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Liang WL, Ma MZ, Min XH, Ouyang X, Liu J, Wu HH, Zhan CX, Li XM. Application and effectiveness of an improved endoscopically guided nasojejunal tube placement technique in critically ill patients: a retrospective cohort study. Transl Gastroenterol Hepatol 2023; 8:36. [PMID: 38021364 PMCID: PMC10643211 DOI: 10.21037/tgh-23-87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background The endoscopic nasojejunal (NJ) placement plays a pivotal role in the nutritional support of critically ill patients. However, the conventional endoscopy-guided tube insertion method presents issues of excessive procedural duration. We have enhanced the traditional endoscopy-guided catheter placement method, enabling a faster and more convenient catheter insertion. Methods We improved the traditional endoscopically guided technique by incorporating an extra silk thread knot at the 25 cm mark on the jejunal segment of the NJ tube to assist endoscopists in accurate tube placement. We conducted the improved NJ tube placement on critically ill patients in need of enteral nutrition (EN). Laboratory data were retrospectively collected before and after the 7-day period of NJ tube placement and EN treatment to evaluate the effectiveness and safety of the improved method. Results A total of 88 critically ill patients, with an average age of 59.6±15.5 years, and a male ratio of 86.4%, who underwent the improved NJ tube placement method were enrolled into analysis finally, achieving a 100% success rate of NJ tube insertion. The average time for tube insertion was 5.9±2.2 min, with a mean insertion depth of 108.8±12.5 cm. The EN tolerance score was 0.79±0.98. Following 7 days of EN therapy, the patients showed significant improvement in serum albumin levels compared to baseline (36.42 vs. 33.66 g/L, P<0.001). Conclusions The improved endoscopically guided NJ tube placement technique is a rapid and safe procedure with excellent patient tolerance. It significantly improves the nutritional status of critically ill patients and facilitates the administration of EN, which requires further validation through randomized controlled trials.
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Affiliation(s)
- Wei-Ling Liang
- Department of Gastroenterology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ming-Zhe Ma
- Department of Gastroenterology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao-Hui Min
- Department of Gastroenterology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xia Ouyang
- Department of Nursing, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jie Liu
- Department of Gastroenterology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hai-Hua Wu
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chun-Xia Zhan
- Department of Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiao-Mei Li
- Department of Gastroenterology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Chen Y, Tian X, Liu C, Zhang L, Xv Y, Xv S. Application of visual placement of a nasojejunal indwelling feeding tube in intensive care unit patients receiving mechanical ventilation. Front Med (Lausanne) 2022; 9:1022815. [PMID: 36482910 PMCID: PMC9722953 DOI: 10.3389/fmed.2022.1022815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/07/2022] [Indexed: 11/23/2022] Open
Abstract
Background Compared with nasogastric nutrition, nasojejunal nutrition may prevent some complications of critically ill patients by maintaining better nutritional status, and blind placement of nasojejunal dwelling feeding tubes is widely used. However, the visual placement seems to be safer and more effective than the blind placement, and is still seldom reported. Objective We tried to develop visual placement of a nasojejunal feeding tube in intensive care unit patients. Methods A total of 122 patients receiving mechanical ventilation were admitted to the Department of Critical Care Medicine of the Fifth Affiliated Hospital of Wenzhou Medical University and received the placement of nasojejunal feeding tubes. These patients were randomly and evenly assigned into two groups, one group receiving visual placement of nasojejunal dwelling feeding tubes and another group receiving blind placement. Actual tube placement was confirmed by X-ray. The primary outcome included the success rates of first placement of feeding tubes. The secondary outcome included the time of tube placement, complications, the total cost, heart rates and respiratory rates. Results The primary outcome showed that the success rates of first placement were 96.70% (59 cases/61 cases) in the visual placement group, and two cases failed due to pyloric stenosis and gastroparesis. The success rates were 83.6% (51 cases/61 cases) in the blind placement group and 10 cases failed due to either wrong placement or retrograde tube migration. The success rates in the visual placement group were higher than that in the blind placement group (P = 0.015). The secondary outcome showed that the time of tube placement in the visual placement group was shorter than that in the blind placement group (P < 0.0001). The cost of tube placement in the visual placement group was higher than that in the blind placement group (P < 0.0001). The statistical differences in complications, heart and respiratory rates were insignificant between the two groups (P > 0.05). Conclusion Compared with the blind placement, the visual placement shortened the time of nasojejunal tube placement and increased success rates of first placement. The visual placement was more efficient, easy to operate, safe, and has potential clinical applications.
