Nasoenteric Tube Research Articles

The efficacy of acupuncture-assisted blind insertion of bullet nasointestinal tube method in patients with ischemic stroke: A retrospective study

Objective: To explore the efficacy of Traditional Chinese Medicine (TCM) acupuncture-assisted blind insertion of bullet nasointestinal tube method in patients with ischemic stroke. Methods: This is a retrospective study using clinical records of 180 patients with ischemic stroke, hospitalized in the Department of Neurology of the Zhejiang Province Tertiary Class A Hospital, Huzhou, China from July 2022 to June 2023. The patients were divided into two groups on the basis of the nasogastric tube insertion method. We selected 90 patients for each group from the database of records by using a random list method. Patients in the observation group underwent TCM acupuncture-assisted blind insertion of nasointestinal tube and those in the control group underwent the traditional bedside blind insertion of bullet nasointestinal tube. Success rate of tube insertion, average tube insertion time, intragastric insertion time, stomach time to jejunal insertion, patient comfort, and patient satisfaction in both groups were compared. Results: The success rate of nasointestinal tube insertion was significantly higher in the observation group compared to the control group (96.6% and 88.9%, p<0.05). There was no statistically significant difference in the time of nasoenteral tube insertion into the stomach (p>0.05). The insertion time from stomach to jejunum in the observation group was significantly shorter than in the control group (p<0.05). The patient comfort and satisfaction levels were significantly higher in the observation group compared to the control group (p<0.05). Conclusion: TCM acupuncture-assisted blind insertion of bullet nasointestinal tube method improves the success rate of tube insertion, shortens the average catheterization time from the stomach to the jejunum and improves patient’s comfort and satisfaction. doi: https://doi.org/10.12669/pjms.40.10.9936 How to cite this: Zhao H, Chen J, Chen H, Lv X, Lu Z, Sun Y. The efficacy of acupuncture-assisted blind insertion of bullet nasointestinal tube method in patients with ischemic stroke: A retrospective study. Pak J Med Sci. 2024;40(10):2208-2212. doi: https://doi.org/10.12669/pjms.40.10.9936 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Accuracy and costs of bedside methods for confirming nasoenteral feeding tube position: a diagnostic accuracy study.

To analyze the accuracy and costs of bedside methods for confirming the position of a nasoenteral feeding tube newly inserted blindly by nurses. Diagnostic accuracy study of three clinical methods (ultrasound, epigastric auscultation, and pH measurement) compared to radiography. The direct costs of each method used to confirm the positioning of the nasoenteral tube were also measured. Seventy-six adult patients underwent a total of 87 nasoenteral tube insertion procedures in hospital units located within the Northeast region of the State of São Paulo, Brazil. The clinical methods were conducted on all study participants in the specified sequence: ultrasound (as index test), followed by epigastric auscultation and pH measurement (also index tests). The outcomes regarding the confirmation of the accurate positioning of the nasoenteral tube are as follows: ultrasonography demonstrated sensitivity and specific of 79.0% and 66.7%, respectively. Epigastric auscultation exhibited a sensitivity of 81.3% and specificity of 83.3%. The pH measurement method displayed sensitivity and specificity of 89.3% and 100% respectively. Additionally, in terms of estimated direct costs, the pH measurement method incurred a higher cost (USD $8.31) compared to the other methods, with a difference of USD $6.68. Based on these results, X-ray examination remains the primary method for confirming the placement of nasoenteral tubes recently inserted blindly at the bedside. However, when considering the costs of the evaluated methods, it is advisable to consider the variations in expenses between non-radiological methods and X-ray examinations.

