Sage Journals: Discover world-class research

Abstract

Background: To determine if a previously described protocol for small bowel feeding tube (SBFT) placement would be feasible for use in surgical/trauma/burn intensive care population; if limiting the number of a professionals placing the tubes would achieve a sufficient success rate for cost effectiveness; and to determine the effectiveness of a certified nutrition support dietitian (CNSD)/clinical nurse specialist (CNS) team approach to tube placement. Method: Prospective trial of bedside small bowel feeding tube placement by a CNS/CNSD team. The setting was an university-affiliated surgical/trauma/burn intensive care unit. A total of 74 patients were included in the study. Results: We successfully placed 64 of 74 (86.4%) SBFTs in our intensive care unit. The CNS successfully placed 32 of 38 tubes and the CNSD placed 32 of 36 tubes. Of the successfully placed tubes 41 (64%) were at or beyond the ligament of Treitz. Of the other 23 (36%), 6 were in the second portion of the duodenum, 12 were in the third portion of the duodenum and 5 were in the fourth portion of the duodenum. Of physicians and nurses surveyed, 100% were more satisfied with bedside SBFT placement vs fluoroscopy SBFT placement. Conclusions: Successful bedside placement of SBFT in a surgical/trauma/burn intensive care setting by a CNSD/CNS team approach is a feasible cost effective alternative to fluoroscopy SBFT placement.

Get full access to this article

View all access options for this article.

References

1. McMahon MM , Farnell MB , Murray MJ. Nutritional support of critically ill patients. Mayo Clin Proc 68:911–920, 1993

2. Saito H , Troki O , Alexander JW , et al. The effect of route of administration on the nutritional state, catabolic hormone secretion and gut mucosal integrity after burn injury. JPEN 11:1–7, 1987

3. Garrel DR , Davignon I , Lopez D. Length of care in patients with severe burns with or without early enteral nutritional support. J Burn Care & Rehabilitation 12:85–90, 1991

4. Kudsk KA , Croce MA , Fabian TC , et al. Enteral versus parenteral feeding: Effects on septic morbidity after blunt and penetrating abdominal trauma. Ann Surg 215:503–511, 1992 _

5. Lipman TO. Grains or veins: Is enteral nutrition really better than parenteral nutrition? A look at the evidence. JPEN 22:167–182, 1998

6. Carr CS , Ling E , Boulous P , et al. Randomized trial of safety and efficacy of immediate postoperative enteral feeding in patients undergoing gastrointestinal resection. BMJ 312:869–871, 1996

7. Montejo JC. Enteral nutrition-related gastrointestinal complications in critically ill patients. A multicenter study. Crit Care Med 27:1447–1453, 1999

8. Heyland D , Cook DJ , Winder B , et al. Enteral nutrition in the critically ill patient: A prospective study. Crit Care Med 23:1055–1060, 1995

9. Zaloga GP. Bedside method for placing small bowel feeding tubes in critically ill patients. Chest 100:1643–1646, 1991

10.

10. Lord LM , Weiser-Mainone A , Pulhamus M , et al. Comparison of weighted vs unweighted enteral feeding tubes for efficacy of transpyloric intubation. JPEN 17:271–273, 1993

11.

11. Thurlow PM. Bedside enteral feeding tube placement into duodenum and jejunum. JPEN 10:101–105, 1986

12.

12. Ahmed W , Levy H , Kudsk K , et al. The rates of spontaneous transpyloric passage of three enteral feeding tubes. Nutr Clin Prac 14:107–110, 1999

13.

13. American Society for Parenteral and Enteral Nutrition . Standards of Practice for Nutrition Support Dietitians. NCP 15:53–59, 2000

14.

14. Methany N , Stewart B , Smith L , et al. pH and concentration of bilirubin in feeding tube aspirates as predictors of tube placement. Nurs Research 48:189–197, 1999

15.

15. Hedberg AM , Lauson DR , Aday LA , et al. Effectiveness of an early postoperative enteral feeding protocol. J Clin Outcome Mgmt 5:21–28, 1998

16.

16. Moore FA , Moore EE , Jones TN , et al. TEN versus TPN following major abdominal trauma reduced septic morbidity. J Trauma 29:916–922, 1989

17.

17. Cook D , Heyland D , Griffith L , et al. Risk factors for clinically important upper gastrointestinal bleeding in patients requiring mechanical ventilation. Crit Care Med 27:2812–2817, 1999

18.

18. Moncure M , Samaha E , Moncure K , et al. Jejunostomy tube feedings should not be stopped in the perioperative patient. JPEN 23:356–359, 1999

Bedside Small Bowel Feeding Tube Placement in Critically III Patients Utilizing a Dietitian/Nurse Team Approach

Abstract

Get full access to this article

References