Nasoenteric Tube Research Articles

Reduced incidence of feeding tube dislodgement and missed feeds in burn patients with nasal bridle securement

IntroductionFeeding tubes in burn patients are at high risk for becoming dislodged as traditional tape securement does not adhere well to sloughed skin, resulting in nutrition delivery disruption and placing patients at increased risk for iatrogenic injury upon reinsertion. MethodsSeventy-four patients admitted to our regional burn center requiring nasoenteric nutritional support were prospectively followed. Fourty-one patients received a nasal bridle while thirty-three received traditional tape and elastic dressings. Primary outcomes centered on measuring clinical efficacy of the nasal bridle system. ResultsConventional tape-secured feeding tubes were dislodged more frequently (0.9±0.2 times per 10 feeding days vs. 0.2±0.1 times per 10 feeding days; p=0.005). Nasal bridle secured tubes showed significantly longer functional life on Kaplan Meier analysis (hazard ratio 0.35; p=0.01). Fewer abdominal x-ray studies were performed to confirm tube placement in nasal bridle patients (1.48±0.13 for nasal bridle vs. 2.21±0.21 for conventional tape-secured; p=0.003). Overall, patients with bridle securement had fewer hours of missed enteric feeds (2.51±0.95hours vs. 6.72±2.07hours; p=0.05). Importantly, utilization of a nasal bridle decreased overall estimated costs for enteric feeding management ($1,379.72±120.70 vs. $1,107.66±63.95; p=0.05). ConclusionsUtilization of a nasal bridle system provides a reliable method for securement of nasoenteric feeding tubes with clinical benefits in the burn patient population.

Early versus delayed enteral feeding in acute pancreatitis

Background: Early enteral feeding through a nasoenteric feeding tube is often used in patients with acute pancreatitis, as compared to previous notion of pancreatic rest. This study aims to compare various outcomes of early and late enteral feeding in severe acute pancreatitis.Methods: This study was a randomized trial conducted at Victoria hospital, Bengaluru between July 2016 and June 2017. Patients with severe acute pancreatitis were randomized into early enteral feeding and late enteral feeding groups in the ratio of 1:1. Early enteral feeding group were started on oral feeds within 24 hours of admission. Late enteral feeding group were started on oral feeds after 72 hours of admission. Patient demographics, clinical findings, investigations, length of hospital stay, complications were assessed and compared.Results: In 124 out of 132 patients were included who met inclusion criteria. The mean age of patients was 28.6 years. There were 120 males (96.7%) and 4 females (3.2%). There were no significant differences in age, sex ratio and comorbidities between the two groups. Early enteral feeds group showed lesser number of gastrointestinal adverse effects after initiation of enteral feeds, lesser number of days taken to develop full tolerance to enteral feeds, lesser number of days of admission, lesser complications like necrotizing pancreatitis, single or multiple organs failure, lesser number of ICU admissions, requiring mechanical ventilation, including lesser mortality when compared to delayed enteral feeds group.Conclusions: Patients with severe acute pancreatitis can safely be started on early enteral feeds within 24 hours of admission.

A systematic review of the effectiveness and complications of using nasal bridles to secure nasoenteral feeding tubes

Systematic literature review regarding efficacy and complication rates of securing nasoenteral tubes with nasal bridles. Studies included: systematic reviews, randomized controlled trials or comparative studies comparing nasal bridles with one or more other method of securing nasoenteral tubes. No restriction on age, language, year of publication or methodology quality was imposed. 18 studies were included. Data extraction was conducted by one reviewer and verified by another. Outcomes evaluated included: rate of tube dislodgement, rate of tube replacement, tube dwelling time, quantified enteral nutrition, cost, complications, and PEG-related morbidity/mortality. Nasal bridling is associated with lower tube dislodgement rate, lower replacement rate and increased length of time of tube in situ , resulting in better delivery of nutrition via nasoenteral tubes secured with nasal bridles compared to conventional methods. However, there is higher incidence of epistaxis/nasal ulceration with nasal bridling compared to conventional methods. Nasal bridle is an easily inserted device that improves nasoenteral tube dwelling time and, subsequently, ability to deliver optimal nutrition.