Magnetic navigation-assisted colonoscopic enteral tube placement in swine (with video): a preliminary study

BackgroundColonoscopic enteral tube placement using current methods has some shortcomings, such as the complexity of the procedure and tube dislodgement. The magnetic navigation technique (MNT) has been proven effective for nasoenteral feeding tube placement, and is associated with reduced cost and time to initiation of nutrition. This study attempted to develop a novel method for enteral tube placement using MNT.MethodsThe MNT device consisted of an external magnet and a 12 Fr tube with a magnet at the end. Ten swine were used, and bowel cleansing was routinely performed before colonoscopy. Intravenous anesthesia with propofol and ketamine was administered. A colonoscopic enteral tube was placed using the MNT. The position of the end of the enteral tube was determined by radiography, and angiography was performed to check for colonic perforations. Colonoscopy was used to detect intestinal mucosal damage after tube removal.ResultsMNT-assisted colonoscopic enteral tube placement was successfully completed in all pigs. The median operating time was 30 (26–47) min. No colon perforation was detected on colonography after enteral tube placement, and no colonic mucosal bleeding or injury was detected after the removal of the enteral tube.ConclusionsMNT-assisted colonoscopic enteral tube placement is feasible and safe in swine and may represent a valuable method for microbial therapy, colonic drainage, and host-microbiota interaction research in the future.

Barriers to Advancing Practice: A Snapshot of RDN Placement of Naso-enteric Feeding Tubes in Michigan

Barriers to Advancing Practice: A Snapshot of RDN Placement of Naso-enteric Feeding Tubes in Michigan

Deep Learning-Based Localization and Detection of Malpositioned Nasogastric Tubes on Portable Supine Chest X-Rays in Intensive Care and Emergency Medicine: A Multi-center Retrospective Study.

Malposition of a nasogastric tube (NGT) can lead to severe complications. We aimed to develop a computer-aided detection (CAD) system to localize NGTs and detect NGT malposition on portable chest X-rays (CXRs). A total of 7378 portable CXRs were retrospectively retrieved from two hospitals between 2015 and 2020. All CXRs were annotated with pixel-level labels for NGT localization and image-level labels for NGT presence and malposition. In the CAD system, DeepLabv3 + with backbone ResNeSt50 and DenseNet121 served as the model architecture for segmentation and classification models, respectively. The CAD system was tested on images from chronologically different datasets (National Taiwan University Hospital (National Taiwan University Hospital)-20), geographically different datasets (National Taiwan University Hospital-Yunlin Branch (YB)), and the public CLiP dataset. For the segmentation model, the Dice coefficients indicated accurate delineation of the NGT course (National Taiwan University Hospital-20: 0.665, 95% confidence interval (CI) 0.630-0.696; National Taiwan University Hospital-Yunlin Branch: 0.646, 95% CI 0.614-0.678). The distance between the predicted and ground-truth NGT tips suggested accurate tip localization (National Taiwan University Hospital-20: 1.64 cm, 95% CI 0.99-2.41; National Taiwan University Hospital-Yunlin Branch: 2.83 cm, 95% CI 1.94-3.76). For the classification model, NGT presence was detected with high accuracy (area under the receiver operating characteristic curve (AUC): National Taiwan University Hospital-20: 0.998, 95% CI 0.995-1.000; National Taiwan University Hospital-Yunlin Branch: 0.998, 95% CI 0.995-1.000; CLiP dataset: 0.991, 95% CI 0.990-0.992). The CAD system also detected NGT malposition with high accuracy (AUC: National Taiwan University Hospital-20: 0.964, 95% CI 0.917-1.000; National Taiwan University Hospital-Yunlin Branch: 0.991, 95% CI 0.970-1.000) and detected abnormal nasoenteric tube positions with favorable performance (AUC: 0.839, 95% CI 0.807-0.869). The CAD system accurately localized NGTs and detected NGT malposition, demonstrating excellent potential for external generalizability.

Enteral Nutritional Therapy in Pediatric Autologous Transplantation: A Descriptive Cohort Study

Introduction: Pediatric hematopoietic stem cell transplantation requires individualized nutritional therapy, and the use of early enteral nutrition is beneficial. This study aims to analyze the use of enteral nutrition therapy in pediatric patients undergoing autologous transplantation. Methods: This is a descriptive cohort study conducted with data from electronic medical records of pediatric patients undergoing autologous transplantation from 2017 to 2022, using enteral nutrition. Nutritional and clinical variables and biochemical markers were assessed at four time points: day 0, day +5, day +10 and day +15. Results: The sample consisted of 50 patients. On average, the nasoenteral tube was inserted on D-4 and the enteral feeding started on D-3. On D0, most patients used a normocaloric polymeric enteral formula, but on D + 10, when diarrhea (p = 0.017) and mucositis (p < 0.001) worsened, the most commonly used enteral formula was a hypocaloric pediatric semi-elemental formula. On D + 15, 35% of patients were receiving parenteral nutrition. At discharge, the patient’s nutritional status had worsened compared to admission (p < 0.001). Discussion: Early use of enteral nutrition was observed, as adopted in other transplant centers and recommended in the literature. Protocols and guidelines are needed to support enteral nutritional therapy in pediatric transplantation.

