Methods Used by Critical Care Nurses to Verify Feeding Tube Placement in Clinical Practice

Bourgault, Annette M.; Heath, Janie; Hooper, Vallire D.; Sole, Mary Lou; NeSmith, Elizabeth G.

doi:10.4037/ccn2015984

Cited by 28 publications

(28 citation statements)

References 35 publications

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“…5,6 Radiography is the most common standard to verify feeding tube placement, but the effort to deimplement (stop) feeding tube assessment by auscultation continues. 5,6 There is a need for nurses to modify tradition-based clinical practices that are harmful, ineffective, or lacking PhD, RN, CNL, 12201 Research Parkway, Suite 300, Orlando, FL 32826 (email: annette.bourgault@ucf …”

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confidence: 99%

“…[2][3][4] For example, assessment of feeding tube placement using auscultation (air insufflation) is an inaccurate method that has been associated with complications such as pneumothorax and pneumonia. 5,6 Radiography is the most common standard to verify feeding tube placement, but the effort to deimplement (stop) feeding tube assessment by auscultation continues. 5,6 There is a need for nurses to modify tradition-based clinical practices that are harmful, ineffective, or lacking 7 Evidence-based practice is an expected standard in health care and incorporates the best research-based evidence and clinical expertise with patient values and preferences.…”

mentioning

confidence: 99%

“…5,6 Radiography is the most common standard to verify feeding tube placement, but the effort to deimplement (stop) feeding tube assessment by auscultation continues. 5,6 There is a need for nurses to modify tradition-based clinical practices that are harmful, ineffective, or lacking 7 Evidence-based practice is an expected standard in health care and incorporates the best research-based evidence and clinical expertise with patient values and preferences. 8,9 Improved patient outcomes have been associated with EBP.…”

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confidence: 99%

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Using Gemba Boards to Facilitate Evidence-Based Practice in Critical Care

Bourgault

Upvall

Graham

2018

Critical Care Nurse

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Background Tradition-based practices lack supporting research evidence and may be harmful or ineffective. Engagement of key stakeholders is a critical step toward facilitating evidence-based practice change. Gemba, derived from Japanese, refers to the real place where work is done. Gemba boards (visual management tools) appear to be an innovative method to engage stakeholders and facilitate evidence-based practice. Objectives To explore the use of gemba boards and gemba huddles to facilitate practice change. Methods Twenty-two critical care nurses participated in interviews in this qualitative, descriptive study. Thematic analysis was used to code and categorize interview data. Two researchers reached consensus on coding and derived themes. Data were managed with qualitative analysis software. Results The code gemba occurred most frequently; a secondary analysis was performed to explore its impact on practice change. Four themes were derived from the gemba code: (1) facilitation of staff, leadership, and interdisciplinary communication, (2) transparency of outcome data, (3) solicitation of staff ideas and feedback, and (4) dissemination of practice changes. Gemba boards and gemba huddles became part of the organizational culture for promoting and disseminating evidence-based practices. Conclusions Unit-based, publicly located gemba boards and huddles have become key components of evidence-based practice culture. Gemba is both a tool and a process to engage team members and the public to generate clinical questions and to plan, implement, and evaluate practice changes. Future research on the effectiveness of gemba boards to facilitate evidence-based practice is warranted. (Critical Care Nurse. 2018;38[3] T ransition from tradition-based practices, sometimes referred to as rituals or "sacred cows," 1 to evidence-based practice (EBP) is a challenge for health care providers. Many current tradition-based practices lack adequate evidence and have the potential to create harm.2-4 For example, assessment of feeding tube placement using auscultation (air insufflation) is an inaccurate method that has been associated with complications such as pneumothorax and pneumonia. 5,6 Radiography is the most common standard to verify feeding tube placement, but the effort to deimplement (stop) feeding tube assessment by auscultation continues. 5,6 There is a need for nurses to modify tradition-based clinical practices that are harmful, ineffective, or lacking PhD, RN, CNL, 12201 Research Parkway, Suite 300, Orlando, FL 32826 (email: annette.bourgault@ucf .edu).To purchase electronic or print reprints, contact the American Association of CriticalCare Nurses, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 899-1712 or (949) 362-2050 (ext 532); fax, (949) 362-2049; email, reprints@aacn.org. evidence and incorporate EBP to achieve optimal patient outcomes and use of resources.