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Affiliation(s)
- Yuequn Chen
- Department of Intensive Care Unit, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, China
| | - Xin Tian
- Department of Intensive Care Unit, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, China,*Correspondence: Xin Tian
| | - Cheng Liu
- Department of Intensive Care Unit, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, China
| | - Liqin Zhang
- Department of Intensive Care Unit, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, China
| | - Yueyuan Xv
- Department of Digestive Internal Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, China
| | - Shuang Xv
- Department of Equipment Department, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Municipal Central Hospital, Lishui, China
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Bond A, Czapran A, Lal S. Small bowel feeding: do you pay the price for bypassing the stomach? Curr Opin Clin Nutr Metab Care 2022; 25:116-121. [PMID: 34966116 DOI: 10.1097/mco.0000000000000804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Hydration and nutritional support is a vital part of medical care, thus a clear understanding of the optimal approach is vital for medical professionals. This is a particularly pertinent issue for patients admitted to a critical care setting. This article aims to define the advantages and disadvantages of gastric and postpyloric feeding in the critical care setting, thus aiding decision-making for clinicians. RECENT FINDINGS Within the article, the main themes covered are those relating to enteral feeding tube placement, the impact of enteral feeding route on ventilator-associated pneumonia, optimization of enteral tube feeding in critical care and the impact that a chosen route may have upon gastrointestinal function. SUMMARY The value of enteral feeding in critical illness is proven beyond doubt and the simplest approach has long been 'if the gut works, use it'. If gastric feeding is not able to be established or is not tolerated then jejunal feeding should be considered as a preferable alternative to parenteral nutrition. Improving access to service or techniques for postpyloric tube placement would assist in optimizing nutritional support in the critical care setting.
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Affiliation(s)
- Ashley Bond
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford
| | - Adam Czapran
- Department of Critical Care, Kings College NHS Foundation Trust, London
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford
- University of Manchester, Manchester, UK
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Ferraboli SF, Beghetto MG. Bedside ultrasonography for the confirmation of nasogastric tube placement: agreement between nurse and physician. Rev Gaucha Enferm 2022; 43:e20220211. [DOI: 10.1590/1983-1447.2022.20220211.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/15/2022] [Indexed: 11/29/2022] Open
Abstract
ABSTRACT Objective To evaluate the agreement between nurse and physician in verifying the positioning of the nasogastric tube by ultrasonography and describe the difficulties faced by nurse in performing the technique. Method Cross-sectional study conducted in 2021, including critical patients after nasogastric tube insertion who were independently evaluated by a nurse and physician, using bedside ultrasonography. The tube was considered adequately positioned when viewed in infradiaphragmatic location in the topography of the stomach. Results In the 30 peer evaluations there was almost perfect agreement (k = 0.93; 95%CI: 0.65 - 0.99). In only one case the nurse was uncertain about the positioning. Some difficulties were reported: abdominal distention (n=2), gas interposition (n=3) and patient movement during the exam (n=2). Conclusion A trained nurse obtained very similar results to those found by a physician in identifying the nasogastric tube placement by means of ultrasonography, suggesting a reproducible and safe technique.
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Ferraboli SF, Beghetto MG. Ultrassonografia à beira do leito para localização da sonda nasoenteral: concordância entre enfermeiro e médico. Rev Gaucha Enferm 2022. [DOI: 10.1590/1983-1447.2022.20220211.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
RESUMO Objetivo Avaliar a concordância entre enfermeiroe médico na determinação da localizaçãoda sonda enteral por ultrassonografia e descrever as dificuldades encontradas pelo enfermeiro na execução da técnica. Método Estudo transversal, realizado em 2021, incluindo pacientes críticos após a inserção dasondaenteral, avaliados de modo independente por enfermeiro e médico, utilizando ultrassonografia à beira do leito. A sonda foi considerada adequadamente posicionada quando visualizada em posição infradiafragmática na topografia do estômago. Resultados Nos 30 pares de avaliações houve concordância quase perfeita (k = 0,93; IC95%: 0,65 - 0,99). Em apenas um caso houve dúvida do enfermeiro sobre o posicionamento. As dificuldades relatadas foram:distensão abdominal (n=2), interposição de gás (n=3) e movimentação do paciente durante o exame (n=2). Conclusão Um enfermeiro capacitadoobteve resultados semelhantes aos encontrados por um médico na identificação do posicionamento da sondaenteral por meio de ultrassonografia, sugerindo tratar-se de uma técnica reprodutível e segura.
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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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Sun J, Li Q, Wu X, Wang X, Liu D. Nurse-performed ultrasound: a new weapon against COVID-19. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:430. [PMID: 32665002 PMCID: PMC7358560 DOI: 10.1186/s13054-020-03160-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/07/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Jianhua Sun
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Qi Li
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xinjuan Wu
- Nursing Department, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xiaoting Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.
| | - Dawei Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
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Chen CX, Wei ZD, Liu YJ, Cheng SZ, Guan XD. Bedside rapid placement of nasointestinal feeding tube via ultrasound-guided stylet positioning in critical COVID-19 patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:361. [PMID: 32552874 PMCID: PMC7301623 DOI: 10.1186/s13054-020-02990-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/12/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Chuan-Xi Chen
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Zheng-Deng Wei
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Yong-Jun Liu
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Shou-Zhen Cheng
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China
| | - Xiang-Dong Guan
- Department of Critical Care Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, China.
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