Diet shapes the metabolite profile in the intact human ileum, which affects PYY release.

The human ileum contains a high density of enteroendocrine L-cells, which release the appetite-suppressing hormones glucagon-like peptide-1 (GLP-1) and peptide tyrosine tyrosine (PYY) in response to food intake. Recent evidence highlighted the potential role of food structures in PYY release, but the link between food structures, ileal metabolites, and appetite hormone release remains unclear owing to limited access to intact human ileum. In a randomized crossover trial (ISRCTN11327221; isrctn.com), we investigated the role of human ileum in GLP-1 and PYY release by giving healthy volunteers diets differing in fiber and food structure: high-fiber (intact or disrupted food structures) or low-fiber disrupted food structures. We used nasoenteric tubes to sample chyme from the intact distal ileum lumina of humans in the fasted state and every 60 min for 480 min postprandially. We demonstrate the highly dynamic, wide-ranging molecular environment of the ileum over time, with a substantial decrease in ileum bacterial numbers and bacterial metabolites after food intake. We also show that high-fiber diets, independent of food structure, increased PYY release compared with a low-fiber diet during 0 to 240 min postprandially. High-fiber diets also increased ileal stachyose, and a disrupted high-fiber diet increased certain ileal amino acids. Treatment of human ileal organoids with ileal fluids or an amino acid and stachyose mixture stimulated PYY expression in a similar profile to blood PYY concentrations, confirming the role of ileal metabolites in PYY release. Our study demonstrates the diet-induced changes over time in the metabolite environment of intact human ileum, which play a role in PYY release.

Fecal microbiota transplantation combined with anti-PD-(L)1 inhibitors as first-line maintenance therapy for advanced gastric and non small cell lung cancer.

2646 Background: Immunotherapy(IT) combined with chemotherapy has gradually emerged as the first-line(1L) standard treatment for most advanced tumors; however, numerous studies have demonstrated that chemo-immunotherapy can lead to a reduction in intestinal microbiota diversity, subsequently resulting in compromised immunity. So we assumed whether supplement gut microbiota through fecal microbiota transplantation (FMT) and subsequent anti-PD-(L)1 inhibitor therapy as maintenance therapy could potentially prolong progression-free survival (PFS) in patients(pts) with advanced gastric and non small cell lung cancers (ChiCTR2100054928). Methods: This is a prospective, single-arm exploratory study. The key inclusion criteria encompassed pts with unresectable advanced gastric/gastroesophageal union carcinoma (GC) and advanced non small cell lung cancer (NSCLC), who demonstrated partial response(PR) or stable disease (SD) after 1L therapy with ECOG scores ranged from 0 to 1.There were 2 FMT healthy donors, FMT was performed via nasoenteric tubes or oral capsules after 1L therapy, followed by maintenance therapy with anti-PD-(L)1 inhibitors until unacceptable toxicity or disease progression(PD). Results: From Jan. 2022 to Dec. 2023, a total of 17 pts were enrolled, including 9 GC and 8 NSCLC. 82% were male, and the median age was 68 years (range, 49-80). All pts achieved either a partial response (PR, n=7) or stable disease (SD, n=10) after 1L therapy and subsequently underwent FMT prior to commencing maintenance therapy. The intestinal microbiomes used for FMT with nasoenteric tubes were from the same donor (GC [n=3], NSCLC [n=5]), while those in the capsules were from a different donor (GC [n=6], NSCLC [n=3]). We defined the time from receiving 1L therapy to FMT as PFS0; and from the FMT to PD as PFS1. The sum of PFS0 and PFS1 represents the time from the start of 1L therapy to PD as PFS. Of the 17 recipients, 12 showed SD (GC [n=6], NSCLC [n=6]) and 5 showed PD (GC [n=3], NSCLC [n=2]). In the GC group, median follow-up was 8.8 months (interquartile range [IQR] 5.1-9.7), with unreached median PFS1 and a one-year PFS rate of 78%. For NSCLC, median follow-up was 8.0 months (IQR 4.2-12.2), with unreached median PFS1 and a one-year PFS rate of 67%. No statistically significant differences were observed in pts who underwent FMT using two distinct methods. 53% of pts reported improved quality of life (QoL). 5 pts (29%) experienced grade 1-2 FMT-related toxicities, primarily gastrointestinal reactions, including diarrhea, gas, and abdominal pain, but no grade 3 or higher adverse events were identified. Conclusions: Administering FMT prior to 1L immune maintenance therapy in pts with advanced GC and NSCLC has the potential to prolong PFS, and demonstrate a favorable safety. However, these findings necessitate validation through larger-scale clinical trials. Clinical trial information: ChiCTR2100054928.

