National Survey of Feeding Tube Verification Practices

Abstract

Background Harm events such as pneumothoraces and pneumonia continue to be associated with feeding tube insertion. Most bedside verification methods are not accurate to discriminate pulmonary from gastrointestinal system. Evidence-based clinical practice guidelines do not support auscultation of feeding tubes in adults, yet auscultation is the most common method used. Objectives Our survey assessed national feeding tube verification practices used by critical care nurses, including progress in auscultation method deimplementation, and stylet reinsertion and cleansing practices. Methods A national survey of 408 critical care nurses was performed. Results The majority performed auscultation (311 of 408 [76%]) to verify feeding tube placement. In the final multivariable model, nursing education, facility type, observation of colleagues performing auscultation, and awareness of an institutional policy were associated with auscultation of feeding tubes. Thirty-five percent used enteral access devices to verify initial feeding tube placement. Stylet cleansing methods were variable; 38% of reinserted stylets were not cleansed. Discussion Minimal progress has been made in deimplementation of auscultation in the past 7 years despite passive knowledge dissemination in research articles, clinical practice guidelines, and procedure manuals. Although pH measure is used as a first-line feeding tube verification method in the United Kingdom, it is rarely used in the United States. Clinical practice guidelines should be updated to incorporate new research on enteral access systems. Conclusions Tradition-based practices such as auscultation and certain stylet cleansing methods should be deimplemented. A focused interdisciplinary, multifaceted program is needed to deimplement auscultation practice for adult feeding tubes.

Microbiome profile informs cleansing and storage practices for reusable feeding tube stylets in critical care

“…Of the 122 nurses who reinserted stylets into feeding tubes, 39% reported using no cleansing method, 21% used an alcohol swab, 15% used tissue/gauze wipe, and 22% rinsed the stylet with water (more than half used tap water vs sterile water) 17 . Six nurses reported using multiple cleansing methods, although it is unknown if these methods were used concurrently 17 . Specific timing of the stylet cleansing (ie, before and/or following stylet reinsertion) was not included in our survey.…”

“…A 2019 national US survey showed variation in cleansing methods of reusable stylets by critical care nurses. Of the 122 nurses who reinserted stylets into feeding tubes, 39% reported using no cleansing method, 21% used an alcohol swab, 15% used tissue/gauze wipe, and 22% rinsed the stylet with water (more than half used tap water vs sterile water) 17 . Six nurses reported using multiple cleansing methods, although it is unknown if these methods were used concurrently 17 .…”

“…A 2019 national survey showed that one-third (122/408; 29%) of US critical care nurses reinserted stylets into feeding tubes, and 39% did not cleanse stylets at all. 17 Reuse of feeding tube stylets has not been associated with infection risk, but it is plausible that a reusable stylet could introduce bacteria into the feeding tube or disrupt biofilm inside of the tube, leading to GI infection. Nonreusable stylets were beyond the scope of our study.…”

“…Stylet cleansing practices vary and are not standardized. A 2019 national survey showed that one‐third (122/408; 29%) of US critical care nurses reinserted stylets into feeding tubes, and 39% did not cleanse stylets at all 17 …”

Fatal Enteral Nutritional Hydrothorax Resulting From Aberrant Placement of a Nasogastric Tube Without Perforation of the Tracheobronchial Tree or Esophagus: A Case Report and Review

“…The American Association of Critical-Care Nurses issued a practice alert on verification of feeding tube placement stating this method should not be used to assess tube placement. Despite this warning, a national survey conducted five years later reported that 76% of health care providers still utilize this auscultation technique (4).…”