Reducing interruptions to continuous enteral nutrition in the intensive care unit: a comparative study

Abstract

Review of practice may reveal opportunities for improvement. Nurse champions can facilitate change processes to improve care.

ASPEN Safe Practices for Enteral Nutrition Therapy

“…They found that a nursing clinical decision support system integrated into the electronic flow sheet increased adherence to guidelines. Change champions have been shown to facilitate change processes to improve care 11 , 16 . This is a role that can be played by appropriate staff who take an active interest in and accountability for enhancing practice.…”

“…However, these therapies are essential in some situations because irreversible hypoxic brain injury trumps the risk of potential aspiration. High‐flow volumes by noninvasive ventilation (NIV), noninvasive positive pressure ventilation (NIPPV), or other means can increase the risk of aspiration, and the risk is further increased in the sedated patient 16 . EN is not always indicated in patients on high‐flow volume NIV as some patients have learned to eat with high‐flow volume NIV without incidence of pneumonia, including patients with neuromuscular diseases such as amyotrophic lateral sclerosis.…”

“…Williams and colleagues 67 conducted a randomized controlled trial and concluded that aspirating GRVs less frequently in critical care was not correlated with increased patient risk of complications from EN but could potentially reduce the risk of contamination of the feeding circuit and the risk of exposure to body fluid. In another study, Williams et al 16 identified other strategies to reduce interruptions to enteral feeding that might increase risks of contamination and negatively affect nutrition outcomes.…”

“…Instead, clinicians are encouraged to use evidence and critical thinking to decide whether to interrupt feedings. Williams and colleagues 16 have reviewed means to reduce avoidable interruptions.…”

Effects of oral care solutions on mucous membrane integrity and bacterial colonization

“…In the bicarbonate and saline groups these scores were higher on the last day than the first day in the enterally fed patients. In literature, it has been reported that parenteral nutrition has more disadvantages due to severe complications that may arise as compared to enteral nutrition (Cherry‐Bukowiec, ; Williams et al ., ). In our study, we also found that the oral mucosa of patients who received parenteral nutrition in the chlorhexidine group was in poorer condition than the ones who received enteral nutrition.…”