Clinical characteristics, epidemiology, and mortality of patients receiving antifungal therapy at a university hospital of the Triângulo Mineiro, Brazil

Background and Objectives: Invasive fungal infections are associated with high morbidity and mortality in patients admitted to hospital, including those receiving appropriate therapy. The aim of this study was to evaluate the use of prophylactic and preemptive antifungal therapy; clinical and epidemiological features; and mortality of patients admitted to an infectious disease ward of a public high complexity hospital in Uberlandia, Minas Gerais, Brazil. Methods: This is a retrospective study carried out in the infectious diseases ward of a public university hospital in Brazil. Data from patients hospitalized in 2019 and 2020 who received azole antifungals (fluconazole, itraconazole, or voriconazole), echinocandin (anidulafungin), and polyene (amphotericin B) were collected from medical records. Results: During the study period, 111 patients received one or more antifungal agent. The length of hospital stays of patients (29.35 days; p=0.0252), mean number of days of antibacterial drug use (23.5 days; p=0.0164), a diagnosis of AIDS (p=0.0397), mechanical ventilation (MV) (p&lt;0.001), and presence of a nasoenteral tube (p&lt;0.01) were variables that were associated with death. Fungal infection was confirmed in 79 (71.2%) patients who used antifungal drugs. The most frequent fungi isolated were Candida spp. (36; 32.4%) and Cryptococcus spp. (22; 19.8%), and there was an association between infection with these fungi and mortality (p&lt;0.05; OR: 7.61 and 5.53, respectively). Regarding antifungal therapy indication, 56 (50.4%) patients received it as empirical therapy, 33 (29.7%) as targeted therapy, and 22 (19.8%) as preemptive therapy. Conclusion: The factors that contributed to mortality of the patients were longer hospital stays, AIDS, antibacterial medication use, mechanical ventilation, and presence of a nasoenteral tube. The type of antifungal therapy used did not influence the mortality in these patients.

Finitude of life in a reference hospital for infectious diseases: a descriptive study

Background: Patients living with serious infectious diseases, such as infection by human immunodeficiency virus (HIV) or tuberculosis (TB), are candidates for palliative care from diagnosis to the advanced stage of the disease. There is a scarcity of studies on palliative care for infectious diseases. The purpose of this study was to describe the clinical and care aspects related to palliative care in patients with severe serious illness that occurs in a referral hospital for infectious diseases. Methods: We conducted a cross-sectional, retrospective study of patients who died of severe advanced disease during hospitalization in a Brazilian reference hospital for infectious diseases from January 2017 to March 2018. We defined serious illness as a health condition that presented a high risk of mortality, and negatively affected a person’s daily function or quality of life, or overloaded their caregivers. Results: There were 95 deaths during this period, of which 77 (81%) were included for analysis. Forty-nine (63.6%) were male. The mean age was 56.3 years (SD 17.34). The average time from hospitalization to death was 8.15 (SD 15.67) days. Of the 77 patients, 24 (31.1%) had active TB, 37 (48%) had HIV infection, and 21 (27.2%) had advanced neoplasia. At the time of death, 49 (62.8%) were admitted to the ward, 8 (10.2%) to the emergency unit, and 21 (26.9%) to the ICU. At the time of death, 51 (63.5%) used vasoactive drugs, 49 (62.8%) used mechanical ventilation, 17 (21.7%) underwent hemodialysis, 56 (71.7%) had a central venous catheter, 55 (70.5%) had an indwelling urinary catheter, 59 (75.6%) were on enteral diet by nasoenteral tube or gastrostomy, and 58 (75.3%) received antibiotic therapy. At the time of death, only 10 (12.9%) patients used opioids to control symptoms of late life, such as pain and dyspnea. Conclusions: Assistance for suffering in patients with severe health conditions and finitude of life, even in a hospital unit specialized in infectious diseases, occurred to a limited extent. It is necessary to evaluate the benefits of a specialized service in palliative care in order to provide better assistance to patients with this profile.

