A breath of fresh air: a quality-improvement study comparing an air-circulating technique versus conventional technique to prevent nasogastric tube dysfunction

BMC Nursing

Steven C. Cunningham¹  Joyce Harps²  Ikenna Ihim³  Murad Bani Hani³ 

[1] Pancreatic and Hepatobiliary Surgery, Saint Agnes Hospital, 900 Caton Avenue, MB 207, Baltimore 21229, MD, USA;The Department of Nursing, Saint Agnes Hospital, Baltimore, MD, USA;The Department of Surgery, Saint Agnes Hospital, Baltimore, MD, USA

关键词: Patient safety;    Pneumonia;    Aspiration;    Nasogastric tube;    NGT;   

Others  :  1234114
DOI  :  10.1186/s12912-015-0111-9

 received in 2014-11-05, accepted in 2015-11-09,  发布年份 2015

【 摘 要 】

Background

Nasogastric tubes are an important component of care in patients with gastrointestinal obstructions. However, they are prone to malfunction despite conventional flushing techniques, with potentially severe consequences. There is no widely accepted, gold-standard way to ensure that a nasogastric tube succeeds in maintaining an empty stomach following flushing.

Methods

We have developed a flushing technique to better ensure successful tube function. We compared this technique to conventional flushing both in vitro (using a plastic stomach model) and in vivo (in a pig model), and we provide a didactic video.

Results

The mean gastric residual volume following our novel flushing technique is nearly 25-fold lower than following conventional flushing (13 mL vs. 330 mL).

Conclusions

Our simple technique is more effective than conventional techniques in maintaining nasogastric tube function and therefore should prevent dangerous vomiting and aspiration pneumonia better than conventional techniques.

【 授权许可】

   
2015 Bani Hani et al.

【 图 表 】

Fig. 1.

Fig. 2.

Fig. 3.

Fig. 4.

Fig. 5.

【 参考文献 】

• [1]Kneuertz PJ, Cunningham SC, Cameron JL, Torrez S, Tapazoglou N, Herman JM, et al.: Palliative surgical management of patients with unresectable pancreatic adenocarcinoma: trends and lessons learned from a large, single institution experience. J Gastrointest Surg 2011, 15(11):1917-1927.
• [2]Cunningham SC, Choti MA: Bellavance EC. Pawlik TM, Palliation of hepatic tumors. Surg Oncol; 2007.
• [3]Cunningham SC, Schulick RD: Palliative management of gastric cancer. Surg Oncol 2007, 16(4):267-275.
• [4]Taylor MR, Lalani N: Adult small bowel obstruction. Acad Emerg Med 2013, 20(6):528-544.
• [5]DeLegge MH: Aspiration pneumonia: incidence, mortality, and at-risk populations. JPEN J Parenter Enteral Nutr 2002, 26(6 Suppl):S19-24.
• [6]Johnson AD: Assessing gastric residual volumes. Crit Care Nurse 2009, 29(5):72-73.
• [7]Makic MB, VonRueden KT, Rauen CA, Chadwick J: Evidence-based practice habits: putting more sacred cows out to pasture. Crit Care Nurse 2011, 31(2):38-61.
• [8]Williams TA, Leslie GD: A review of the nursing care of enteral feeding tubes in critically ill adults: part II. Intensive Crit Care Nurs 2005, 21(1):5-15.
• [9]Williams TA, Leslie GD: A review of the nursing care of enteral feeding tubes in critically ill adults: part I. Intensive Crit Care Nurs 2004, 20(6):330-343.
• [10]Sanko JS: Aspiration assessment and prevention in critically ill enterally fed patients: evidence-based recommendations for practice. Gastroenterol Nurs 2004, 27(6):279-285.
• [11]Ankrum JA, Olechowski A, Canseco JA, Greenblatt E, Roberts MP, Hanumara NC, et al.: Nasogastric tube design to reduce clogging and simplify flushing. J Med Devices 2011, 5:027510-1.
• [12]Lahiri SK: Preventing gastric regurgitation with a ballooned nasogastric tube. Ann R Coll Surg Engl 1987, 69(3):122-126.
• [13]Guenter P: Safe practices for enteral nutrition in critically ill patients. Crit Care NursClin North Am 2010, 22(2):197-208.
• [14]Bankhead R, Boullata J, Brantley S, Corkins M, Guenter P, Krenitsky J, et al.: Enteral nutrition practice recommendations. JPEN J Parenter Enteral Nutr 2009, 33(2):122-167.
• [15]Perry AG, Potter PA. Skill 34-4: Inserting and maintaining a nasogastric tube for gastric decompression. In: Ostendorf W, editor. Clinical Nursing Skills & Techniques, 7th Edition. Saint Louis, Missouri: Mosby Elsevier; 2010.
• [16]NGT 501 (Nasogastric Tube 501): How to Make This Tube Really Suck [http://www.youtube.com/watch?v=VHmQdCTfIzY]. Accessed December 4, 2014.
• [17]Chang WK, McClave SA, Lee MS, Chao YC: Monitoring bolus nasogastric tube feeding by the Brix value determination and residual volume measurement of gastric contents. JPEN J Parenter Enteral Nutr 2004, 28(2):105-112.
• [18]Chang WK, McClave SA, Hsieh CB, Chao YC: Gastric residual volume (GRV) and gastric contents measurement by refractometry. JPEN J Parenter Enteral Nutr 2007, 31(1):63-68.
• [19]Chang WK, McClave SA, Chao YC: Continuous nasogastric tube feeding: monitoring by combined use of refractometry and traditional gastric residual volumes. Clin Nutr 2004, 23(1):105-112.
• [20]Reignier J, Mercier E, Le Gouge A, Boulain T, Desachy A, Bellec F, et al.: Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial. JAMA 2013, 309(3):249-256.
• [21]Williams TA, Leslie G, Mills L, Leen T, Davies H, Hendron D, et al. Frequency of Aspirating Gastric Tubes for Patients Receiving Enteral Nutrition in the ICU: A Randomized Controlled Trial. JPEN J Parenter Enteral Nutr. 2013.
• [22]Montejo JC, Minambres E, Bordeje L, Mesejo A, Acosta J, Heras A, et al.: Gastric residual volume during enteral nutrition in ICU patients: the REGANE study. Intensive Care Med 2010, 36(8):1386-1393.
• [23]Ahmad S, Le V, Kaitha S, Morton J, Ali T: Nasogastric tube feedings and gastric residual volume: a regional survey. South Med J 2012, 105(8):394-398.
• [24]Metheny NA, Stewart J, Nuetzel G, Oliver D, Clouse RE: Effect of feeding-tube properties on residual volume measurements in tube-fed patients. JPEN J Parenter Enteral Nutr 2005, 29(3):192-197.
• [25]McClave SA, Lukan JK, Stefater JA, Lowen CC, Looney SW, Matheson PJ, et al.: Poor validity of residual volumes as a marker for risk of aspiration in critically ill patients. Crit Care Med 2005, 33(2):324-330.
• [26]McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, et al.: Directors ASPENBo: 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(3):277-316.