS, METHOD, INTERVENTION Oral ingestion or the instillation of a colored beverage prior to tube replacement was used in a midwestern healthcare clinical setting to enhance returns in both volume and color via the newly replaced gastrostomy tube. A retrospective review of this practice was conducted, which included 176 gastric tube replacements over 4 years. RESULTS A significant increase in volume of returns via the newly replaced tube was noted (P < .001) and a strong correlation of color to the ingested or consumed beverage was found with 95% of returns reflecting color tinting of the beverage or in many cases, strong color change to that of the beverage color. CONCLUSION Presented is a simple, cost-effective method that has shown to be clinically useful in assessing placement of newly replaced gastrostomy tubes that may be useful in other practices and settings.
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Affiliation(s)
- Carol McGinnis
- Sanford USD Medical Center, Sioux Falls, South Dakota, USA
| | - Sara Marroquin
- USD Sanford School of Medicine/ Department of Surgery, Sioux Falls, South Dakota, 57105, USA
| | - Valerie Reed
- Sanford Research, Sioux Falls, South Dakota, USA
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Bourgault AM, Upvall MJ, Nicastro S, Powers J. Challenges of de-implementing feeding tube auscultation: A qualitative study. Int J Nurs Pract 2021; 28:e13026. [PMID: 34664768 DOI: 10.1111/ijn.13026] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 06/25/2021] [Accepted: 09/25/2021] [Indexed: 11/30/2022]
Abstract
AIM This qualitative study explored de-implementation of feeding tube auscultation practice in adult patients by critical care nurses. BACKGROUND Despite years of evidence suggesting inaccuracy and harm, auscultation (air bolus method) continues to be used by the majority of critical care nurses to verify small-bore feeding tube placement in adults. DESIGN This descriptive qualitative study used thematic analysis with telephone interview data. METHODS Fourteen critical care nurses from four stratified groups within the United States (by hospital type and auscultation practice) participated in telephone interviews. RESULTS Two major themes of individual influence and organizational leadership emerged from the data. Categories identified key components required for auscultation de-implementation. CONCLUSIONS Nurses feel obligated to follow hospital policies and expressed less accountability for their own practice. Organizational leadership involvement is recommended to facilitate de-implementation of this tradition-based, low-value practice and mitigate harm events.
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Affiliation(s)
- Annette M Bourgault
- College of Nursing, University of Central Florida, Orlando, Florida, USA.,Orlando Health, Orlando, Florida, USA
| | - Michele J Upvall
- College of Nursing, University of Central Florida, Orlando, Florida, USA
| | - Samantha Nicastro
- College of Nursing, University of Central Florida, Orlando, Florida, USA
| | - Jan Powers
- Parkview Health System, Fort Wayne, Indiana, USA
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Gardner L, Wallace S. Nasogastric Tube Placement: A Cross-Comparison of Verification Methods Used in Pennsylvania Hospitals and How They Align With Guidelines. PATIENT SAFETY 2021. [DOI: 10.33940/med/2021.9.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Nasogastric tubes (NGTs) are used as an alternative approach to deliver nutrition and medications, or a method to remove stomach contents. Insertion of these tubes is considered a simple procedure; however, wrong placement or dislodged tubes can lead to patient harm and possibly death. The risk of harm and death increases when misplaced or dislodged tubes are not identified prior to using them. We queried the Pennsylvania Patient Safety Reporting System for events that occurred between January 1, 2017, and June 30, 2020. We analyzed those reports that provided supplemental information describing NGT placement verification methods to determine how these activities aligned with NGT guidelines. The use of X-rays and pH aspirate, guideline-approved verification methods, were identified in 90.8% (544 of 599) of the reports. In 9.2% (55 of 599) of the reports, the use of non-recommended verification methods (e.g., insertion of air bolus/auscultation, were identified). Reports indicated that patients aged less than one year old experienced a higher percentage of non-recommended verification methods being used when compared to all other patients. Interviews with staff at three healthcare facilities discussed their approach to verifying NGT placement. Risk reduction strategies comprise using the guideline recommendations to verify NGT placement and avoiding the use of non-recommended verification methods.
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Saunders RN, Kelly-Schuette KA, Davis AT, Koehler TJ, Gayed BN, Durling LT, Chapman AJ, Gibson CJ. Sumping's Up: A Multidisciplinary Educational Initiative on Gastric Drainage Tubes. J Contin Educ Nurs 2021; 51:484-488. [PMID: 32976618 DOI: 10.3928/00220124-20200914-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 05/04/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Nasogastric tube placement is widely taught, and tube maintenance relies on astute nursing care with adherence to both institutional and evidence-based recommendations. However, precise adherence to current recommendations relies on knowledge base regarding the identification of malfunctioning gastric drainage tubes. Troubleshooting skills are crucial in maintaining patient safety and recognizing malfunction. METHOD Educational sessions on nasogastric and orogastric decompression tube management, led by a surgical intensive care fellow at a level 1 trauma center, were offered to critical care nurses. A presession and postsession survey evaluated the nurses' subjective and objective knowledge and comfort with naso/orogastric decompression tube management. RESULTS Ninety-seven critical care RNs participated. For all questions, the proportion of correct answers significantly increased from presession survey to postsession survey (p < .001). Ninety-seven percent of all participants found the session to be very helpful. CONCLUSION Physician-led educational sessions on naso/orogastric decompression tube management were well-received and improved subjective and objective measurements of nurses' knowledge and comfort level with gastric decompression tubes. [J Contin Educ Nurs. 2020;51(10):484-488.].
