Pulmonary aspiration of gastric contents is common in enterally fed patients. Tinting enteral feedings with blue dye is thought to aid the early detection of aspiration in hospitalized patients. The blue-dye method is popular despite evidence that it is not sensitive. Reports of absorption of blue dye from enteral feedings in patients with sepsis and other critical illnesses are increasing. The presence of blue and green skin and urine, and serum discoloration has been linked with death. FD&C Blue No.1 and related dyes have toxic effects on mitochondria, suggesting that dye absorption is harmful. This study reviews the literature on the dye method and dye pharmacology, reports the results of a survey of current dye use, and describes 2 recent deaths associated with blue-dye absorption. We concluded that the use of blue dye in enteral feedings should be abandoned and replaced by evidence-based methods for the prevention of aspiration.
Obstruction of enteral tubes places clinicians at a therapeutic crossroad. One must either remove the current device and replace it, or remove the obstruction from the tube. The following article addresses issues related to clogged or obstructed enteral feeding tubes, and methods used to restore patency to these devices. Additionally, the article describes the approach the Nutritional Support Service at St. Mary of the Plains Hospital uses in restoring patency to occluded enteral feeding tubes.
Purpose:To assist the pharmacy clinician engaged in nutrition support in staying current with the most pertinent literature. Methods: Several experienced board-certifi ed clinical pharmacists in nutrition support compiled a list of publications published in 2013 that they considered to be important to their practice. The citation list was compiled into a Web-based survey whereby pharmacist members of the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), GI-Liver-Nutrition Practice Research Network of the American College of Clinical Pharmacy, and the Pharmacy and Pharmacology Section of the Society of Critical Care Medicine were asked to rank each article according to level of importance in their practice. Results: A total of 30 articles were identifi ed by the author group. Thirty-six participants responded to the survey. The top-ranked papers by participants from the Web-based survey were reviewed by the authors. Due to its high level of importance, the parenteral nutrition safety consensus recommendations article, to be published in 2014 by A.S.P.E.N., was also reviewed. Conclusion: It is recommended that the informed pharmacist, who is engaged in nutrition support therapy, be familiar with the majority of these publications.
Key Words-consensus, enteral nutrition, guidelines, nutrition support, outcomes, parenteral nutritionHosp Pharm-2014;49:717-730 whereby the clinical pharmacist provides pharmacotherapy services along with nutrition support responsibilities. This paradigm shift has arguably been partially attributed to the fi nancially motivated decline in the provision of interdisciplinary nutrition support teams by US hospitals over the past couple of decades. 1 S taying current with the literature is a requirement for the informed pharmacist who maintains an evidence-based clinical practice. This requirement has become increasingly more challenging to fulfi ll as a paradigm shift has changed the practice culture of a full-time pharmacy nutrition support specialist to a more integrated model
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