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confidence: 99%

mentioning

confidence: 99%

“…5,6 Radiography is the most common standard to verify feeding tube placement, but the effort to deimplement (stop) feeding tube assessment by auscultation continues. 5,6 There is a need for nurses to modify tradition-based clinical practices that are harmful, ineffective, or lacking 7 Evidence-based practice is an expected standard in health care and incorporates the best research-based evidence and clinical expertise with patient values and preferences. 8,9 Improved patient outcomes have been associated with EBP.…”

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confidence: 99%

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Using Gemba Boards to Facilitate Evidence-Based Practice in Critical Care

Bourgault

Upvall

Graham

2018

Critical Care Nurse

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“…Auscultation (air bolus) and water bubbling methods should no longer be used for verification of feeding tube placement because those methods are inaccurate. 1,2,13 The COR-TRAK electromagnetic placement device has shown promising results for accurate placement of feeding tubes in the small bowel when operated by highly trained and experienced users.…”

mentioning

confidence: 99%

“…1,2 Insertion of feeding tubes may be performed blindly, with visualization using ultrasound or endoscopy, or with use of a real-time visual aid such as an electromagnetic placement device. Practice guidelines recommend radiographic confirmation as the gold standard to verify placement of all feeding tubes in adults.…”

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confidence: 99%

Cortrak-Assisted Feeding Tube Insertion: A Comprehensive Review of Adverse Events in the MAUDE Database

Bourgault

Aguirre

Ibrahim

2017

American Journal of Critical Care

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Background Electromagnetic devices to guide feeding tube placement such as the CORTRAK Enteral Access System have shown promising results; however, researchers in recent studies have expressed concern that a higher level of user expertise may be required for safe use. Objectives To review adverse events related to CORTRAK-assisted feeding tube insertion reported in the Food and Drug Administration’s Manufacturer and User Facility Device Experience (MAUDE) database. Methods A retrospective, secondary analysis of the MAUDE database was performed to evaluate adverse events (ie, injury or death of patient) related to CORTRAK. Results Fifty-four adverse events between January 1, 2006 and February 29, 2016 were identified and reviewed. Most events (98%) involved feeding tube placement in the lungs (37%, left lung; 46%, right lung; 15%, not specified). Lung complications included pneumothorax (77%) and pneumonitis (21%). Death occurred in 17% of lung placements. Clinicians failed to recognize placement in 89% of CORTRAK insertion tracings reviewed. Conclusions Lung placement is not unique to CORTRAK and is an inherent risk of all feeding tube insertions. In known or suspected lung placement, feeding tubes should be removed and radiography performed to assess for pneumothorax. Clinicians must observe closely for lung placement and discriminate lung from gastric placement on insertion tracings. Clinicians require specialized training and experience to develop competency in using the CORTRAK device, although the exact amount of experience needed is unknown.

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Successful Identification of Anatomical Markers and Placement of Feeding Tubes in Critically Ill Patients via Camera‐Assisted Technology with Real‐Time Video Guidance

Wischmeyer

McMoon

Waldron

et al. 2018

J Parenter Enteral Nutr

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Methods Used by Critical Care Nurses to Verify Feeding Tube Placement in Clinical Practice

Abstract: T he findings presented here are a subset of results from a larger study that examined critical care nurses' adoption of the American Association of Critical-Care Nurses (AACN) practice alert on feeding tube placement and the clinical practices recommended therein.

Cited by 28 publications

References 35 publications

Using Gemba Boards to Facilitate Evidence-Based Practice in Critical Care

Using Gemba Boards to Facilitate Evidence-Based Practice in Critical Care

Cortrak-Assisted Feeding Tube Insertion: A Comprehensive Review of Adverse Events in the MAUDE Database

Successful Identification of Anatomical Markers and Placement of Feeding Tubes in Critically Ill Patients via Camera‐Assisted Technology with Real‐Time Video Guidance

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