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Nayahangan LJ, Konge L, Russell L, Andersen S. Training and education of healthcare workers during viral epidemics: a systematic review. BMJ Open 2021; 11:e044111. [PMID: 34049907 PMCID: PMC8166630 DOI: 10.1136/bmjopen-2020-044111] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 05/11/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND It is necessary to train a large number of healthcare workers (HCW) within a limited time to ensure adequate human resources during an epidemic. There remains an urgent need for best practices on development and implementation of training programmes. OBJECTIVE To explore published literature in relation to training and education for viral epidemics as well as the effect of these interventions to inform training of HCW. DATA SOURCES Systematic searches in five databases performed between 1 January 2000 and 24 April 2020 for studies reporting on educational interventions in response to major viral epidemics. STUDY ELIGIBILITY CRITERIA All studies on educational interventions developed, implemented and evaluated in response to major global viral outbreaks from 2000 to 2020. PARTICIPANTS Healthcare workers. INTERVENTIONS Educational or training interventions. STUDY APPRAISAL AND SYNTHESIS METHODS Descriptive information were extracted and synthesised according to content, competency category, educational methodology, educational effects and level of educational outcome. Quality appraisal was performed using a criterion-based checklist. RESULTS A total of 15 676 records were identified and 46 studies were included. Most studies were motivated by the Ebola virus outbreak with doctors and nurses as primary learners. Traditional didactic methods were commonly used to teach theoretical knowledge. Simulation-based training was used mainly for training of technical skills, such as donning and doffing of personal protective equipment. Evaluation of the interventions consisted mostly of surveys on learner satisfaction and confidence or tests of knowledge and skills. Only three studies investigated transfer to the clinical setting or effect on patient outcomes. CONCLUSIONS AND IMPLICATIONS OF FINDINGS The included studies describe important educational experiences from past epidemics with a variety of educational content, design and modes of delivery. High-level educational evidence is limited. Evidence-based and standardised training programmes that are easily adapted locally are recommended in preparation for future outbreaks.
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Affiliation(s)
- Leizl Joy Nayahangan
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resouces and Education, The Capital Region of Denmark, Copenhagen, Denmark
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resouces and Education, The Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lene Russell
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resouces and Education, The Capital Region of Denmark, Copenhagen, Denmark
- Department of Intensive Care, Rigshospitalet, Copenhagen, Denmark
| | - Steven Andersen
- Copenhagen Academy for Medical Education and Simulation (CAMES), Centre for Human Resouces and Education, The Capital Region of Denmark, Copenhagen, Denmark
- Department of Otorhinolaryngology-Head & Neck Surgery, Rigshospitalet, Copenhagen, Denmark
- Department of Otolaryngology, Ohio State University, Columbus, Ohio, USA
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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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Tripathi R, Hinic K. Best Practices to Verify Ongoing Placement of NG or OG Tube After Initial X-ray Confirmation. Worldviews Evid Based Nurs 2021; 18:311-313. [PMID: 33991060 DOI: 10.1111/wvn.12507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many patients in intensive care units (ICU) require nasogastric (NG) or orogastric (OG) tubes. These patients often require a combination of sedatives that can alter level of consciousness and impair cough or gag reflexes. Such factors can lead to NG/OG tube displacement. Using a misplaced tube can lead to aspiration, lung injury, infection, and even death. AIMS To standardize ongoing verification of NG tube placement practices in our 34-bed Medical-Surgical ICU. METHODS The Johns Hopkins Nursing Model was utilized to guide this project. A literature review and critical appraisal were performed to establish NG/OG tube best practices. Best practices were implemented and assessed (via a survey and charting audits). RESULTS Fifteen publications were identified and appraised as Level 4 and 5 sources. Best evidence supported that at the time of radiographic confirmation of the tube site, it should be marked with inedible ink or adhesive tape where it exits the nares; tube location should be checked at 4-hour intervals; and placement/patency should be checked in patients who complain of pain, vomiting, or coughing. Following the practice change, N = 40 nurses indicated improvement in verification of NG/OG tube knowledge, "OK to use" order was verified for 89% of patients, and 63% of tubes were marked with tape at the exit site. LINKING ACTION TO EVIDENCE Adherence to current, evidence-based strategies for NG/OG tube verification promotes patient safety. Monitoring practice changes is critical to determine whether a best practice is sustained. Electronic health records must be current to guide and support evidence-based nursing practice.
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Affiliation(s)
- Rekha Tripathi
- Morristown Medical Center Intensive Care Unit, Morristown, NJ, USA
| | - Katherine Hinic
- Morristown Medical Center, Seton Hall University College of Nursing, Nutley, NJ, USA
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National Survey of Feeding Tube Verification Practices: An Urgent Call for Auscultation Deimplementation. Dimens Crit Care Nurs 2021; 39:329-338. [PMID: 33009273 DOI: 10.1097/dcc.0000000000000440] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Harm events such as pneumothoraces and pneumonia continue to be associated with feeding tube insertion. Most bedside verification methods are not accurate to discriminate pulmonary from gastrointestinal system. Evidence-based clinical practice guidelines do not support auscultation of feeding tubes in adults, yet auscultation is the most common method used. OBJECTIVES Our survey assessed national feeding tube verification practices used by critical care nurses, including progress in auscultation method deimplementation, and stylet reinsertion and cleansing practices. METHODS A national survey of 408 critical care nurses was performed. RESULTS The majority performed auscultation (311 of 408 [76%]) to verify feeding tube placement. In the final multivariable model, nursing education, facility type, observation of colleagues performing auscultation, and awareness of an institutional policy were associated with auscultation of feeding tubes. Thirty-five percent used enteral access devices to verify initial feeding tube placement. Stylet cleansing methods were variable; 38% of reinserted stylets were not cleansed. DISCUSSION Minimal progress has been made in deimplementation of auscultation in the past 7 years despite passive knowledge dissemination in research articles, clinical practice guidelines, and procedure manuals. Although pH measure is used as a first-line feeding tube verification method in the United Kingdom, it is rarely used in the United States. Clinical practice guidelines should be updated to incorporate new research on enteral access systems. CONCLUSIONS Tradition-based practices such as auscultation and certain stylet cleansing methods should be deimplemented. A focused interdisciplinary, multifaceted program is needed to deimplement auscultation practice for adult feeding tubes.
