Post‐pyloric feeding tube placement in critically ill patients: Extending the scope of practice for Australian dietitians

Yandell, Rosalie; Chapman, Marianne J.; O’Connor, Stephanie; Shanks, Alison; Lange, Kylie; Deane, Adam M.

doi:10.1111/1747-0080.12362

Cited by 9 publications

(19 citation statements)

References 23 publications

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“…Suitably skilled and experienced ICU dietitians, in the UK and internationally, can safely and successfully insert post-pyloric feeding tubes in these patients along with performing indirect calorimetry to enhance the nutrition assessment of the patient. 23,24 Leading international critical care dietitians are helping shape the evidence base for critical care nutrition by contributing to large multicentre nutritional trials such as the CALORIES trial 12 and international nutrition support guidelines. 11,25 Future for dietitians in critical care…”

Section: Current Impact Of the Critical Care Dietitianmentioning

confidence: 99%

The role of dietitians in critical care

Terblanche

2018

Journal of the Intensive Care Society

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Section: Current Impact Of the Critical Care Dietitianmentioning

confidence: 99%

The role of dietitians in critical care

Terblanche

2018

Journal of the Intensive Care Society

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“…Patients were admitted to the operative theater 2 (1-3) times during their ICU admission, with no difference in duration of operative-theater stay between the groups: .506 Received RRT, n (%) 6 ( 10) 2 ( 7) 4 (14) .424 Sepsis, n (%) 11 ( 19) 8 ( 27) 3 (10) .181 Pneumonia, n (%) 13 ( 22) 8 ( 27) 5 (17) .532 VAP specific, n (%) 13 ( 22) 8 ( 27) 5 (17) .…”

Section: Medical Therapymentioning

confidence: 99%

“…9 In critically ill patients with major burns, the preferred method of nutrient administration is via the enteral route. 8,10,11 Along with the decreased cost, compared with parenteral nutrition (PN), 11,12 the benefits of enteral nutrition (EN) include an improved immune response, the potential suppression of the hypermetabolic response, and the minimization of sepsis, 2,8,[11][12][13][14] all of which contribute to reduced mortality and hospital length of stay. 2,12 A systematic review and meta-analysis of 7 randomized controlled trials comprising 527 patients with major burns (>20% total body surface area [TBSA]) revealed that early feeding (≤24 hours after burn injury) was significantly associated with reduced mortality and clinical complications, such as rates of wound infection and protein catabolism.…”

Section: Introductionmentioning

confidence: 99%

“…A potential strategy to overcome delayed gastric emptying is to bypass the stomach altogether. 8,14 Postpyloric feeding has been shown to be a safe and effective way to reduce nutrition deficits and has a gut-protective effect in regard to oxygen balance of the splanchnic region. 4,21,22 However, it is suspected that delaying the insertion of postpyloric tubes (PPTs) until the point at which GI dysmotility has developed is more likely to result in insertion failure.…”

Section: Introductionmentioning

confidence: 99%

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Nutrition and Gastrointestinal Dysmotility in Critically Ill Burn Patients: A Retrospective Observational Study

Sierp

Kurmis

Lange

et al. 2020

J Parenter Enteral Nutr

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Background Gastrointestinal (GI) dysmotility impedes nutrient delivery in critically ill patients with major burns. We aimed to quantify the incidence, timing, and factors associated with GI dysmotility and subsequent nutrition delivery. Methods A 10‐year retrospective observational study included mechanically ventilated, adult, critically ill patients with ≥15% total body surface area (TBSA) burns receiving nutrition support. Patients with a single gastric residual volume ≥250 mL were categorized as having GI dysmotility. Daily medical and nutrition data were extracted for ≤14 days in the intensive care unit (ICU). Data are mean (SD) or median (interquartile range). Factors associated with GI dysmotility and the effect on nutrition and clinical outcomes were assessed. Results Fifty‐nine patients were eligible; 51% (n = 30) with GI dysmotility and 49% (n = 29) without. Baseline characteristics (dysmotility vs no dysmotility) were age (48 [33–60] vs 34 [26–46] years); Acute Physiology and Chronic Health Evaluation II score (16 [12–17] vs 13 [10–16]); sex ([men] 80% vs 86%); and TBSA (49% [35%–59%] vs 38% [26%–55%]). Older age was associated with increased probability of dysmotility (P = .049). GI dysmotility occurred 32 (19–63) hours after ICU admission but was not associated with reduced nutrient delivery. Postpyloric tube insertions were attempted in 83% (n = 25) of patients, with 72% (n = 18) being successful. Postpyloric feeding achieved higher nutrition adequacy than gastric feeding (energy: 82% [95% CI, 70–94] vs 68% [95% CI, 63–74], P = .036; protein: 75% [95% CI, 65–86] vs 61% [95% CI, 56–65], P = .009). Conclusion GI dysmotility occurs early in critically ill burn patients, and postpyloric feeding improves nutrition delivery.

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“…The Australian dietetics profession has been active in this space over recent years and the number of advanced and extended practice roles and procedures introduced into the Australian health‐care setting continues to slowly grow. Published examples of the successful introduction of novel advanced and extended practice roles include a dietitian‐led gastroenterology clinic service, post‐pyloric feeding tube placement in critically ill patients, and dysphagia screening and intervention …”

Section: Introductionmentioning

confidence: 99%

Introducing novel advanced practice roles into the health workforce: Dietitians leading in gastrostomy management

Simmance

Cortinovis

Green

et al. 2018

Nutrition & Dietetics

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Aim: The number of advanced practice roles in the Australian health-care system is growing alongside contemporary health-care reforms. The present study aimed to evaluate the impact of introducing novel advanced practice dietitian roles in gastrostomy tube (g-tube) management and develop a competency framework for progressing opportunities in dietetics practice and policy. Methods: A questionnaire was distributed to service lead dietitians at six participating health-care networks at the completion of a dedicated advanced practice funding grant, and at 12-month follow up. Service changes (e.g. number of dietitians credentialed, service and adverse events, change in patient waiting times and staff satisfaction), enablers and barriers for the implementation of the novel roles (including pre-, during, and post-implementation), and clinical costing estimates to measure the financial impact on the health system were investigated. Participant feedback was also used to synthesise the development of an advanced scope of practice pathway to competency. Results: Responses were received from all participating health-care networks. Five out of six sites successfully implemented an advanced practice role in g-tube management, with conservative health system savings estimated at $185 000. Ten dietitians were credentialed, with a further seven trainees in progress. Over 200 service events were recorded, including those diverted from other health professionals. Enabling factors for successful introduction included strong executive and stakeholder support, resources provided by grant funding, and established credentialing governance committees. Barriers included recruitment and governance processes. Conclusions: Opportunities exist for further expansion of advanced and extended practice roles for dietitians to meet future health-care demands.

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Post‐pyloric feeding tube placement in critically ill patients: Extending the scope of practice for Australian dietitians

Abstract: A dietitian can be trained to safely and successfully place PPFT in critically ill patients.

Cited by 9 publications

References 23 publications

The role of dietitians in critical care

The role of dietitians in critical care

Nutrition and Gastrointestinal Dysmotility in Critically Ill Burn Patients: A Retrospective Observational Study

Introducing novel advanced practice roles into the health workforce: Dietitians leading in gastrostomy management

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