Devices and Techniques for Bedside Enteral Feeding Tube Placement

Roberts, Susan; Echeverria, Pamela; Gabriel, Sabrey A.

doi:10.1177/0115426507022004412

Cited by 39 publications

(59 citation statements)

References 33 publications

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“…Alternatives to blind placement include nurse-driven methods such as the colorimetric carbon dioxide detector, the magnetically guided feeding tube, and the electromagnetic placement device. 56 The colorimetric device is used to detect the presence or absence of carbon dioxide, allowing the clinician to determine gastric versus lung placement of the feeding tube. 56 The magnetically guided feeding tube uses a magnetic device to lead the feeding tube through the gastrointestinal tract into the intestine and has been used successfully to ensure postpyloric placement.…”

Section: Consideration Of Postpyloric Feeding Accessmentioning

confidence: 99%

Interruptions in Enteral Nutrition Delivery in Critically Ill Patients and Recommendations for Clinical Practice

Stewart

2014

Critical Care Nurse

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M alnutrition results when nutritional intake does not meet metabolic requirements. Critically ill patients are at an increased risk for malnutrition because of alterations in protein and energy metabolism displayed in response to trauma, major surgery, burns, and sepsis 1 and may be unable to tolerate oral nutrition. Critical care nurses are well positioned to screen patients at risk for malnutrition and to work in conjunction with the multidisciplinary team to develop and implement interventions to prevent and treat malnutrition. Interruptions in Enteral Nutrition Delivery in Critically Ill Patients and Recommendations for Clinical Practice MELISSA L. STEWART, RN, DNP, MSN, CCNS, CCRNThis article has been designated for CNE credit. A closed-book, multiple-choice examination follows this article, which tests your knowledge of the following objectives:1. List consequences of malnutrition in critically ill patients 2. Discuss how current nursing routines may contribute to interruptions in enteral nutrition in critically ill patients 3. Describe nursing interventions to improve the delivery of nutrition to critically ill patients CNE Continuing Nursing EducationCover Malnutrition is common in critically ill patients and is associated with poor outcomes for patients and increased health care spending. Enteral nutrition is the method of choice for nutrition delivery. Enteral nutrition delivery practices vary widely, and underfeeding is widespread in critical care. Interruptions in enteral nutrition due to performance of procedures, positioning, technical issues with feeding accesses, and gastrointestinal intolerance contribute to underfeeding. Strategies such as head-of-bed positioning, use of prokinetic agents, tolerance of higher gastric residual volumes, consideration of postpyloric feeding access, and use of a nutrition support protocol may decrease time spent without nutrition. (Critical Care Nurse.

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Section: Consideration Of Postpyloric Feeding Accessmentioning

confidence: 99%

Interruptions in Enteral Nutrition Delivery in Critically Ill Patients and Recommendations for Clinical Practice

Stewart

2014

Critical Care Nurse

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“…Various methods have been sought in order to confirm the position of the tube. 10,11 Relying on cough reflex is not recommended for patients who are either sedated or intubated for they are likely to have decreased or absent cough reflexes. 12 Visual inspection of aspirate, palpation of the epigastrium, and auscultation during air insufflation are all unreliable methods.…”

Section: Blind Bedside Placement Of Feeding Tubesmentioning

confidence: 99%

“…3,9 Transnasal feeding tubes can be placed blindly at the bedside which makes it suitable for critically ill patients who are often restrained to numerous monitoring devices or under ventilator care. 7,10,11 However, blind placement of nasogastric or nasojejunal feeding tubes is unreliable and not free from complications. [12][13][14][15] In this regard, various modalities for guidance from fluoroscopy to endoscopy have been introduced in the literature.…”

Section: Introductionmentioning

confidence: 99%

Placement of feeding tubes using fluoroscopy guidance and over-the-wire technique: A technical review

Kim

Shin

2017

Int J Gastrointest Interv

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Nutritional support is essential for improving the outcome in critically ill patients. Enteral nutrition possesses advantages over total parenteral nutrition in that it maintains the physiologic barrier function of the gastrointestinal mucosa. Short-term enteral nutrition can be achieved through transnasal feeding tubes. Traditionally, feeding tubes have been placed at bedside in a blind fashion. However, blind tube placement is unreliable as it may result in improper positioning of the tubes. Numerous complications arising from misplacement have been reported in the literature. A number of modalities may be used in order to improve the accuracy and safety of transnasal feeding tube placement. Fluoroscopy is widely accepted for this purpose. Together with the use of water-soluble contrast media and over-the-wire technique, fluoroscopy-guided placement of nasogastric or nasojejunal feeding tubes offers a higher rate of technical success while decreasing procedure time as well as the incidence of procedure-related complications.

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“…32,34,35 Submergence Submerging the open end of the NG-EAD in water and observing for bubbles synchronous with expiratory respiration is a bedside verification technique sometimes used in adults. 37 The submergence method may be helpful to determine tracheal placement if rhythmic bubbling is observed; however, the absence of bubbling does not ensure gastric location. Therefore, submergence is not considered an efficient, reliable method of verifying NG-EAD location.…”

mentioning

confidence: 99%

“…Therefore, submergence is not considered an efficient, reliable method of verifying NG-EAD location. 37,38 In addition, the tube submersion method may increase the risk for aspiration with the patient's inspiration and is therefore not recommended.…”

mentioning

confidence: 99%

Nasogastric Tube Placement and Verification in Children: Review of the Current Literature

Irving¹,

Lyman

Northington

et al. 2014

Critical Care Nurse

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Placement of a nasogastric enteral access device (NG-EAD), often referred to as a nasogastric tube, is common practice and largely in the domain of nursing care. Most often an NG-EAD is placed at the bedside without radiographic assistance. Correct initial placement and ongoing location verification are the primary challenges surrounding NG-EAD use and have implications for patient safety. Although considered an innocuous procedure, placement of an NG-EAD carries risk of serious and potentially lethal complications. Despite acknowledgment that an abdominal radiograph is the gold standard, other methods of verifying placement location are widely used and have success rates from 80% to 85%. The long-standing challenges surrounding bedside placement of NG-EADs and a practice alert issued by the Child Health Patient Safety Organization on this issue were the stimuli for the conception of The New Opportunities for Verification of Enteral Tube Location Project sponsored by the American Society for Parenteral and Enteral Nutrition. Its mission is to identify and promote best practices with the potential of technology development that will enable accurate determination of NG-EAD placement for both the inpatient and outpatient pediatric populations. This article presents the challenges of bedside NG-EAD placement and ongoing location verification in children through an overview of the current state of the science. It is important for all health care professionals to be knowledgeable about the current literature, to be vigilant for possible complications, and to avoid complacency with NG-EAD placement and ongoing verification of tube location.

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Devices and Techniques for Bedside Enteral Feeding Tube Placement

Cited by 39 publications

References 33 publications

Interruptions in Enteral Nutrition Delivery in Critically Ill Patients and Recommendations for Clinical Practice

Interruptions in Enteral Nutrition Delivery in Critically Ill Patients and Recommendations for Clinical Practice

Placement of feeding tubes using fluoroscopy guidance and over-the-wire technique: A technical review

Nasogastric Tube Placement and Verification in Children: Review of the Current Literature

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