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Shain LM, McHale L, Ahmed T. Hemothorax Following Traumatic Dobhoff Tube Insertion. Cureus 2021; 13:e13097. [PMID: 33728119 PMCID: PMC7935303 DOI: 10.7759/cureus.13097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Dobhoff tube is a specialized small-bore and flexible nasogastric tube that makes it more comfortable for placement than a usual nasogastric tube. Dobhoff tube insertion is commonly considered a relatively safe bedside procedure, but it is not without its associated risks. Inadvertent tracheobronchial placement of Dobhoff tube has been associated with severe complications, most notably pneumothorax. We present a rare cause of right-sided hemothorax following tracheobronchial insertion of a Dobhoff tube with a prolonged and arduous clinical course.
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Affiliation(s)
| | - Leslie McHale
- Internal Medicine, University of Kentucky, Lexington, USA
| | - Taha Ahmed
- Internal Medicine, University of Kentucky, Lexington, USA
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Xu LC, Huang XJ, Lin BX, Zheng JY, Zhu HH. Clinical nurses' nasogastric feeding practices in adults: a multicenter cross-sectional survey in China. J Int Med Res 2021; 48:300060520920051. [PMID: 32349566 PMCID: PMC7218984 DOI: 10.1177/0300060520920051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE We aimed to investigate practices of nasogastric tube (NGT) intubation and feeding for adults by clinical nurses in China. METHODS A self-designed and validated questionnaire comprising 30 questions was distributed to 560 clinical nurses in three comprehensive hospitals of Xiamen, China. The questionnaire covered participants' demographic characteristics, NGT placement, administration of enteral nutrition (EN), and monitoring or management of feeding intolerance. RESULTS A total 464 (82.9%) questionnaires were completed; 36.2% of nurses used nose-ear-xiphoid and 79.5% forehead-xiphoid measurement to define the internal length of the NGT. Many participants still used traditional methods to confirm NGT placement (auscultation of injected air 50.2%, bubble test 34.7% and observing feeding tube aspirate 34.3%). Bolus feeding was the most commonly used technique to administer EN. A total 97.0% of all nurses used syringes to measure gastric residual volume (GRV), and 62.7% measured GRV every 4-8 hours. The most frequently used GRV threshold values were 200 mL (44.6%) and 150 mL (25.2%). Most nurses stopped feeding immediately when encountering high GRV (84.3%) or diarrhea (45.0%). The nasogastric feeding practices of many clinical nurses were not consistent with international guidelines. CONCLUSIONS Our study can provide an impetus for nursing administrators to revise their nasogastric feeding procedures, to promote compliance with evidence-based guidelines.
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Affiliation(s)
- Li-Chun Xu
- Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China
| | - Xiao-Jin Huang
- Zhongshan Hospital, Xiamen University, Xiamen, Fujian, China
| | - Bi-Xia Lin
- Xiamen Cardiovascular Hospital Xiamen University, Xiamen, Fujian, China
| | - Jun-Yi Zheng
- Nursing Department of Xiamen University, Xiamen, Fujian, China
| | - Hai-Hua Zhu
- The First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
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18
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Motta APG, Rigobello MCG, Silveira RCDCP, Gimenes FRE. Nasogastric/nasoenteric tube-related adverse events: an integrative review. Rev Lat Am Enfermagem 2021; 29:e3400. [PMID: 33439952 PMCID: PMC7798396 DOI: 10.1590/1518-8345.3355.3400] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 07/23/2020] [Indexed: 12/23/2022] Open
Abstract
Objective: to analyze in the scientific literature the evidence on nasogastric/nasoenteric tube related adverse events in adult patients. Method: integrative literature review through the search of publications in journals indexed in PubMed/MEDLINE, CINAHL, LILACS, EMBASE and Scopus, and hand searching, was undertaken up to April 2017. Results: the sample consisted of 69 primary studies, mainly in English and published in the USA and UK. They were divided in two main categories and subcategories: the first category refers to Mechanical Adverse Events (respiratory complications; esophageal or pharyngeal complications; tube obstruction; intestinal perforation; intracranial perforation and unplanned tube removal) and the second alludes to Others (pressure injury related to fixation and misconnections). Death was reported in 16 articles. Conclusion: nasogastric/nasoenteric tube related adverse events are relatively common and the majority involved respiratory harm that resulted in increased hospitalization and/or death. The results may contribute to healthcare professionals, especially nurses, to develop an evidence-based guideline for insertion and correct positioning of bedside enteral tubes in adult patients.
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Affiliation(s)
- Ana Paula Gobbo Motta
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Mayara Carvalho Godinho Rigobello
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | | | - Fernanda Raphael Escobar Gimenes
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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19
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Lee RK, Gallagher JJ, Ejike JC, Hunt L. Intra-abdominal Hypertension and the Open Abdomen: Nursing Guidelines From the Abdominal Compartment Society. Crit Care Nurse 2020; 40:13-26. [PMID: 32006038 DOI: 10.4037/ccn2020772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Intra-abdominal hypertension has been identified as an independent risk factor for death in critically ill patients. Known risk factors for intra-abdominal hypertension indicate that intra-abdominal pressures should be measured and monitored. The Abdominal Compartment Society has identified medical and surgical interventions to relieve intra-abdominal hypertension or to manage the open abdomen if abdominal compartment syndrome occurs. The purpose of this article is to describe assessments and interventions for managing intra-abdominal hypertension and open abdomen that are within the scope of practice for direct-care nurses. These guidelines provide direction to critical care nurses caring for these patients.
