Current Practices in Home Management of Nasogastric Tube Placement in Pediatric Patients: A Survey of Parents and Homecare Providers

Northington, LaDonna; Lyman, Beth; Guenter, Peggi; Irving, Sharon Y.; Duesing, Lori

doi:10.1016/j.pedn.2017.01.005

Cited by 23 publications

(23 citation statements)

References 28 publications

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“…One example is miscommunication that can occur among the various providers involved in care (eg, physicians, home health nurses, parents) . Instructions provided to parents on medically complex aspects of care may be inconsistent or misunderstood . Parents may also experience difficulties in carrying out the mechanical aspects of managing medical equipment.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Home Parenteral Nutrition: Indications and Short‐Term Outcomes in a Large National Sample of Commercially Insured Children and Adolescents

Afolabi

Fairman

2018

Nut in Clin Prac

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Background To support families managing the complex requirements of home parenteral nutrition (HPN) in pediatric patients, health professionals need information about HPN indications and complications. Nationally representative information is limited. Methods A retrospective cohort analysis of the Truven Health MarketScan Commercial Claims and Encounters Database was performed and identified 683 patients aged ≤18 years receiving HPN during dates of service from January 2013 through September 2015. Baseline diagnoses were measured in the 30 days before the first observed HPN claim (preindex). Indications for older (aged 13–18 years) and younger (aged ≤12 years) children were compared. Hospital and emergency department (ED) utilization rates were measured for 30 postindex days. Results Gastrointestinal diagnoses and/or symptoms affected more than three‐quarters of patients. Short bowel syndrome was more common in younger than in older patients (24% vs 7%, respectively), and colitis was less common (13% vs 33%; both P < .01). Cancer was common in both age groups (22%–23%). Additional diagnoses indicating complex medical conditions were observed in a minority of patients: sepsis (9%), convulsions/epilepsy (7%), encephalopathy (3%), and immune deficiency (3%). From the preindex to postindex periods, rates of inpatient hospitalization declined from 78% to 41%, but hospital ED visits increased from 10% to 14%. In both periods, >95% of hospital and ED use was disease related. Conclusion In a nationally representative sample of commercially insured pediatric patients treated with HPN, complex medical conditions were common. Findings highlight the importance of American Society for Parenteral and Enteral Nutrition recommendations for team‐based care.

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Section: Discussionmentioning

confidence: 99%

Pediatric Home Parenteral Nutrition: Indications and Short‐Term Outcomes in a Large National Sample of Commercially Insured Children and Adolescents

Afolabi

Fairman

2018

Nut in Clin Prac

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“…For example, nasoenteric tubes (NETs) increase the risk of sinusitis, nasal tissue erosion, reflux, aspiration, and pneumonia when used for longer than 1 month . Although intermittent NET placement by HEN adults using a self‐insertion technique may be preferred by some patients, more frequently competent HCPs place tubes and confirm placement with radiographic tests in adults to avoid inappropriately positioned tubes . Adults and children have the same risks for tube dislodgement; however, blind placement of NETs by registered nurses occurs more frequently in hospitalized children than adults .…”

Section: Mechanical and Infectious Issuesmentioning

confidence: 99%

“…Consequently, routine checks of the GRV are unnecessary and should be avoided. Home methods of clearing a clogged tube include warm water flushes, use of pancreatic enzymes, and bicarbonate or carbonated beverages as a last resort …”

Section: Mechanical and Infectious Issuesmentioning

confidence: 99%

Addressing Frequent Issues of Home Enteral Nutrition Patients

et al. 2019

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The home enteral nutrition (HEN) population is a medically diverse group whose number has increased substantially in recent decades. Although medically stable compared with acute care patients requiring nutrition support, HEN population needs are unique and require a team approach to manage nutrition. Frequently encountered issues by the HEN team include mechanical issues of the tube site, gastrointestinal and metabolic problems, and patient preferences regarding tube weaning, formula selection, and compliance. A thorough search of the published literature on how to manage these issues was conducted using scientific healthcare databases with the following inclusion criteria: English only, last 10 years, and reviews and clinical trials. Where appropriate, references from the retrieved articles were hand‐searched for relevant articles older than 10 years and cited in this review. The purpose of this review is to provide the HEN team with strategies to address the top issues of home enteral feeding.

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“…Another benefit of a TEAD pertains to body image issues for adolescents who may require intermittent nocturnal enteral feedings but do not want a G tube that could possibly be seen by others. A recent study found 8% of children receiving NG feedings at home were 13–18 years old 10 . Placement of a TEAD involves selection of the best tube, accurate estimation of the appropriate insertion length, and the use of evidence‐based placement verification methods.…”

Section: Temporary Enteral Access Devicesmentioning

confidence: 99%

“…Children considered at risk for misplaced TEAD include neonates, neurologically impaired children, and sedated, critically ill children 9 . The home care study previously cited by Northington et al 10 found that 28% of caregivers reported inadvertently misplacing an NG tube in their child, with many of those placements likely being pulmonary based on written descriptions by parents about how they knew the tube was misplaced. Investigators did not ask if the child received formula via the misplaced tube.…”

Section: Temporary Enteral Access Devicesmentioning

confidence: 99%

Pediatric Enteral Access Device Management

2016

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Enteral nutrition (EN) support has proven to be a nutrition intervention that can provide full or partial calories to promote growth and development in infants and children. To supply these nutrients, an enteral access device is required, and the use of these devices is growing. Placement of the proper device for the patient need, along with appropriate care and monitoring, is required for individualized patient management. When complications arise, early identification and management can prevent more serious morbidity. Complication management requires a tiered approach starting with staff nurses and ending with a physician expert. In addition to this, each institution needs to have an approach that is coordinated among disciplines and departments to promote consistency of practice. The formation of an enteral access team is a conduit for clinical experts to provide education to families, patients, and healthcare professionals while serving as a platform to address product and practice issues.

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Current Practices in Home Management of Nasogastric Tube Placement in Pediatric Patients: A Survey of Parents and Homecare Providers

Cited by 23 publications

References 28 publications

Pediatric Home Parenteral Nutrition: Indications and Short‐Term Outcomes in a Large National Sample of Commercially Insured Children and Adolescents

Pediatric Home Parenteral Nutrition: Indications and Short‐Term Outcomes in a Large National Sample of Commercially Insured Children and Adolescents

Addressing Frequent Issues of Home Enteral Nutrition Patients

Pediatric Enteral Access Device Management

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