Profile of patients using nasoenteric probe at the adult emergency service in a public hospital

Introduction: Part of the prognosis of hospitalized patient depends on nutritional status and the safety and efficacy of the feeding administration route. Therefore, the aim of this study was to identify data on the indication of nasoenteric tube (NET) prescription to analyze the profile of these patients. Methods : A retrospective cross-sectional study was carried out with data collection in medical records of patients over 18 years of age, of both sexes, treated at the Emergency Adult Service (EAS), using NET. Results: there was a predominance of females (51.9%); neurological disease was the most prevalent underlying disease, and 57.8% had more than one diagnosed disease. Malnutrition, bronchopneumonia, and dysphagia were present in 23.6%, 27% and 40% of the cases, respectively. There was a request for speech-language evaluation in only 8.7% of the patients. And 80.7% did not use NET prior to emergency care. Regarding the indications for the use of NET by group of underlying disease, low food intake was the most prevalent clinical reason described in the medical records, followed by dysphagia, with a higher prevalence of patients taking NET for nutritional reasons. There was no justification for prescription in 15.2% of the sample. There was an association between the variables bronchopneumonia and dysphagia (p = 0.01). Conclusion : It was verified that in the studied population there are risk factors for dysphagia. The analysis of the population profile in the present study contributed to increased knowledge and information about this population regarding the criteria for indication of the use of the alternative route. Keywords: Deglutition disorders; enteral nutrition; emergency medical services

Nasal Bridling of Nasoenteric Feeding Tubes

Introduction A trend of dislodged nasogastric tubes was noted in children at a high risk for loss of enteral feeding access. There is known morbidity associated with early nasogastric tube dislodgement. Despite nursing and family education regarding the importance of these surgically placed tubes, the optimal method of securing nasogastric tubes is undetermined. Methods A nasal bridling program was implemented from February 2015 to February 2017 for pediatric surgical patients less than 1 year old requiring nasoenteric feeding tubes. The pediatric surgical service oversaw education and implementation of the program. Retrospective data collection was performed. Variables included weight and age at the time of tube placement, indications, method of placement, bridle duration, associated complications, unintended dislodgement, and diagnosis outcomes. Results Fourteen bridle systems were placed in 12 children with diagnoses including tracheoesophageal fistula, congenital diaphragmatic hernia, congenital heart disease with poor oral skills/feeding, and duodenal atresia and stenosis for 444 patient days. The average duration of bridling was 31.7 days per patient. Of the 14 bridles placed, only one unintended tube removal occurred. Discussion Bridling of nasoenteric feeding tubes is a safe and effective method for preventing unintended tube dislodgement, leading to improved patient care in the pediatric surgical population less than 1 year old. On the basis of our institution's results, ongoing continuing education for use and care of nasoenteric feeding tubes is recommended for the pediatric surgical population.

Postoperative symbiotic in patients with head and neck cancer: a double-blind randomised trial.

Studies on the 'gut origin of sepsis' have suggested that stressful insults, such as surgery, can affect intestinal permeability, leading to bacterial translocation. Symbiotics have been reported to be able to improve gut permeability and modulate the immunologic system, thereby decreasing postoperative complications. Therefore we aimed to evaluate the postoperative use of symbiotics in head and neck cancer surgical patients for intestinal function and permeability, as well as the postoperative outcomes. Patients were double-blind randomised into the symbiotic (n 18) or the control group (n 18). Samples were administered twice a day by nasoenteric tube, starting on the 1st postoperative day until the 5th to 7th day, and comprised 109 colony-forming units/ml each of Lactobacillus paracasei, L. rhamnosus, L. acidophilus, and Bifidobacterium lactis plus 6 g of fructo-oligosaccharides, or a placebo (6 g of maltodextrin). Intestinal function (day of first evacuation, total stool episodes, stool consistency, gastrointestinal tract symptoms and gut permeability by diamine oxidase (DAO) enzyme) and postoperative complications (infectious and non-infectious) were assessed. Results of comparison of the pre- and postoperative periods showed that the groups were similar for all outcome variables. In all, twelve patients had complications in the symbiotic group v. nine in the control group (P>0·05), and the preoperative-postoperative DAO activity ranged from 28·5 (sd 15·4) to 32·7 (sd 11·0) ng/ml in the symbiotic group and 35·2 (sd 17·7) to 34·1 (sd 12·0) ng/ml in the control group (P>0·05). In conclusion, postoperative symbiotics did not impact on intestinal function and postoperative outcomes of head and neck surgical patients.