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Affiliation(s)
- Rosemary K Lee
- Rosemary K. Lee is an acute care nurse practitioner and clinical nurse specialist at Baptist Health South Florida, Coral Gables, Florida
| | - John J Gallagher
- John J. Gallagher is a clinical nurse specialist and trauma program coordinator, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania
| | - Janeth Chiaka Ejike
- Janeth Chiaka Ejike is an associate professor of pediatrics, pediatric critical care medicine practitioner, and Program Director of the Pediatric Critical Care Medicine Fellowship at Loma Linda University Children's Hospital, Loma Linda, California
| | - Leanne Hunt
- Leanne Hunt is a senior lecturer at Western Sydney University and a registered nurse at Liverpool Hospital, Sydney, Australia
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20
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Rigobello MCG, Elias Junior J, Bonacim CAG, Silveira RCDCP, Bonardi FC, Nunes RS, Pereira RA, Gimenes FRE. Accuracy of the combined method (auscultation and pH measurement) and ultrasonography for confirmation of gastric tube placement: a study protocol for a prospective study. BMJ Open 2020; 10:e036033. [PMID: 32998915 PMCID: PMC7528351 DOI: 10.1136/bmjopen-2019-036033] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Patients using a nasogastric tube (NGT) are vulnerable to adverse events, therefore proper assessment of these patients, verification of the correct tube placement and constant monitoring by the nursing staff are strategies that can reduce adverse events and risks associated with the care. The aim of this study will be to assess the accuracy of the combined method (auscultation and pH measurement) and ultrasonography for confirmation of gastric tube placement compared with the X-ray method. A further aim will be to measure and provide evidence for the direct costs of each method of confirming NGT placement and to evaluate the impact of each method on the mean direct cost of the patient. METHODS AND ANALYSIS This is a prospective, single-centre study of diagnostic accuracy. Data will be collected in the clinical and surgical wards, intensive care unit and coronary care unit of a Brazilian teaching hospital. The sample will consist of 385 assessments, performed in adult patients that agree to participate in the study and that receive an NGT. The combined method and the ultrasound will be the index tests and will be performed on all study participants for later comparison with an X-ray examination, considered the reference standard and the gold standard to distinguish between gastric and pulmonary placement. Sensitivity, specificity, positive predictive value and negative predictive value will be calculated to assess the diagnostic accuracy of the methods investigated in this study, with Cohen's kappa analysis used to evaluate the degree of concordance. ETHICS AND DISSEMINATION The study was approved by the Research Ethics Committee of the University of São Paulo at Ribeirão Preto College of Nursing, registration number: 83087318.4.0000.5393. The findings will be reported through academic journals, seminars and conference presentations, social media, print media, the internet and community/stakeholder engagement activities.
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Affiliation(s)
- Mayara Carvalho Godinho Rigobello
- Departamento de Enfermagem Geral e Especializada, Universidade de São Paulo Escola de Enfermagem de Ribeirão Preto, Ribeirao Preto, São Paulo, Brazil
| | - Jorge Elias Junior
- Departamento de Imagens Médicas, Hematologia e Oncologia Clínica, Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto, Ribeirao Preto, São Paulo, Brazil
| | - Carlos Alberto Grespan Bonacim
- Departamento de Contabilidade, Universidade de São Paulo Faculdade de Economia Administração e Contabilidade de Ribeirão Preto, Ribeirao Preto, São Paulo, Brazil
| | | | - Fernanda Caroline Bonardi
- Departamento de Enfermagem Geral e Especializada, Universidade de São Paulo Escola de Enfermagem de Ribeirão Preto, Ribeirao Preto, São Paulo, Brazil
| | - Roosevelt Santos Nunes
- Departamento de Cirurgia e Anatomia, Centro de Terapia Intensiva, Universidade de São Paulo Faculdade de Medicina de Ribeirão Preto, Ribeirao Preto, São Paulo, Brazil
| | - Rosana Aparecida Pereira
- Departamento de Enfermagem Geral e Especializada, Universidade de São Paulo Escola de Enfermagem de Ribeirão Preto, Ribeirao Preto, São Paulo, Brazil
| | - Fernanda Raphael Escobar Gimenes
- Departamento de Enfermagem Geral e Especializada, Universidade de São Paulo Escola de Enfermagem de Ribeirão Preto, Ribeirao Preto, São Paulo, Brazil
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21
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The Feasibility Study of a Revised Standard Care Procedure on the Capacity of Nasogastric Tube Placement Verification Among Critical Care Nurses. J Nurs Res 2020; 27:e31. [PMID: 30747820 PMCID: PMC6641657 DOI: 10.1097/jnr.0000000000000302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Evidence-based studies propose that the aspirate pH test may be easily and reliably conducted to verify the proper placement of nasogastric tubes (NGTs). Nurses rarely implement this procedure because of the lack of related knowledge. Purpose The purpose of this study was to explore the feasibility of implementing a revised standard care procedure to enhance nurses' ability to verify placement of the NGT. Methods his study used a quasi-experimental, longitudinal research design. Nurses from two intensive care units were randomly assigned to the experimental group (n = 35) and the control group (n = 31). A revised standard-of-care procedure to confirm the proper placement of an NGT was incorporated into a slideshow presentation, a printed leaflet, and an audit checklist. The experimental group received continuous education and individual teaching on the revised standard-of-care procedure, whereas the control group did not receive additional education and continued to provide conventional care. The study gathered data using scales designed to address knowledge of and attitudes toward verification of NGT placement and the checklist for auditing the NGT care procedure. Scales were implemented before and after the practice program was conducted, in Months 1, 2, and 3, to evaluate the feasibility of the developed improvement measures. Results This study found significant improvements in the experimental group in terms of knowledge regarding NGT placement verification and the NGT care auditing procedure. The positive improvement of the intervention on the NGT care auditing procedure remained for at least 3 months after the end of the intervention. Conclusions The findings suggest that using an aspirate pH test is a feasible approach to verify NGT placement in critical care units, a crucial aspect of care necessary to promote patient safety and quality of care.
