Incidence of Sinusitis Associated With Endotracheal and Nasogastric Tubes: NIS Database

Placement of Nasogastric Feeding Tube and Postinsertion Care Review

Insertion and postinsertion care of enteral nasogastric feeding tubes are common procedures in the United States, with more than 1.2 million temporary nasogastric feeding tubes inserted annually. Although there are some evidence-based practice guidelines and recommendations for care of these tubes, variation in practice still exists. Additional research is needed to determine the best methodology for insertion and confirmation of nasogastric feeding tubes. Routine competency and training on feeding tube insertion, enteral nutrition, and postinsertion care is crucial to prevent patient safety events. Variable results have been reported with different technologies; however, radiographic confirmation remains the criterion standard. It is important that health care institutions develop standardized procedures for insertion and confirmation on the basis of evidence-based practices to minimize risks and complications from temporary nasogastric feeding tubes.

Analysis of a Novel Nasoenteral Tube Design

Background: Tube patency is essential for patients who receive enteral nutrition via a small bore naso-enteral feeding tube. Formation of a clog within these tubes interrupts and delays delivery of nutrition. Unfortunately, current tubes are prone to clogging. A small-bore naso-enteral feeding tube that gradually increases in diameter over its length could mitigate the risk of clog formation.

Methods: Small-bore feeding tubes that increase in diameter over their length, were evaluated relative to current (constant diameter) tubes to determine if a tapered tube design could reduce the pressure required to clear an established clog in benchtop testing at pressures representative of those achieved safely in the clinical environment.

Results: Incorporating a tapered design into an 8F nasal feeding tube significantly reduced the pressure to expel an established clog by 62% (p < 0.05; 258.6 kPa vs. 710.8 kPa, respectively).

Conclusion: When compared to constant diameter tubes with the same proximal outside diameter, a tapered tube design permits clearance of an established clog at lower pressure.

An overview of percutaneous endoscopic gastrostomy tube placement in the intensive care unit

Critically ill patients are at increased risk for malnutrition as they often have underlying acute and chronic illness, stress related catabolism, decreased appetite, trauma and ongoing inflammation. Malnutrition is recognized as a leading cause of adverse outcomes, higher mortality, and increased hospital costs. Percutaneous endoscopic gastrostomy (PEG) tubes provide a safe and effective route to provide supplemental enteral nutrition to these patients. PEG placement has essentially replaced surgical gastrostomy as the modality of choice for longer term feeding in patients. This is a highly prevalent procedure with 160,000 to 200,000 PEG procedures performed each year in the United States. The purpose of this review is to provide an overview of current knowledge and practice standards with regards to placement of PEG tube in the Intensive Care Unit (ICU). When a patient is considered for a PEG tube, it is important to evaluate the treatment alternatives and identify the best option for each patient. In this review, we provide the advantages and disadvantages of various feeding modalities and devices. We review the indications and contraindications for PEG tube placement as well as the risks of this procedure. We then describe in detail the per-oral pull, per-oral push, and direct percutaneous techniques for PEG tube placement. Additionally, we review the feasibility of having interventional pulmonologists place PEG tubes in the ICU.

Development of a Competency Model for Placement and Verification of Nasogastric and Nasoenteric Feeding Tubes for Adult Hospitalized Patients

Nasogastric/nasoenteric (NG/NE) feeding tube placements are associated with adverse events and, without proper training, can lead to devastating and significant patient harm related to misplacement. Safe feeding tube placement practices and verification are critical. There are many procedures and techniques for placement and verification; this paper provides an overview and update of techniques to guide practitioners in making clinical decisions. Regardless of placement technique and verification practices employed, it is essential that training and competency are maintained and documented for all clinicians placing NG/NE feeding tubes. This paper has been approved by the American Society for Parenteral and Enteral Nutrition (ASPEN) Board of Directors.

Mortality and cause of death in patients with tracheostomy: Longitudinal follow-up study using a national sample cohort

BACKGROUND

The purpose of this study was to evaluate the long-term mortality and cause of death in patients with tracheostomy.

METHODS

Data from the Korean National Health Insurance Service-Health Screening Cohort were collected from 2002 to 2013. A total of 2394 tracheostomy participants and 9536 control participants were included in this study. The crude and adjusted hazard ratios (HRs) for tracheostomy-associated mortality were analyzed. Subgroup analysis according to age and cause of death was analyzed.

RESULTS

The tracheostomy group showed a significantly higher rate of death (69.1%) than the nontracheostomy group (13.3%). The adjusted HR for mortality was 13.5 in the tracheostomy group. The most common cause of death after tracheostomy was a circulatory disease, followed by neoplasm, respiratory disease, and trauma.

CONCLUSIONS

Patients with tracheostomy had a significantly increased long-term mortality rate compared with patients with nontracheostomy. The circulatory disease was the most common cause of death following tracheostomy.