Causes of nasoenteral tube obstruction in tertiary hospital patients

Enteral nutritional support for an elderly critically ill patient with gastroesophageal reflux disease and situs inversus totalis: a case report

Herein, we present a case of serious protein-energy malnutrition in an elderly critically ill patient with situs inversus totalis. It was difficult to implement enteral nutrition in this patient for more than 2 months of hospitalisation in another hospital, and we applied electromagnetic navigation guidance to implement enteral nutrition after successful placement of nasojejunal tubes. We reviewed the management of enteral nutrition support.

Nurses' Knowledge in the Prevention and Management of Nasointestinal Tube Obstruction: A Cross Sectional Study

Background

The nasointestinal tube is a route of nutritional support for patients and maintaining patency is essential. Given the key role nurses play in the management and monitoring of these tubes, they need to have sufficient knowledge and skills to ensure the safety and well-being of the patients.

Objective

To investigate the status quo of nurses' knowledge of prevention and management of nasointestinal tube obstruction in six hospitals, and to analyze the influencing factors.

Methods

A cross-sectional survey was conducted using the convenience sampling method, applying a general information questionnaire and a questionnaire on knowledge of prevention and management of nasointestinal tube obstruction.

Results

A total of 268 valid questionnaires were collected. The mean score for nurses' knowledge was 47.65±4.09 out of a maximum possible score of 60 points on the questionnaire, with the score for storage and use of nutritional solutions being the lowest. The univariate analysis showed that there were statistically significant differences in the knowledge scores of nasointestinal tube prevention and management among nurses with different age, educational background, professional title, hospital grade, department, length of exposure to nasointestinal tubes, qualification of nasointestinal tube placement, and training experience. The multiple linear regression analysis showed that professional title, department and training experience were the influencing factors of nurses' knowledge of nasointestinal tube obstruction prevention and management. Specifically, nurses with higher professional titles, more training experiences, or those working in intensive care units and surgical departments were more likely to achieve higher total knowledge scores in the prevention and management of nasointestinal tube occlusion.

Conclusions 

The study shows that nurses' knowledge of nasointestinal tube obstruction prevention and management is in the upper-middle level. Nursing managers should strengthen systematic training and improve interdepartmental exchange to promote young nurses' knowledge and quality of nasointestinal tube care.

Qualitative study on the ability of neurological nurses to manage patients with indwelling gastrointestinal canal

Aim and objectives

This study aims to assess the proficiency of nurses in the neurology department in managing patients with indwelling gastrointestinal canal.

Background

Many critically ill patients in neurology departments require the placement of nasoenteric tubes to provide enteral nutrition. However, in clinical practice, there exists considerable variability in nurses' competencies regarding the management of patients with nasoenteric tubes. A thorough understanding of the challenges nurses face throughout the entire process of nasoenteric tube care and the development of targeted improvement measures are crucial for delivering enhanced patient care and facilitating patient recovery.

Design

A qualitative interview study.

Methods

From August to October 2023, 11 neurological nurses were recruited offline in three hospitals for semi-structured and in-depth interviews. The data analysis uses the KJ method to summarize and classify the themes from the semi-structured interview results, and then organize the themes into a coherent visual and logical path. The COREQ list is used.

Results

The researchers conducted semi-structured interviews with 11 neurology nurses from three hospitals using a purposive sampling method, of which 64% of the participants were female and 36% were male; the average age was 38.27 ± 7.85 years; 27% from the Department of Neurology, 73% from the Department of Neurosurgery; junior professional titles accounted for 18%, intermediate professional titles accounted for 64%, senior professional titles accounted for 18%; 27% of the subjects were head nurses and 73% were nurses. The study identified 5 themes: (1) Preparation and evaluation before intubation; (2) Enhancement of intubation success rates; (3) Prevention of complications; (4) Management of complications and emergencies; (5) The acquisition of relevant knowledge and experience. In clinical practice, the bedside blind insertion technique is random and has not yet formed a unified standard, and the specific operation details and techniques need to be further improved.

Conclusion

Disparities exist in the nursing capabilities of neurology nurses due to variations in their knowledge and experience regarding gastrointestinal canal management.

Medication delivery errors in outpatients with percutaneous endoscopic gastrostomy: effect on tube feeding replacement

Patients with enteral access usually receive oral drugs via feeding tubes and correct drug administration remains a challenge. The aim of this study was to identify common medication delivery errors (MDEs) in outpatients with percutaneous endoscopic gastrostomy (PEG) and evaluate their association with the need for tube replacement due to deterioration or clogging. A 2-year retrospective study that comprised adult outpatients with a placed/replaced PEG tube and whose electronic medical record included home medication was carried out. Treatment with medication that should not be crushed and administered through an enteral feeding tube was considered an MDE. We included 269 patients and 213 MDEs (20% of oral prescriptions) were detected in 159. Ninety-two percent of the medications associated with MDEs could be substituted by appropriate formulations. Tube replacement due to obstruction was needed in 85 patients. MDEs were associated with increased risk for tube replacement (OR 2.17; 95% CI 1.10-4.27). Omeprazole enteric-coated capsules were associated with the greatest risk (OR 2.24; 95% CI 1.01-4.93). PEG outpatients are highly exposed to MDEs, leading to a significant increase in the odds of tube replacement, mainly when treated with omeprazole. The use of appropriate alternative therapies would prevent unnecessary adverse events.

Incidence and time until the first traction or obstruction of the nasoenteral tube in hospitalized adults

OBJECTIVE

To determine incidence and time until first traction or obstruction of nasoenteral tube in hospitalized adults.

METHODS

Prospective double cohort study that included 494 adults who were users of nasoenteral tubes as inpatients in two clinical units and two surgical units in a teaching hospital. The occurrence of tube tractions and obstructions was monitored daily between 2017 and 2019. The Kaplan-Meier method was used to estimate time until the first event.

RESULTS

Tube traction occurred in 33% of the sample, and the incidence of the event was higher on the first five days of tube use. Tube obstruction incidence was 3.4% and grew as tube use time increased.

CONCLUSION

Traction incidence was higher at the beginning of the period of use, whereas obstruction incidence grew as tube use time increased.