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22
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Pereira F, Azevedo R, Tristan J. Misplacement of a nasogastric feeding tube: a case report. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 112:159. [PMID: 31985258 DOI: 10.17235/reed.2020.6512/2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Nasogastric tube (NGT) insertion is widely used for enteral feeding. After blind insertion of a NGT, confirmation of correct placement prior to feeding using reliable methods is mandatory. NGT misplacement in the respiratory tract can lead to serious complications. We report a case of a patient with dysphagia and malnutrition that needed enteral feeding as nutritional support. A NGT was blindly inserted, and its gastric position was confirmed through air insufflation and epigastric auscultation. Enteral feeding was initiated. Few hours later, the patient presented with respiratory distress. An urgent thoracic computed tomography was requested due to suspiction of pulmonary embolism, which revealed the NGT in the respiratory tree and a pneumonia in the lower lobe of the right lung. The NGT was removed, a new insertion was attempted and its gastric position was confirmed by radiography. Enteral feeding was initiated uneventfully. This case highlights the need for use of reliable methods of confirming tube location in order to avoid complications of misplacement.
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Affiliation(s)
| | | | - José Tristan
- Gastroenterology, Amato Lusitano Hospital, Portugal
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23
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Zoeller S, Bechtold ML, Burns B, Cattell T, Grenda B, Haffke L, Larimer C, Powers J, Reuning F, Tweel L, Guenter P. Dispelling Myths and Unfounded Practices About Enteral Nutrition. Nutr Clin Pract 2020; 35:196-204. [PMID: 31994794 DOI: 10.1002/ncp.10456] [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: 11/09/2022] Open
Abstract
Many protocols and steps in the process of enteral nutrition (EN) use are not overly supported with strong research and have been done the same way over many years without questioning the use of best-practices evidence. This article reports many of the myths and unfounded practices surrounding EN and attempts to refute those myths with current evidence. These practices include those about enteral access devices, formulas, enteral administration, and complications.
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Affiliation(s)
| | - Matthew L Bechtold
- Division of Gastroenterology & Hepatology Department of Medicine University Hospital & Clinics, Columbia, Missouri, USA
| | - Berri Burns
- Infusion Pharmacy at Home, Center for Connected Care, Cleveland Clinic, BOC, Independence, Ohio, USA
| | - Theresa Cattell
- Nutrition Support Riverside Methodist Hospital, Columbus, Ohio, USA
| | | | - Lindsey Haffke
- CHI Health at Home - Home Infusion Pharmacy, Omaha, Nebraska, USA
| | - Cara Larimer
- Enteral Nutrition Moog Medical Devices Group, Salt Lake City, Utah, USA
| | - Jan Powers
- Nursing Research and Professional Practice, Parkview Health System, Fort Wayne, Indiana, USA
| | | | - Lauren Tweel
- Chinook Regional Hospital, Alberta Health Services, South Zone, Lethbridge, Alberta, Canada
| | - Peggi Guenter
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
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- Orlando VAMC, Orlando, Florida, USA
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24
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Jacobson LE, Olayan M, Williams JM, Schultz JF, Wise HM, Singh A, Saxe JM, Benjamin R, Emery M, Vilem H, Kirby DF. Feasibility and safety of a novel electromagnetic device for small-bore feeding tube placement. Trauma Surg Acute Care Open 2019; 4:e000330. [PMID: 31799414 PMCID: PMC6861064 DOI: 10.1136/tsaco-2019-000330] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/23/2019] [Accepted: 10/09/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Misplacement of enteral feeding tubes (EFT) in the lungs is a serious and potentially fatal event. A recent Food and Drug Administration Patient Safety Alert emphasized the need for improved technology for the safe and effective delivery of EFTs. OBJECTIVE We investigated the feasibility and safety of ENvue, a novel electromagnetic tracking system (EMTS) to aid qualified operators in the placement of EFT. METHODS This is a prospective, single-arm study of patients in intensive care units at two US hospitals who required EFTs. The primary outcome was appropriate placement of EFTs without occurrence of guidance-related adverse events (AEs), as confirmed by both EMTS and radiography. Secondary outcomes were reconfirmation of the EFT tip location at a follow-up visit using the EMTS compared with radiography, tube retrograde migration from initial location and AEs. RESULTS Sixty-five patients were included in the intent-to-treat analysis. EFTs were successfully placed in 57 patients. In eight patients, placement was unsuccessful due to anatomic abnormalities. According to both the EMTS and radiography, no lung placements occurred. No pneumothoraces were reported, nor any guidance-related AEs. Precise agreement of tube tip location was achieved between the EMTS evaluations and radiographs for 56 of the 58 (96.5%) successful placements (one patient had two placements). Tube tip location was re-confirmed 12-49 hours after EFT insertion by the EMTS and radiographs in 48 patients (84%). For 43/48 patients (89.5%), full agreement between the EMTS and radiography evaluations was observed. For the five remaining patients, the misalignment between the evaluations was within the gastrointestinal tract. Retrograde migration from the initial location was observed in 4/49 patients (8%). CONCLUSION A novel electromagnetic system demonstrated feasibility and safety of real-time and follow-up tracking of EFT placement into the stomach and small intestine, as confirmed by radiographs. No inadvertent placements into the lungs were documented. LEVEL OF EVIDENCE Level V (large case series).