Establishing Decision Trees for Predicting Successful Postpyloric Nasoenteric Tube Placement in Critically Ill Patients.

Despite the use of prokinetic agents, the overall success rate for postpyloric placement via a self-propelled spiral nasoenteric tube is quite low. This retrospective study was conducted in the intensive care units of 11 university hospitals from 2006 to 2016 among adult patients who underwent self-propelled spiral nasoenteric tube insertion. Success was defined as postpyloric nasoenteric tube placement confirmed by abdominal x-ray scan 24 hours after tube insertion. Chi-square automatic interaction detection (CHAID), simple classification and regression trees (SimpleCart), and J48 methodologies were used to develop decision tree models, and multiple logistic regression (LR) methodology was used to develop an LR model for predicting successful postpyloric nasoenteric tube placement. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of these models. Successful postpyloric nasoenteric tube placement was confirmed in 427 of 939 patients enrolled. For predicting successful postpyloric nasoenteric tube placement, the performance of the 3 decision trees was similar in terms of the AUCs: 0.715 for the CHAID model, 0.682 for the SimpleCart model, and 0.671 for the J48 model. The AUC of the LR model was 0.729, which outperformed the J48 model. Both the CHAID and LR models achieved an acceptable discrimination for predicting successful postpyloric nasoenteric tube placement and were useful for intensivists in the setting of self-propelled spiral nasoenteric tube insertion.

IMPLEMENTAÇÃO DE DIAGNÓSTICOS E CUIDADOS DE ENFERMAGEM PÓS SONDA NASOENTERAL EM SERVIÇO DE EMERGÊNCIA

O objetivo deste estudo foi identificar a frequência de diagnósticos de enfermagem e cuidados relacionados à inserção e manutenção de sonda nasoenteral. Coorte prospectiva de adultos de uma emergência, em hospital universitário do sul do Brasil, entre abril e julho de 2015. Os pacientes foram acompanhados da indicação ao uso da sonda nasoenteral. Prontuários foram revisados para identificar diagnósticos de enfermagem e cuidados nas 24 horas após a inserção. Das 150 inserções de sonda, 20,7% (n=31) tiveram algum diagnóstico de enfermagem relacionado. “Nutrição desequilibrada: menos que as necessidades corporais” foi o mais frequente (n=22, 71%). Em 64 (42,7%) do total de inserções houve prescrição de pelo menos um cuidado. “Implementar cuidados com sonda” foi prescrito 41 vezes de forma isolada ou combinada. Houve maior proporção de cuidados quando havia diagnósticos de enfermagem implementados (p<0,001). Observa-se que, apesar da utilização da sonda nasoenteral exigir diferentes cuidados, a implementação de diagnósticos de enfermagem e cuidados em emergência ainda são baixas.

Absenteísmo, rotatividade e indicadores de qualidade do cuidado em enfermagem: estudo transversal

Aim: to analyze the indexes of absenteeism and turnover, and their relationship with quality indicators in assistance. Method: this is a transversal study, performed with records of absences/changes of 59 nursing professionals of an intensive care unit; records of quality/incidence indicators, and medical records of the 108 patients hospitalized during the period of data collection. The coefficient of linear correlation was used among the indicators of assisting management and quality control. Results: the average rate of absenteeism was 9.41% (of nurses) and 12.52% (of technicians); turnover rates reached 2.53% (nurses), and 3.57% (technicians). There was a strong correlation (r>0.7) between: turnover of nurses and the incidence of accidental extubation (p=0.464); rate of absenteeism among technicians and the loss of nasoenteral tube (p=0.300); pressure injury (p=0.100) and loss of central catheter (p=0.200), which was also correlated with the rate of absenteeism of nurses (p=0.113). Conclusion: the results demonstrated can subsidize new approaches for the management of personnel and better assistance, aiming to reduce the damages to the patient.

