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

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.

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