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Affiliation(s)
- Lewis E Jacobson
- Trauma Department, St. Vincent Indianapolis Hospital, Indianapolis, Indiana, USA
| | - May Olayan
- Center for Human Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jamie M Williams
- Trauma Department, St. Vincent Indianapolis Hospital, Indianapolis, Indiana, USA
| | - Jacqueline F Schultz
- Trauma Department, St. Vincent Indianapolis Hospital, Indianapolis, Indiana, USA
| | - Hannah M Wise
- Trauma Department, St. Vincent Indianapolis Hospital, Indianapolis, Indiana, USA
| | - Amandeep Singh
- Center for Human Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jonathan M Saxe
- Trauma Department, St. Vincent Indianapolis Hospital, Indianapolis, Indiana, USA
| | - Richard Benjamin
- Center for Human Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marie Emery
- Center for Human Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | - Hilary Vilem
- Center for Human Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
| | - Donald F Kirby
- Center for Human Nutrition, Cleveland Clinic, Cleveland, Ohio, USA
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25
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Killian M, Reeve NE, Slivinski A, Bradford JY, Horigan A, Barnason S, Foley A, Johnson M, Kaiser J, MacPherson-Dias R, Proehl JA, Stapleton SJ, Valdez AM, Vanhoy MA, Zaleski ME, Gillespie G, Proehl JA, Bishop-Royse J, Wolf L, Delao A, Gates L. Clinical Practice Guideline: Gastric Tube Placement Verification. J Emerg Nurs 2019; 45:306.e1-306.e19. [PMID: 31056115 DOI: 10.1016/j.jen.2019.03.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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26
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Metheny NA, Krieger MM, Healey F, Meert KL. A review of guidelines to distinguish between gastric and pulmonary placement of nasogastric tubes. Heart Lung 2019; 48:226-235. [PMID: 30665700 DOI: 10.1016/j.hrtlng.2019.01.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 01/17/2023]
Abstract
The purpose of this review was to (1) identify areas of agreement and disagreement in guidelines/recommendations to distinguish between gastric and pulmonary placement of nasogastric tube and (2) summarize factors that affect choices made by clinicians regarding which method(s) to use in specific situations. Systematic searches were conducted in the PubMed, Scopus, and CINAHL Plus databases using a combination of keywords and data-specific subject headings. Searches were limited to guidelines/recommendations from national level specialty groups and governmental sources published in the English language between January 1, 2015 and September 20, 2018. Fourteen guidelines that described methods to distinguish between gastric and pulmonary placement of nasogastric tubes were identified from a variety of geographic locations. Tube placement testing methods included in the review were: radiography, respiratory distress, aspirate appearance, aspirate pH, auscultation, carbon dioxide detection and enteral access devices. All fourteen guidelines agreed that radiography is the most accurate testing method. Of the nonradiographic methods, pH testing was most favored; least favored was auscultation.
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Affiliation(s)
- Norma A Metheny
- St. Louis University School of Nursing, 3525 Caroline Mall, St. Louis, MO 63104, USA.
| | - Mary M Krieger
- St. Louis University School of Nursing, 3525 Caroline Mall, St. Louis, MO 63104, USA.
| | - Frances Healey
- National Health Services, Wellington House, 133-155 Waterloo Road, London SE1 8UG, United Kingdom.
| | - Kathleen L Meert
- Childrens Hospital, Wayne State University, 3901 Beaubien Street, Detroit, MI, USA.
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27
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Pediatric Nasogastric Tubes in the Home: Recommendations for Practice. Home Healthc Now 2018; 36:148-153. [PMID: 29722704 DOI: 10.1097/nhh.0000000000000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
One of the dilemmas facing home healthcare nurses is the placement of a nasogastric tube (NGT) in the home setting coupled with being assured and confident that the NGT tip is in the correct position, that is, the stomach. There are very limited data to address the issue of management of an NGT in the home care setting with even less guidance for the pediatric population. Therefore, home healthcare nurses must use agency policy and procedures coupled with their own education, knowledge, experience, and skills when performing this procedure. These may vary from agency to agency, thus providing inconsistencies in teaching and techniques.
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28
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Irving SY, Rempel G, Lyman B, Sevilla WMA, Northington L, Guenter P. Pediatric Nasogastric Tube Placement and Verification: Best Practice Recommendations From the NOVEL Project. Nutr Clin Pract 2018; 33:921-927. [PMID: 30187517 DOI: 10.1002/ncp.10189] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The placement of a nasogastric tube (NGT) in a pediatric patient is a common practice that is generally perceived as a benign bedside procedure. There is potential risk for NGT misplacement with each insertion. A misplaced NGT compromises patient safety, increasing the risk for serious and even fatal complications. There is no standardized method for verification of the initial NGT placement or reverification assessment of NGT location prior to use. Measurement of the acidity or pH of the gastric aspirate is the most frequently used evidence-based method to verify NGT placement. The radiograph, when properly obtained and interpreted, is considered the gold standard to verify NGT location. However, the uncertainty regarding cumulative radiation exposure related to radiographs in pediatric patients is a concern. To minimize risk and improve patient safety, there is a need to identify best practice and to standardize care for initial and ongoing NGT location verification. This article provides consensus recommendations for best practice related to NGT location verification in pediatric patients. These consensus recommendations are not intended as absolute policy statements; instead, they are intended to supplement but not replace professional training and judgment. These consensus recommendations have been approved by the American Society for Parental and Enteral Nutrition (ASPEN) Board of Directors.
