Risk of Aspiration in Icu Patients Undergoing Enteral Tube Feeding
Gastric Residual Volume and Aspiration in Critically Ill Patients Receiving Gastric Feedings
Introduction
Many times, enteral tubes are used to feed critically ill patients and obtain gastric decompression. Proper procedure when conducting enteral tube feeding is imperative to ensure there is not an unacceptable risk of aspiration to such patients. The self-care theory can be used to apply clinical care to critically ill patients regarding the issues around their enteral tube feeding when viable and how they may increase their health and well being during and after their hospital stay (Grando, 2005).
Literature Review The use of enteral tubes is commonly used for critically ill patients, therefore, Williams and Leslie (2004) conducted a study to determine nurses’ knowledge and practices regarding placement of these tubes. The researchers used a computerized literature review and an evidence-based classification system to study enteral tube management. First, they found that evidence to support placement of the tube in locations other than the abdomen was inconclusive. Nevertheless, they found that nurses often withheld feeding unnecessarily and instead enteral feeding should continue if gastric residual volumes are not excessive. In addition, nurses should frequently check gastric residual volumes at various intervals, however, “prokenitics that aid gastric emptying should be used if absorption of feeds is problematic” (p. 330). In addition, nurses were aware that contamination of feeding tubes can be decreased through careful and meticulous handing of the apparatus and the use of closed systems rather than open systems. Barr, McQuiggan, Kozar, and Moore (2004) also examined gastric feeding as an extension of enternal nutrition protocol. Nurses who indiscriminately used gastric feeding for critically ill patients may impose an unacceptable risk of aspiration. Thus, the researchers developed a protocol to identify patients who need to be fed
Introduction
Many times, enteral tubes are used to feed critically ill patients and obtain gastric decompression. Proper procedure when conducting enteral tube feeding is imperative to ensure there is not an unacceptable risk of aspiration to such patients. The self-care theory can be used to apply clinical care to critically ill patients regarding the issues around their enteral tube feeding when viable and how they may increase their health and well being during and after their hospital stay (Grando, 2005).
Literature Review The use of enteral tubes is commonly used for critically ill patients, therefore, Williams and Leslie (2004) conducted a study to determine nurses’ knowledge and practices regarding placement of these tubes. The researchers used a computerized literature review and an evidence-based classification system to study enteral tube management. First, they found that evidence to support placement of the tube in locations other than the abdomen was inconclusive. Nevertheless, they found that nurses often withheld feeding unnecessarily and instead enteral feeding should continue if gastric residual volumes are not excessive. In addition, nurses should frequently check gastric residual volumes at various intervals, however, “prokenitics that aid gastric emptying should be used if absorption of feeds is problematic” (p. 330). In addition, nurses were aware that contamination of feeding tubes can be decreased through careful and meticulous handing of the apparatus and the use of closed systems rather than open systems. Barr, McQuiggan, Kozar, and Moore (2004) also examined gastric feeding as an extension of enternal nutrition protocol. Nurses who indiscriminately used gastric feeding for critically ill patients may impose an unacceptable risk of aspiration. Thus, the researchers developed a protocol to identify patients who need to be fed
References: Barr, A.B., McQuiggan, M.M., Kozar, R., & Moore, F.A. (2004). Gastric feeding as an extension of an established enteral nutrition protocol. Nutrition in Clinical Practice, 19(5), 504-510. Grando, V.T. (2005). A self-care deficit nursing theory practice model for advanced practice psychiatric/mental health nursing. The Official Journal of the International Orem Society, 13(1), 4-8. Kumar, Coleen P. (2007). Application of Orem’s self-care deficit theory and standardized nursing languages in a case study of a woman with diabetes. International Journal of Nursing Terminologies and Classifications, 18(3), 103- 110. Mirr Jansen, M.P. & Zwygart-Stauffacher (2006). Advanced practice nursing: Core concepts for professional role development. New York: Springer Publishing Company. Williams, T.W. & Leslie, G.D. (2004). A review of the nursing care of enteral feeding tubes in crucially ill adults: Part I. Intensive and Critical Care Nursing, 20(6), 330-343.