Monitoring for Intolerance to Gastric Tube Feedings: A National Survey

Self Cite

Background Although most critically ill patients experience at least 1 blind insertion of a feeding tube during their stay in an intensive care unit, little is known about the types of health care personnel who perform these insertions or about methods used to determine proper positioning of the tubes. Objectives To describe results from a national survey of critical care nurses about feeding tube practices in their adult intensive care units. The questions asked included who performs blind insertions of feeding tubes and what methods are used to determine if the tubes are properly positioned. Methods Data were collected from members of the American Association of Critical-Care Nurses via pencil-and-paper and online surveys. Results from both forms were combined for data analysis and were compared with practice recommendations of national-level organizations. Results A total of 2298 responses were obtained. Physicians perform more blind insertions of styleted feeding tubes than do nurses; in contrast, nurses place more nonstyleted tubes. Radiographic confirmation of correct position is mandated more often for blindly inserted styleted tubes (92.3%) than for nonstyleted tubes (57.5%). The 3 most commonly used bedside methods to determine tube location are auscultation for air injected via the tube, appearance of feeding tube aspirate, and observation for indications of respiratory distress. Conclusions Recommendations from multiple national-level organizations to obtain radiographic confirmation that each blindly inserted feeding tube is correctly positioned before the first use of the tube are not adequately implemented. Auscultation is widely used despite recommendations to the contrary.

Section: Survey Methodsmentioning

confidence: 99%

“…As indicated in a previous report, 33 Which of the following bedside methods are advocated in your ICU to confirm that a feeding tube has remained in correct position AFTER feedings have been started? (Please mark all that apply.)…”

Section: Respondentsmentioning

confidence: 99%

Blind Insertion of Feeding Tubes in Intensive Care Units: A National Survey

Metheny

Stewart

Mills

2012

Self Cite

“…Based on a survey among 2298 clinicians, Metheny et al 56 concluded that recommendations to obtain radiographic confirmation of the correct position for each feeding tube that is blindly inserted are not satisfactorily implemented. Instead and despite the recommendation to the contrary, auscultation is a widely used technique.…”

Section: Safety Issuesmentioning

confidence: 99%

“…55 A survey among American critical care nurses revealed that the most frequent thresholds used to interrupt enteral feeding were residual volumes of 200 or 250 mL. 56 Only 12.5% of nurses indicated that they allowed residual volumes up to 500 mL before interrupting feedings. Clearly, a need exists for the development and proper implementation of protocols based on current guidelines.…”

Section: Nutritionmentioning

confidence: 99%

Insights and Advances in Multidisciplinary Critical Care: A Review of Recent Research

Blot

Afonso

Labeau

2014

The intensive care unit is a work environment where superior dedication is pivotal to optimize patients' outcomes. As this demanding commitment is multidisciplinary in nature, it requires special qualities of health care workers and organizations. Thus research in the field covers a broad spectrum of activities necessary to deliver cutting-edge care. However, given the abundance of research articles and education activities available, it is difficult for modern critical care clinicians to keep up with the latest progress and innovations in the field. This article broadly summarizes new developments in multidisciplinary intensive care, providing elementary information about advanced insights in the field by briefly describing selected articles bundled in specific topics. Issues considered include cardiovascular care, monitoring, mechanical ventilation, infection and sepsis, nutrition, education, patient safety, pain assessment and control, delirium, mental health, ethics, and outcomes research.

“…7 Furthermore, the same population was surveyed about enteral feeding practices in 2010. 56 A survey link was posted on the AACN Facebook page on week 4 of our study. The volume of respondents increased by 153 (25%), suggesting that social media may be an effective recruitment tool for online surveys.…”

Section: Limitationsmentioning

confidence: 99%

Factors Influencing Critical Care Nurses' Adoption of the AACN Practice Alert on Verification of Feeding Tube Placement

Bourgault¹,

Heath²,

Hooper³

et al. 2014

A closed-book, multiple-choice examination following this article tests your under standing of the following objectives: Methods Critical care nurses were invited to participate in a national, online questionnaire, guided by Rogers' diffusion of innovation framework. Descriptive statistics and logistic regression were used for data analysis. Alpha level was set at 0.05. Results Fifty-five percent of the 370 participating nurses were aware of the practice alert, and 45% had adopted it in practice. Only 29% of the adopters had also implemented all 4 clinical practices. Significant predictors of adoption included BSN or higher nursing education and guideline characteristics of observability and trialability. Predictors of implementation of the clinical practices included staff nurse/charge nurse role, academic medical center, research/web-based information sources, and perception of a policy. Policy was the only significant predictor of implementation of all 4 practices. Adoption of the practice alert was also a predictor for 2 of 4 clinical practices. Conclusions Personal and organizational factors influenced implementation of practices associated with an AACN practice alert. Although a research-practice gap exists, the practice alert was a significant source of information for 2 of the clinical practices.