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Affiliation(s)
- Sharon Y Irving
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.,Department of Critical Care Nursing, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Gina Rempel
- Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.,Children's Hospital Winnipeg, Winnipeg, Manitoba, Canada
| | - Beth Lyman
- Nutrition Support Team, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Wednesday Marie A Sevilla
- Division of Pediatric Gastroenterology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - LaDonna Northington
- University of Mississippi Medical Center School of Nursing, Jackson, Mississippi, USA
| | - Peggi Guenter
- Clinical Practice, Quality, and Advocacy, American Society for Parenteral and Enteral Nutrition (ASPEN), Silver Spring, Maryland, USA
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29
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Abidali A, Mangram A, Shirah GR, Wilson W, Abidali A, Moeser P, Dzandu JK. Bilateral Pneumothoraces in a Trauma Patient After Dobhoff Tube Insertion. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:244-248. [PMID: 29503437 PMCID: PMC5850843 DOI: 10.12659/ajcr.906846] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Patient: Male, 74 Final Diagnosis: Pneumothorax Symptoms: Hypoxemia • shortness of breath Medication: — Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
- Ali Abidali
- Department of General Surgery, HonorHealth John C. Lincoln Medical Center, Phoenix, AZ, USA
| | - Alicia Mangram
- Department of General Surgery, HonorHealth John C. Lincoln Medical Center, Phoenix, AZ, USA.,Department of Trauma Surgery, HonorHealth John C. Lincoln Medical Center, Phoenix, AZ, USA
| | - Gina R Shirah
- Department of General Surgery, HonorHealth John C. Lincoln Medical Center, Phoenix, AZ, USA.,Department of Trauma Surgery, HonorHealth John C. Lincoln Medical Center, Phoenix, AZ, USA
| | - Whitney Wilson
- Department of General Surgery, HonorHealth John C. Lincoln Medical Center, Phoenix, AZ, USA
| | - Ahmed Abidali
- New College of Interdisciplinary Arts and Sciences, Arizona State University, Glendale, AZ, USA
| | - Phillip Moeser
- Medical Diagnostic Imaging Group, HonorHealth John C. Lincoln Medical Center, Phoenix, AZ, USA
| | - James K Dzandu
- Department of General Surgery, HonorHealth John C. Lincoln Medical Center, Phoenix, AZ, USA.,Department of Trauma Surgery, HonorHealth John C. Lincoln Medical Center, Phoenix, AZ, USA
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30
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Mandal M, Karmakar A, Basu SR. Nasogastric tube insertion in anaesthetised, intubated adult patients: A comparison between three techniques. Indian J Anaesth 2018; 62:609-615. [PMID: 30166656 PMCID: PMC6100283 DOI: 10.4103/ija.ija_342_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background and Aims: The existence of several methods for proper placement of nasogastric tube (NGT) and introduction of various novel methods day-by-day indicates that no method is perfect or universally accepted. However, the quest for the best is still on. Application of cold in various forms to stiffen the NGT has been tested inconsistently over the last three decades. In the recent past, frozen NGT has been compared only with conventional methods. Hence, the present study was designed to evaluate the efficacy of the frozen technique in comparison with conventional and reverse Sellick's manoeuvre. Methods: A total of 195 adult patients undergoing abdominal surgeries in anaesthetised and intubated state requiring NGT insertion were allocated to three groups to have their NGT placement using either the conventional method (Group A) or using frozen NGT (Group B) or applying reverse Sellick's manoeuvre (Group C). The number of successful placements of NGT within two attempts, procedure time, and incidences of adverse events were noted. Results: The highest success rate regarding the successful placement of NGT was observed using reverse Sellick's manoeuvre (95.2%), closely followed by the frozen NGT technique (84.6%) in comparison with conventional method (69.2%). The procedure time was the least with reverse Sellick's manoeuvre (31.5 ± 9.5 s) compared with conventional (42.2 ± 21.4 s) and frozen technique (42.1 ± 13.2 s). Conclusion: Nasogastric tube insertion using reverse Sellick's manoeuvre shows the highest success rate and having the least adverse events among the compared three methods in anaesthetised, intubated adult patients.
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Affiliation(s)
- Mohanchandra Mandal
- Department of Anaesthesiology, N.R.S. Medical College, Kolkata, West Bengal, India
| | - Anirban Karmakar
- Department of Anaesthesiology, Siliguri District Hospital, Siliguri, West Bengal, India
| | - Sekhar Ranjan Basu
- Department of Anaesthesiology, North Bengal Medical College, Siliguri, West Bengal, India
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31
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Abstract
Critically ill patients have increased metabolic requirements and must rely on the administration of nutritional therapy to meet those demands. Yet, according to research almost half of all hospitalized patients are not fed, are underfed, or are malnourished while in the hospital. This article demonstrates the importance of early feedings in critical care unit, and the available options open to nurses supporting initiation and management of early feedings. Enteral nutrition has proven to be an important therapeutic strategy for improving the outcomes of critically ill patients and the critical care nurse plays an integral role in their success.
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Affiliation(s)
- Teresa D Welch
- Capstone College of Nursing, The University of Alabama, Box 870358, 601 University Boulevard East, Tuscaloosa, AL 35401, USA.