Safety and Efficacy of Electromagnetic-Guided Bedside Placement of Nasoenteral Feeding Tubes versus Standard Placement

Although enteral feeding in critically ill patients has been shown to be beneficial, reliable postpyloric placement of feeding tubes remains a challenge. The standard of care involves blind placement, frequently requiring multiple attempts, and radiographs. To evaluate the effect of electromagnetic-guided bedside placement in reducing time to establishment of feeding, lung placement, use of radiography, and cost, we initiated a prospective trial using electromagnetic-guided bedside placement and compared them to a retrospective cohort. Fifty-three consecutive placements of nasoenteral feeding tubes were made using electromagnetic-guidance on patients requiring enteral nutrition in a surgical intensive care unit at a tertiary care center. Sixty-three placement attempts in the preceding seven months served as controls. There were no significant differences between the two groups in terms of age, sex, weight, body mass index, hiatal or ventral hernias, or previous esophageal/gastric operations. The number of radiographs needed per patient, need for fluoroscopy, radiology charge per patient for the tube placement, and time from first attempt at placement to confirmation of postpyloric location were lower for the electromagnetic-guided group. Use of electromagnetic guidance allows reliable and cost-effective postpyloric enteral feeding tube placement compared with blind insertion.

High versus low energy administration in the early phase of acute pancreatitis (GOULASH trial): protocol of a multicentre randomised double-blind clinical trial

IntroductionAcute pancreatitis (AP) is an inflammatory disease with no specific treatment. Mitochondrial injury followed by ATP depletion in both acinar and ductal cells is a recently discovered early event in...

Role of Ultrasonography in Detecting the Localisation of the Nasoenteric Tube.

In this study, we aimed to determine the success rate of nasoenteric tube (NET) insertion into the postpyloric area using ultrasonography (USG) and compare with the commonly used method direct abdominal graphy. A single anaesthesiologist placed all the NETs. The NET was visualised by two radiologists simultaneously using USG. The localisation of the tube was confirmed using an abdominal graph in all patients. The blind bedside method was used for NET insertion into 34 patients. Eleven of the tubes were detected passing through the postpyloric area using USG. In one case, the NET could not be visualised in the postpyloric area using USG; however, it was detected in the postpyloric area through control abdominal radiography. In 22 patients, NETs were detected in the stomach using control abdominal radiography. The rate of imaging post pyloric using USG was 91.6%. When all cases were considered, catheter localisation was detected accurately using USG by 97% (33 in 34 patients). USG is a reliable and practical alternative to radiography, which can be used to detect localisation of the nasogastric tube and NET.

Self-Expanding Metal Stents Improve Swallowing and Maintain Nutrition During Neoadjuvant Therapy for Esophageal Cancer.

Patients with locally advanced esophageal cancer can have significant dysphagia. Nutritional support during neoadjuvant therapy is often delivered via nasoenteric or percutaneous feeding tubes. These approaches do not allow for per-oral feeding. Evaluate the safety and efficacy of fully covered self-expanding metal esophageal stents for nutritional support during neoadjuvant therapy. This was a pilot, prospective study at a single tertiary center. From March 2012 to May 2013, consecutive patients with esophageal cancer eligible for neoadjuvant therapy were enrolled. Metal stents were placed prior to starting neoadjuvant therapy. Data were collected at baseline and predetermined intervals until an endpoint (surgery or disease progression). Outcomes included dysphagia grade, satisfaction of swallowing score, nutritional status (weight, serum albumin), impact on surgery, and adverse events. Fourteen stents were placed in 12 patients (59.1±9.5years, 11 men, 1 woman). Dysphagia grade (pre 3.4±0.5 vs post 0.2±0.4, p<0.0001) and swallowing scores (20.2±5.9 vs 6.3±4.7, p<0.0001) significantly improved after stent placement. Improvements were sustained throughout neoadjuvant therapy. Body weight and serum albumin levels remained stable. Adverse events included severe chest pain (2), food impaction (1), and delayed stent migration (2). Five patients underwent surgical resection. No significant chemoradiation or operative adverse events occurred due to the presence of a stent. During neoadjuvant therapy for esophageal cancer, self-expanding metal stents are safe and effective in relieving dysphagia and maintaining nutrition. They allow patients to eat orally, thereby improving patient satisfaction. The presence of an in situ stent did not interfere with surgery.