Real-Time Camera Image-Guided Nasoenteric Tube Placement in Prone COVID-19 ICU Patients: A Single-Center Study.

Background & Aims: This study aims to assess the application value of the real-time camera image-guided nasoenteric tube placement in critically ill COVID-19 patients undergoing endotracheal intubation and prone position ventilation therapy. Methods: We enrolled 116 COVID-19 patients receiving endotracheal intubation and prone position ventilation therapy in the intensive care unit (ICU). Patients were randomly divided into the real-time camera image-guided nasoenteric tube placement (n = 58) and bedside blind insertion (n = 58) groups. The success rate, placement time, complications, cost, heart rate, respiratory rate, Glasgow Coma Scale (GCS), and Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores were compared between the 2 groups. Results: For ICU patients with COVID-19 undergoing prone position ventilation therapy, the success rate and cost were significantly higher in the real-time camera image-guided group compared to the bedside blind group (P < .05). The placement time and complication incidence were significantly lower in the real-time camera image-guided group (P < .05). The differences in heart rate, respiratory rate, GCS scores, and APACHE-II scores were insignificant (P > .05). Conclusions: The real-time camera image-guided nasoenteric tube placement system had advantages for ICU COVID-19 patients undergoing prone position ventilation therapy, including a high success rate, short placement time, and no impact on patient position during tube placement. Real-time camera image-guided nasoenteric tube placement can be performed in any position, and demonstrates high efficiency, safety, and accuracy.

Dedicated home enteral feeding dietitian: Facilitating nasoenteric feeding tube discharges within a specialist oesophagogastric service

Dedicated home enteral feeding dietitian: Facilitating nasoenteric feeding tube discharges within a specialist oesophagogastric service

Teaching and Assessing Bedside Procedures: A Standardized Cross-Disciplinary Framework for Graduate Medical Education.

Performing bedside procedures requires knowledge, reasoning, physical adeptness, and self-confidence; however, no consensus on a specific, comprehensive strategy for bedside procedure training and implementation is available. Bedside procedure training and credentialing processes across large institutions may vary among departments and specialties, leading to variable standards, creating an environment that lacks consistent accountability, and making quality improvement difficult. In this Scholarly Perspective, the authors describe a standardized bedside procedure training and certification process for graduate medical education with a common, institution-wide educational framework for teaching and assessing the following 7 important bedside procedures: paracentesis; thoracentesis; central venous catheterization; arterial catheterization; bladder catheterization or Foley catheterization; lumbar puncture; and nasogastric, orogastric, and nasoenteric tube placement. The proposed framework is a 4-stage process that includes 1 preparatory learning stage with simulation practice for knowledge acquisition and 3 clinical stages to guide learners from low-risk to high-risk practice and from high to low supervision. The pilot rollout took place at Henry Ford Hospital from December 2020 to July 2021 for 165 residents in the emergency medicine and/or internal medicine residency programs. The program was fully implemented institution-wide in July 2021. Assessment strategies encompass critical action checklists to confirm procedural understanding and a global rating scale to measure performance quality. A major aim of the bedside procedure training and certification was to standardize assessments so that physician trainers from multiple specialties could train, assess, and supervise any participating trainee, regardless of discipline. The authors list considerations revealed from the pilot rollout regarding electronic tracking systems and several benefits and implementation challenges to establishing institution-wide standards. The proposed framework was assembled by a multidisciplinary physician task force and will assist other institutions in adopting best approaches for training physicians in performing these critically important and difficult-to-perform procedures.

