Some advanced practice nutrition support dietitians have added small bowel feeding tube placement to their scope of responsibility. This is due, in part, to the challenges of gaining early enteral access in patients with functioning GI tracts. Emerging literature supports the practice of skilled practitioners placing feeding tubes at bedside. A variety of methods can be used to place tubes at the bedside. The nutrition support dietitian must understand licensure and liability considerations to perform this invasive procedure. This article will review literature reports of dietitians placing feeding tubes and provide information on the methods used, training and competencies required, and legal issues involved.
BlochAMailletJOWinklerMFHowellWH. Issues and Choices in Clinical Nutrition Practice. Philadelphia, PA: Lippincott Williams & Wilkins; 2007:6-7.
2.
Joint Standards Task Force of A.S.P.E.N. and the American Dietetic Association Dietitians in Nutrition Support Dietetic Practice Group; RussellMSteiberMBrantleyS. American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) and American Dietetic Association (ADA): Standards of practice and standards of professional performance for registered dietitians (generalist, specialty, and advanced) in nutrition support. Nutr Clin Pract. 2007;22:558-586.
3.
McClaveSAMartindaleRGVanekVW; A.S.P.E.N. Board of Directors; American College of Critical Care Medicine; Society of Critical Care Medicine. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2009;33:277-316.
4.
PeterJMoranJPhillips-HughesJ. A meta-analysis of treatment outcomes of early enteral versus early parenteral nutrition in hospitalized patients. Crit Care Med. 2005;33:213-220.
5.
TaylorBSchallomL. Bedside small bowel feeding tube placement in critically ill patients utilizing a dietitian/nurse team approach. Nutr Clin Pract. 2001;16:258-262.
6.
CresciGMartindaleR. Bedside placement of small bowel feeding tubes in hospitalized patients: a new role for the dietitian. Nutrition. 2003;19:843-846.
7.
JimenezLRamageJ. Benefits of postpyloric enteral access replacement by a nutrition support dietitian. Nutr Clin Pract. 2004;19:518-522.
8.
GrayRTynanCReedL. Bedside electromagnetic feeding tube placement: an improvement over traditional technique?Nutr Clin Pract. 2007;22:436-444.
9.
MeyerRHarrisonSCooperMHabibiP. Successful blind placement of nasojejunal tubes in a pediatric intensive care unit. J Adv Nurs. 2007;60;402-408.
10.
LeeAJEveRBennettMJ. Evaluation of a technique for blind placement of post-pyloric feeding tubes in intensive care: application in patients with gastric ileus. Intensive Care Med. 2006;32:553-556.
11.
LordLWeiser-MaimoneAPulhamusMSaxH. Comparison of weighted vs. unweighted enteral feeding tubes for efficacy of transpyloric intubation. JPEN J Parenter Enteral Nutr. 1993;17:271-273.
12.
RobertsSEcheverriaPGabrielS. Devices and techniques for enteral bedside tube placement. Nutr Clin Pract. 2007;22:412-420.
13.
CresciGMellngerJ. History of nonsurgical enteral tube feeding access. Nutr Clin Pract. 2006;21:522-528.
14.
WhatleyKTurnerWWDeyMLeonardJGuthrieM. When does metoclopramide facilitate transpyloric intubation?JPEN J Parenter Enteral Nutr. 1984;8:679-681.
15.
PazHLWeinarMShermanMS. Motility agents for the placement of weighted and unweighted feeding tubes in critically ill patients. Intensive Care Med. 1996;22:301-304.
16.
SalasidisRFleiszerTJohnstonR. Air insufflation technique of enteral tube insertion: a randomized, controlled trial. Crit Care Med. 1998;26:1036-1039.
17.
SlagtCInnesRBihariDLawrenceJShehabiY. A novel method for insertion of post-pyloric feeding tubes at the bedside without endoscopic or fluoroscopic assistance: a prospective study. Intensive Care Med. 2004;30:103-107.
18.
ZalogaGP. Bedside method for placing small bowel feeding tubes in critically ill patients. Chest. 1991;100:1643-1646.
19.
LevyHHayesJBoivinMTombaT. Transpyloric feeding tube placement in critically ill patients using electromyogram and erythromycin infusion. Chest. 2004;125:587-591.
20.
GabrielSAckermannR. Placement of nasoenteral feeding tubes using external magnetic guidance. JPEN J Parenter Enteral Nutr. 2004;28:119-122.
21.
KearnsPJDonnaC. A controlled comparison of traditional feeding tube verification methods to a bedside, electromagnetic technique. JPEN J Parenter Enteral Nutr. 2001;25:210-215.
22.
GrayRReedLHandalP. Enhanced access for delivery of enteral feedings in the intensive care unit utilizing a team approach and an electromagnetic tube placement device [abstract]. Nutr Clin Pract. 2006;21:238. Abstract NP86.
23.
AckermanMMickDBianchiC. The effectiveness of the Cortrak device in avoiding lung placement of small bore enteral feeding tubes [abstract]. Am J Crit Care. 2004;13:268.
24.
PhangJMarshWPragerR. Feeding tube placement with the aid of a new electromagnetic transmitter [abstract]. JPEN J Parenter Enteral Nutr. 2006;30:S48-S49. Abstract SO82.
25.
O’MearaDMireles-CabodevilaEFrameF. Evaluation of delivery of enteral nutrition in critically ill patients receiving enteral nutrition. Am J Crit Care. 2008;17:53-61.
26.
RassiasABallPCorwinHL. A prospective study of tracheopulmonary complications associated with the placement of narrow-bore enteral feeding tubes. Crit Care. 1998;2:1-4.
27.
TynanCReedL. Placement of SBFT by advance practice dietitians: common practice?Support Line. 2008;4:12-18.
Department of Health & Human Services, Centers for Medicare & Medicaid Services. Centers for Medicare & Medicaid Services (CMS) Requirements for Hospital Medical Staff Privileging. Ref. S&C-05-04. November12, 2004. Centers for Medicare & Medicaid Services Website. http://www.cms.hhs.gov/SurveyCertificationGenInfo/downloads/SCLetter05-04.pdf. Accessed March 17, 2009.
30.
HagerMHMcCauleySM. Clinical privileging…what it is and isn’t. J Am Diet Assoc. 2009;109:400-402.
31.
PalmerS. Dietitians in the legal line of fire. Today’s Dietitian. 2008;10:52.
