Factors associated with mechanical device-related complications in tube fed patients: A multicenter prospective cohort study

Abstract

Aims To identify the types of nasogastric/nasoenteric tube (NGT/NET)-related adverse events and to analyze the degree of harm and the factors associated with mechanical device-related complications. Materials and methods A prospective cohort study was conducted from October 2017 to April 2019 in seven Brazilian hospitals. Data from 447 adult patients with NGT/NET were collected through electronic forms. Three methods were used to assess the NGT/NET-related adverse events: (1) encouraging spontaneous reports; (2) regular visits to the wards; and (3) review of medical records. The events were classified as mechanical device-related complications and other events. The degree of harm was classified according to the World Health Organization’s International Classification for Patient Safety. Data were analyzed using the R program, version 3.5.3. The following tests were applied to identify associations between the explanatory and response variables: Cochran-Armitage Chi-Square test, Fisher’s exact test, and Linear-by-linear Chi-Square test. Logistic regression analysis was performed to verify the predictors of mechanical device-related complications. All analyses were performed considering a 5% significance level. Results 191 NGT/NET-related adverse events were identified in 116 patients; the majority were mechanical device-related complications and resulted in mild harm to the patient. At the moment of the event, patients had a mean of 3.27 comorbidities, were highly dependent on nursing care, with high risk of death and altered level of consciousness. There was no association between the degree of harm and the care complexity, disease severity or level of consciousness. Intensive care was the strongest predictor for mechanical device-related complications and critical patients had a four times greater likelihood of presenting this type of event when compared to patients receiving minimal care. Conclusion Intensive care patients should receive special attention as the complexity of care is an important predictor for mechanical device-related complications in tube fed patients.

Adverse events in critically ill patients: a cross-sectional study

“…The loss of the enteral tube and accidental extubation are events that occur, most of the time, during the execution of the bed bath performed by the nursing team ( 4 , 17 , 18 , 25 ) . Critically ill patients are four times more likely to have enteral tube-related AEs compared to patients receiving minimal care ( 5 , 25 ) . Thus, the nursing dimensioning shall be adequate to the care need identified in the unit.…”

“…Thus, the nursing dimensioning shall be adequate to the care need identified in the unit. Furthermore, the use of an evidence-based care protocol can help reduce these adverse events ( 2 , 3 , 25 ) .…”

“…PI may have a higher frequency due to the ease of diagnosis, knowledge, and recording by nurses in the clinical record, unlike accidental extubation, fall, and loss of central venous access and enteral tube (15,(17)(18)(19)(20)(21)(22)(23)(24) . The loss of the enteral tube and accidental extubation are events that occur, most of the time, during the execution of the bed bath performed by the nursing team (4,(17)(18)25) . Critically ill patients are four times more likely to have enteral tube-related AEs compared to patients receiving minimal care (5,25) .…”

Continuous enteral protease inhibition as a novel treatment for experimental trauma/hemorrhagic shock

“…This poses two significant challenges to the development of a safe infusion protocol: optimizing the delivery rate depending on the site of placement of the infusion tube (post-vs. pre-pyloric), and minimizing and preventing retrograde flow from the stomach into the esophagus, which could result in aspiration into the airways and subsequent pneumonia/pneumonitis [20][21][22]. The latter is still to date one of the most significant risks related to enteral feeding of critically ill patients, which motivates the need for novel technologies to monitor the placement of the enteral feeding tube and prevent and control reflux [23][24][25]. Thus, the protocol was optimized with the goal of minimizing (and possibly eliminating) the possibility of reflux from the intestine and stomach into the esophagus.…”

Impact of a quality improvement programme on the preparation and administration of medications via a nasoenteral feeding tube: 2014–2019 intervention study

“…1 A multicentre survey conducted in seven hospitals across four regions of Brazil found that accidental loss and tube obstruction were the most common mechanical incidents in adult patients receiving enteral nutrition. 2 These incidents are often attributed to professionals' lack of knowledge about best practices in dose preparation and administration, as well as inadequate training and equipment for correct medication preparation. 3 Reducing tube obstruction rates should be a priority for healthcare institutions, as such incidents increase costs and the risk of negative outcomes for patients.…”