Nasoenteral tube: factors associated with delay between indication and use in emergency services.

to know the time between indication and use of a nasoenteral tube (NET) and factors associated with delays. A prospective cohort study that followed adults in a Brazilian emergency department, since the indication of the use of a NET, evaluating clinical variables and the work process. The Generalized Estimated Equations model was adopted to identify factors associated with the delays in each stage of the process. the time between indication and use of NET was 573 (IQR: 3601,093) minutes, in 150 insertions of NET. Insertions in patients who previously did not use it; delays in the medical, nutrition, and nursing care routine; use of mechanical ventilation; noradrenaline; and fasting were factors for longer time before the use of the tube. the time between indication and use of NET was high, exceeding 10 hours in half of the cases. Factors related to the clinical condition of the patient and to the care management would contribute to delays.

32-Year-Old-Woman With Abdominal Pain

32-Year-Old-Woman With Abdominal Pain

Application of bronchoscope for the placement of nasoenteric feeding tube in patients with esophagectomy: a novel technique.

Currently the available techniques for the placement of nasoenteric feeding tube (NET), utilizing transnasal gastroscope are fast and tolerable, which is known as the most popular method. However, lots of hospitals don't have this endoscopic system. Bronchoscope, which is the basic respiratory endoscope, not only has the advantages of transnasal endoscopy, but also is popular in common hospitals. We used oxygen instillation as air supply plant of the bronchoscope, which broke its application limitation in digestive tract. The aim of this study is to evaluate the feasibility and availability of the method of placing NET with the bronchoscope in patients with esophagectomy. From January 2013 to January 2016, a total of 48 patients with esophagectomy who underwent NET placement with the bronchoscope were included in our study. Information concerning age, gender, as well as background disease of the patients was collected. The success rate, procedure duration, and complications were recorded for each patient. The technique success rate reached 100%, procedure time ranged from 150 to 750 s, with an average time of 257 s. All patients tolerated well under local anesthesia, no complication of epistaxis or perforation occurred. The new technique of placing NET with the bronchoscope is fast, safe, effective, and well tolerated for patients with esophagectomy.

Total parenteral nutrition in a twin pregnancy after suicide attempt with a corrosive substance

Introduction. Self-poisoning is not frequent during pregnancy. We present a successful treatment of a woman 20 weeks pregnant with twins with self-inflicted poisoning by a caustic substance. Case outline. A 34-year-old pregnant woman was admitted to our institution after self-inflicted poisoning with concentrated acetic acid. Initial clinical evaluation showed severe diffuse erythema of the mouth and oropharynx, a systemic inflammatory response syndrome, and dichorionic diamniotic twin pregnancy in the 20th week of gestation confirmed on abdominal ultrasound. An indirect laryngoscopic examination revealed severe generalized hyperemia of the laryngeal mucosa with corrosive changes in the pharyngeal mucosa, especially of the posterior pharyngeal wall. Due to pain, urgent esophagogastroduodenoscopy could not be performed, and because of the patient?s refusal a feeding gastrostomy or jejunostomy could not be created. The patient was given ?all-in-one? total parenteral nutrition in addition to other supportive therapy. Gradual introduction of enteral nutrition via a nasoenteric tube placed in the second month of hospitalization failed due to severe vomiting. After almost three months of total parenteral nutrition, enteral nutrition was nevertheless introduced; we then started with oral fluids, increasing gradually to a regular diet, and needed almost half a month to reach the adequate nutritional goal. The delivery was spontaneous at the 36th week of pregnancy and the patient gave birth to two normal healthy girls (46 cm / 2,580 g and 48 cm / 2,960 g, respectively). Conclusion. Total parenteral nutrition can be a safe choice for providing prolonged and adequate nutritional intake even in a twin pregnancy without adverse effects on fetal growth.