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32
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Metheny NA, Pawluszka A, Lulic M, Hinyard LJ, Meert KL. Testing Placement of Gastric Feeding Tubes in Infants. Am J Crit Care 2017; 26:466-473. [PMID: 29092869 DOI: 10.4037/ajcc2017378] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Inadvertent positioning of a nasogastric tube in the lung can cause serious complications, so identifying methods to detect improperly inserted tubes is imperative. OBJECTIVES To compare the sensitivity, specificity, and negative and positive predictive values of 4 pH cut points (< 4.0, < 4.5, < 5.0, and < 5.5) in differentiating gastric and tracheal aspirates under various treatment conditions and to explore the utility of a pepsin assay for distinguishing between gastric and tracheal aspirates. METHODS Gastric and tracheal aspirates were collected from critically ill infants undergoing mechanical ventilation who had nasogastric or orogastric feeding tubes. Aspirates were tested with colorimetric pH indicators and a rapid pepsin assay. Information about treatment conditions was obtained from medical records. RESULTS Two hundred twelve gastric aspirates and 60 tracheal aspirates were collected from 212 patients. Sensitivity was highest and specificity was lowest at the gastric aspirate pH cut point of less than 5.5. Positive predictive values were 100% at all pH cut points less than 5.0. Negative predictive values were higher at the pH cut point of less than 5.0 than at cut points less than 4.5. A higher percentage of pepsin-positive readings was found in gastric aspirates (88.3%) than in tracheal aspirates (5.4%). CONCLUSION For a desired positive predictive value of 100%, a pH cut point of less than 5.0 provides the best negative predictive values, regardless of gastric acid inhibitor administration and feeding status. The pepsin assay is promising as an additional marker to distinguish gastric from tracheal aspirates.
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Affiliation(s)
- Norma A. Metheny
- Norma A. Metheny is a professor of nursing at Saint Louis University, St Louis, Missouri. Ann Pawluszka is a research coordinator, Melanie Lulic is a research assistant, and Kathleen L. Meert is a professor of pediatrics and chief of critical care medicine at the Children’s Hospital of Michigan, Wayne State University, Detroit, Michigan. Leslie J. Hinyard is an associate professor and associate director for academic affairs at the Center for Health Outcomes Research, Saint Louis University
| | - Ann Pawluszka
- Norma A. Metheny is a professor of nursing at Saint Louis University, St Louis, Missouri. Ann Pawluszka is a research coordinator, Melanie Lulic is a research assistant, and Kathleen L. Meert is a professor of pediatrics and chief of critical care medicine at the Children’s Hospital of Michigan, Wayne State University, Detroit, Michigan. Leslie J. Hinyard is an associate professor and associate director for academic affairs at the Center for Health Outcomes Research, Saint Louis University
| | - Melanie Lulic
- Norma A. Metheny is a professor of nursing at Saint Louis University, St Louis, Missouri. Ann Pawluszka is a research coordinator, Melanie Lulic is a research assistant, and Kathleen L. Meert is a professor of pediatrics and chief of critical care medicine at the Children’s Hospital of Michigan, Wayne State University, Detroit, Michigan. Leslie J. Hinyard is an associate professor and associate director for academic affairs at the Center for Health Outcomes Research, Saint Louis University
| | - Leslie J. Hinyard
- Norma A. Metheny is a professor of nursing at Saint Louis University, St Louis, Missouri. Ann Pawluszka is a research coordinator, Melanie Lulic is a research assistant, and Kathleen L. Meert is a professor of pediatrics and chief of critical care medicine at the Children’s Hospital of Michigan, Wayne State University, Detroit, Michigan. Leslie J. Hinyard is an associate professor and associate director for academic affairs at the Center for Health Outcomes Research, Saint Louis University
| | - Kathleen L. Meert
- Norma A. Metheny is a professor of nursing at Saint Louis University, St Louis, Missouri. Ann Pawluszka is a research coordinator, Melanie Lulic is a research assistant, and Kathleen L. Meert is a professor of pediatrics and chief of critical care medicine at the Children’s Hospital of Michigan, Wayne State University, Detroit, Michigan. Leslie J. Hinyard is an associate professor and associate director for academic affairs at the Center for Health Outcomes Research, Saint Louis University
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Dias FDSB, Emidio SCD, Lopes MHBDM, Shimo AKK, Beck ARM, Carmona EV. Procedures for measuring and verifying gastric tube placement in newborns: an integrative review. Rev Lat Am Enfermagem 2017; 25:e2908. [PMID: 28699995 PMCID: PMC5511002 DOI: 10.1590/1518-8345.1841.2908] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 04/06/2017] [Indexed: 11/21/2022] Open
Abstract
Objective: to investigate evidence in the literature on procedures for measuring gastric tube
insertion in newborns and verifying its placement, using alternative procedures to
radiological examination. Method: an integrative review of the literature carried out in the Cochrane, LILACS,
CINAHL, EMBASE, MEDLINE and Scopus databases using the descriptors “Intubation,
gastrointestinal” and “newborns” in original articles. Results: seventeen publications were included and categorized as “measuring method” or
“technique for verifying placement”. Regarding measuring methods, the measurements
of two morphological distances and the application of two formulas, one based on
weight and another based on height, were found. Regarding the techniques for
assessing placement, the following were found: electromagnetic tracing, diaphragm
electrical activity, CO2 detection, indigo carmine solution,
epigastrium auscultation, gastric secretion aspiration, color inspection, and
evaluation of pH, enzymes and bilirubin. Conclusion: the measuring method using nose to earlobe to a point midway between the xiphoid
process and the umbilicus measurement presents the best evidence. Equations based
on weight and height need to be experimentally tested. The return of secretion
into the tube aspiration, color assessment and secretion pH are reliable
indicators to identify gastric tube placement, and are the currently indicated
techniques.
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Affiliation(s)
| | - Suellen Cristina Dias Emidio
- Doctoral student, Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas, SP, Brazil. Scholarship holder at Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | | | | | - Ana Raquel Medeiros Beck
- PhD, Professor, Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Elenice Valentim Carmona
- PhD, Professor, Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas, SP, Brazil
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