Nutrition Support Nurse Clinicians at a Central Texas tertiary care facility have developed a research-based nasoenteric feeding tube insertion procedure that minimizes the potential for inadvertent passage of a feeding tube containing a stylet into the respiratory tract and maximizes placement of the feeding tube in the desired gastric or duodenal location. The first 79 staff nurses to be certified to use the technique had a 90% duodenal placement success rate under supervision. No bedside feeding tube insertion complications have been noted since the initiation of the certification program 6 years ago. This article describes the feeding tube insertion technique used in the certification process and the research on which it is based.
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References
1.
Metheny N., Reed L., Wiersema L., et al. Effectiveness of pH measurements in predicting feeding tube placement: an update. Nurs Res1993;42:324-31.
2.
Hanson RLPredictive criteria for length of nasogastric tube insertion for tube feeding . JPEN1979;3:160-3.
3.
Metheny N.Minimizing respiratory complications of nasoenteric tube feedings: state of the science. Heart Lung1993;22:213-23.
4.
Strong RM, Condon SC, Solinger MR, et al. Equal aspiration rates from postpylorus and intragastric-placed small-bore nasoenteric feeding tubes: a randomized, prospective study. JPEN1992;16:59-63.
5.
Henderson JM , Strodel WE, Gilinsky NHLimitations of percutaneous endoscopic jejunostomy . JPEN1993;17:546-50.
6.
Vane DW, Shiffler M., Grosfeld JL, et al. Reduced lower esophageal sphincter (LES) pressure after acute and chronic brain injury. J Pediatr Surg1982 ;17:960-3.
7.
Mullan H., Roubenoff RA, Roubenoff R.Risk of pulmonary aspiration among patients receiving enteral nutrition support . JPEN1992;16:160-4.
Metheny NA, Eisenberg P., Spies M.Aspiration pneumonia in patients fed through nasoenteral tubes. Heart Lung1986;15:256-61.
10.
Montecalvo MA, Stegar KA, Farber HW, et al. Nutritional outcome and pneumonia in critical care patients randomized to gastric versus jejunal tube feedings . Crit Care Med1992 ;20:1377-87.
11.
Metheny N., Dettenmeier P., Hampton K., et al. Detection of inadvertent respiratory placement of small-bore feeding tubes: a report of 10 cases. Heart Lung1990;19:631-8.
12.
Roubenoff R. , Ravich WJPneumothorax due to nasogastric feeding tubes: report of four cases, review of the literature, and recommendations for prevention . Arch Intern Med1989;149:184-8.
13.
McWey RE , Curry NS, Schabel SI, et al. Complications of nasoenteric feeding tubes. Am J Surg1988 ;155:253-7.
14.
Gottlieb K. , Iber F.Techniques for avoiding complications with enteral feeding tubes. J Crit Illness1991 ;6:817-24.
Raff M., Cho S., Dale R.A technique for positioning nasoenteral feeding tubes. JPEN1987;11:210-3.
17.
Chang JL, Melnick B., Bedger R., et al. Inadvertent endobronchial intubation with nasogastric tube. Arch Otolaryngol1982;108:528-9.
18.
Griggs B., Hoppe M. Update: nasogastric tube feeding. AJN1979;Mar:481-5.
19.
Metheny N., Reed L., Worseck M., et al. How to aspirate fluid from small-bore feeding tubes. AJN1993;May:86-8.
20.
Welch JA, Dye JS, Games C., et al. Staff nurses' experiences as co-investigators in a clinical research project. Pediatr Nurs1990;16:364-96.
21.
Welch SK, Hanlon MD, Waits M., et al. Comparison of four bedside indicators used to predict duodenal feeding tube placement with radiography. JPEN1994;18:525-30.
22.
Nakao M., Killam D., Wilson R.Pneumothorax secondary to inadvertent nasotracheal placement of a nasoenteric tube past a cuffed endotracheal tube. Crit Care Med1983;11:210-1.
23.
Boyes RJ, Kruse JANasogastric and nasoenteric intubation. Crit Care Clin1992;8:865-78.
24.
Thurlow P.Bedside enteral feeding tube placement into duodenum and jejunum. JPEN1986:10:104-5.
25.
Zaloga GPBedside method for placing small bowel feeding tubes in critically ill patients-A prospective study. Chest1991 ;100:1643-6.
26.
Ugo P., Mohler P., Wilson G.Bedside postpyloric placement of weighted feeding tubes. Nutr Clin Pract1992;7:284-7.
27.
Metheny NA, Clouse RE, Clark JM, et al. pH testing of feeding-tube aspirates to determine placement . Nutr Clin Pract1994;9:185-90.
28.
Metheny N., Williams P., Wiersema L., et al. Effectiveness of pH measurements in predicting feeding tube placement. Nurs Res1987;38:280-5.
29.
Berry S., Schoettker P., Orr M.pH measurements as guide for establishing short-term postpyloric enteral access . Nutrition1994;10:419-23.
30.
Zaloga GPPrevention of infection with endogenous organisms. In Browne D, et al, eds. Treatment of radiation injuries. New York: Plenum Press , 1990:115-26.
31.
Posniak H., Gottlieb K., Mikolaitis S., et al. What happens to blindly placed nasoenteral tubes? J Am Coll Nutr1993;12:318.
32.
Marian M., Rappaport W., Cunningham D., et al. The failure of conventional methods to promote spontaneous transpyloric feeding tube passage and the safety of intragastric feeding in the critically ill ventilated patient. Surg Gynecol Obstet1993;176:475-9.
33.
Mercer L.Confirming location of feeding tubes. TMF Progr Notes1994;12:2.
34.
Kittinger J. , Sandler R., Heizer W.Efficacy of metoclopramide as an adjunct to duodenal placement of small-bore feeding tubes: a randomized, placebo-controlled, double-blind study. JPEN1987;11:33-7.
35.
Luchtefeld W. , Shapiro M., Durham R.Efficacy of metoclopramide in facilitating duodenal placement of small-bore feeding tubes in trauma patients . ASPEN, Abstract, 18th Clinical Congress, 1994.
36.
Lord L., Weiser-Maimone A., Pulhamus M., et al. Comparison of weighted vs. unweighted enteral feeding tubes for efficacy of transpyloric intubation. JPEN1993;17:271-3.
37.
West HHTopical anesthesia for nasogastric tube placement. Ann Emerg Med1982;11:645.
38.
Boyette DMLetter to the editor. AAO-HNS Bulletin, March 13, 1991.