Is Selective Digestive Decontamination Useful for Critically Ill Patients?

In this study we review the rationale for using selective digestive decontamination (SDD) in critically ill patients, and its effects on clinical outcomes and rates of infection with antimicrobial-resistant microorganisms. SDD consists of the application of nonabsorbable antibiotics to the oropharynx and through a nasogastric or nasoenteral tube, in association with a 4-day course of an intravenous third-generation cephalosporin. The enteral component aims at preventing oral and rectal colonization with potentially pathogenic nosocomial aerobic gram-negative bacilli and yeasts while preserving normal protective anaerobic enteral flora. The short-course systemic component aims at eradicating oral endogenous gram-positive bacteria. SDD decreases the risk of nosocomial infections, and reduces by one-quarter the mortality of patients on mechanical ventilation in settings with low prevalence of antibiotic resistance. Evidence from randomized trials suggests that SDD does not increase rates of antimicrobial-resistant microorganisms, and may reduce resistance rates to some antibiotics. However, several limitations decrease our confidence on these data, particularly for settings with high baseline rates of antimicrobial-resistant microorganisms. Although SDD has a clear potential to improve clinical outcomes of critically patients, its long-term ecologic effects on rates of antimicrobial resistant require appropriate assessment by large multinational cluster randomized trials. Before these results are available, the use of SDD cannot be recommended in most parts of the world, except in settings with very low baseline prevalence of antibiotic resistance.

Clinical Outcome of Early Enteral Feeding on Patients Post Esophagectomy

Objectives: Aim of our work is to study the effect of early enteral feeding through either nasoentral or feeding jejunostomy tube post esophagectomy on patients recovery and hospital stay. Background: Postoperative nutrition is a well known aspect of care in recent years and has been shown to decrease the incidence of complications and hospital stay. Enteral nutrition has been shown to be superior to parenteral nutrition as it is more physiological, safer, cheaper and early enteral nutrition has been clearly confirmed to reduce postoperative morbidity. Methods: This is randomized combined retrospective and prospective study that is conducted in surgical oncology department, South Egypt cancer institute, Assiut University; from October 2012 to October 2016. Patients in this study were divided into two groups: group 1 includes patients with feeding jejunostomy and group 2 is patients with nasoenteral tube. Results: 25 Patients included in this study (19 males & 6 females). All cases were primarily diagnosed as esophageal cancer, middle and lower 1/3 esophagus or proximal gastric carcinoma infiltrating cardia by clinical data associated with abdominal sonar and/or C.T scan and upper endoscopy with biopsy. There was no significant difference in catheter related complications (P value 0.238). There was no operative mortality. Conclusion: Early postoperative enteral nutrition was feasible and safe for patients undergoing esophagectomy. There is no significant difference between NE and FJ. Enteral nutrition either through nasoenteral or feeding jejunostomy is an effective method for postoperative nutritional support in this type of major surgery.

Refeeding syndrome

Refeeding syndrome (RFS) is a clinical entity occurring in severely malnourished individuals, usually after initiation or reinitiation of definitive nutritional support. The clinical presentation is varied, and a high index of suspicion is required for diagnosis. The following case illustrates this condition: An 80-year-old male patient is admitted to the intensive care unit with delirium, dehydration and malnutrition. The patient is treated with intravenous fluids for volume repletion, and acute electrolyte abnormalities are being corrected. He responds well to this initial management. On hospital day #2, he is started on nasoenteric tube feeds providing approximately 1750 kcal/day. On hospital day #3, the patient begins to experience progressive shortness of breath, muscle weakness and peripheral edema. He then develops cardiac arrhythmia and electrolyte panel shows hypophosphatemia, hypomagnesemia, and hypokalemia. A diagnosis of RFS is made, and the patient is managed with correction of electrolyte abnormalities and continued provision of adequate caloric intake.The following core competencies are addressed in this article: Medical knowledge, Patient care.Republished with permission from: Prabhakaran S. Absite corner: Refeeding syndrome. OPUS 12 Scientist 2010;4(1):3-5.