Beyond the gut: spectrum of magnetic surgery devices.

Since the 1970s, magnetic force has been used to augment modern surgical techniques with the aims of minimizing surgical trauma and optimizing minimally-invasive systems. The majority of current clinical applications for magnetic surgery are largely centered around gastrointestinal uses-such as gastrointestinal or bilioenteric anastomosis creation, stricturoplasty, sphincter augmentation, and the guidance of nasoenteric feeding tubes. However, as the field of magnetic surgery continues to advance, the development and clinical implementation of magnetic devices has expanded to treat a variety of non-gastrointestinal disorders including musculoskeletal (pectus excavatum, scoliosis), respiratory (obstructive sleep apnea), cardiovascular (coronary artery stenosis, end-stage renal disease), and genitourinary (stricture, nephrolithiasis) conditions. The purpose of this review is to discuss the current state of innovative magnetic surgical devices under clinical investigation or commercially available for the treatment of non-gastrointestinal disorders.

Agreement Between Epigastric Auscultation and pH Measurement in the Confirmation of Nasoenteral Tube Placement.

This study aimed to evaluate the agreement between epigastric auscultation and pH measurement in the confirmation of nasoenteral tube placement. A cross-sectional study carried out in a medium-sized private hospital in the interior of the state of São Paulo. Forty-nine patients who were submitted to ninety insertion procedures and confirmation of tube placement. aimed at evaluating the agreement of clinical methods used by nurses to confirm the positioning of a nasoenteral tube inserted blindly at the bedside, by measuring the parameters of sensitivity, specificity, positive predictive value, and negative predictive value. The epigastric auscultation was the method that presented the highest sensitivity (100.0%), but lower specificity (2.0%). The measurement of the pH presented lower sensitivity (63.0%) than the auscultation, however, higher specificity (58%). Moreover, the positive predictive value of the pH measurement was 55% and the negative predictive value was 66%. There was no agreement between the epigastric auscultation and the pH measurement with the radiography. The pH measurement did not allow for distinguishing between gastric and enteric positioning, due to the similarity of the esophageal and pulmonary pH with the pH of the intestine. Furthermore, external factors such as the use of medication and reduced fasting time may interfere with the pH value.

Nasoenteric Tube Placement in Patients with Esophageal Varices: A Review of the Current Evidence and Society Guidelines.

Esophageal varices are a common complication of portal hypertension and variceal bleeding can be associated with significant morbidity and mortality. Hospitalized patients with cirrhosis might require nasoenteric tube (NET) placement, commonly for nutritional support and/or medication administration. However, the fear of causing massive variceal bleeding among clinicians might lead to hesitancy or complete avoidance of NET placement in patients who either have a known history of esophageal varices or are at risk to have them. Several experts and society guidelines addressed this concern with variable recommendations and degrees of evidence. In this article, we present an extensive review of the literature and latest society guidelines that address the safety of NET placement in patients with esophageal varices.

S720 The Gold Standard for Nasoenteric Tube Placement Gets Tarnished?

S720 The Gold Standard for Nasoenteric Tube Placement Gets Tarnished?

Poleptání jícnu a žaludku – nejnovější pohled na diagnostiku a léčbu

Summary Introduction: Ingestion of a corrosive substance is an infrequent but serious condition with a possible threat to life. Symptoms and diagnosis: Clinical symptoms of esophageal burns are non-specific and are determined by the degree and extent of injury Subjective symptoms do not lead to a diagnosis without information of corrosive substance ingestion. It is necessary to define the substance and find out information of its local and systemic toxicity. The next step should be an ENT examination to descibe local extent of corrosive injury in the oral cavity, pharynx and larynx and exclude severe injury and oedema of larynx and urgency of tracheostomy or intubation. A flexible endoscopy of the upper digestive tract is essential for further treatment. The aim of the endoscopic examination is to evaluate the extent of changes in the oesophagus and stomach. If GIT perforation is suspected, CT scan of the thorax and abdomen must precede the endoscopy. Treatment: In the presence of obstructive respiratory symptoms, laryngeal edema or severe burns of the airways is necessary to secure the airways as the first step. Wide-spread antibiotics should be used in the case of perforation of the oesophagus, in the third stage corrosions and in lung involvement. Corticoids are not indicated as a prevention of strictures, the only indication is to reduce oedema of the airways. Patient’s nutrition depends on degree and extent of the injury. Patients with I and II.A degree burns are nourished orally, a liquid diet for 48 hours is recommended. In patients with II.B and III. degree oral intake is excluded and nasoenteral tube is inserted for tube feeding. In case of GIT perforation, an acute surgical procedure is indicated. Stenosis of the oesophagus are frequent and severe long-term consequences of severe corrosions and long-term care and repeated interventions to restore of possibility of oral feeding could be indicated. Conclusion: Oesophageal and stomach burns are less frequent injuries. However, due to its severity, it can endanger patient’s life or its quality for long years. Multidisciplinary approach is essential in corrosive injuries management. Key words corrosion – endoscopy – corticoids – nutrition – stricture

Role of registered dietitians in nasoenteric feeding tube placement.

Provision of enteral nutrition (EN) in hospitalized patients is an integral part of clinical care. For various reasons, including but not limited to delayed enteral access placement and EN initiation, it is becoming more prevalent for registered dietitians (RDs) to place feeding tubes in various clinical settings. Although numerous RDs have expanded their practice by learning this skill, many remain hesitant about adding feeding tube placement to their scope of responsibilities. Feeding tube placement is within RDs' scope of practice. The recently updated Accreditation Council for Education in Nutrition and Dietetics (ACEND) standards is requiring dietetic interns to learn the process and assist in placing feeding tubes. This will help promote the inclusion of this practice and open doors for future advancement in the scope of practice for RDs. This review will provide an overview of feeding tube placement methods, evidence-based techniques, training, competencies, and barriers to accepting this practice in dietetics.

Nutrition practices in critically ill adults receiving noninvasive ventilation: A quantitative survey of Australian and New Zealand intensive care clinicians

BackgroundNoninvasive ventilation (NIV) is frequently used in the intensive care unit (ICU), yet there is a paucity of evidence to guide nutrition management during this therapy. Understanding clinicians' views on nutrition practices during NIV will inform research to address this knowledge gap. ObjectiveThe objective of this study was to describe Australian and New Zealand clinicians' views and perceptions of nutrition management during NIV in critically ill adults. MethodsA cross-sectional quantitative online survey of Australian and New Zealand medical and nursing staff with ≥12 months ICU experience was disseminated through professional organisations via purposive snowball sampling from 29 August to 9 October 2022. Data collection included demographics, current practices, and views and perceptions of nutrition during NIV. Surveys <50% complete were excluded. Data are represented in number (%). ResultsA total of 152 surveys were analysed; 71 (47%) nursing, 69 (45%) medical, and 12 (8%) not specified. There was limited consensus on nutrition management during NIV; however, most clinicians (n = 108, 79%) reported that nutrition during NIV was ‘important or very important’. Oral intake was perceived to be the most common route (n = 83, 55%), and 29 (21%) respondents viewed this as the safest. Most respondents (n = 106, 78%) reported that ≤50% of energy targets were met, with gastric enteral nutrition considered most likely to meet targets (n = 55, 40%). Reported nutrition barriers were aspiration risk (n = 87, 64%), fasting for intubation (n = 84, 62%), and nutrition perceived as a lower priority (n = 73, 54%). Reported facilitators were evidence-based guidelines (n = 77, 57%) and an NIV interface compatible with enteral nutrition tube (n = 77, 57%). ConclusionICU medical and nursing staff reported nutrition during NIV to be important; however, there was a lack of consensus on the route of feeding considered to be the safest and most likely to achieve nutrition targets. Interventions to minimise aspiration and fasting, including an interface with nasoenteric tube compatibility, should be explored.