Securing Orogastic and Nasogastric Tubes in Intubated Patients

Evolving Therapeutic Roles of Nasogastric Tubes: Current Concepts in Clinical Practice

Nasogastric tubes (NGT) have been in use for over 100 years and are still considered as essential and resuscitative tools in multiple medical specialties for acute and chronic care. They are vital for decompression of the stomach in the presence of bowel obstruction in the critically ill and useful as a conduit for the administration of medications and sometimes for short term parenteral nutrition. The placement of nasogastric tubes is relatively routine. However, they must be inserted and maintained safely and effectively to avoid serious and possibly even fatal associated complications. This review focuses on recent updates in research regarding nasogastric tubes. Cognizance of the recent advances in indications, contraindications, techniques of insertion, confirmation of correct positioning, securement, complications, management of complications, and state of the art research about the nasogastric tube is crucial for practitioners of all medical and surgical specialties.

Reducing Nares Acquired Pressure Injuries "Protect the Nares Because I Care" Project in Adult Inpatients: A Quality Improvement Project

PURPOSE

The purpose of this quality improvement (QI) project was to develop a preventive care bundle to reduce the incidence of nares acquired pressure injuries (NAPIs) to 3% in the adult inpatient population.

PARTICIPANTS AND SETTING

Participants included adult inpatients in a large, Magnet-designated, 664-bed academic medical center in the Midwestern United States.

APPROACH

Through our organization's "RUSH Way" QI model, we developed an evidence-based NAPI Bundle comprising a "T"-shaped hydrocolloid thin barrier, a tube holder securement device, patient assessments, and site checks. The project was initiated by a team of clinicians and administrators. An incidence report was conducted of hospital-wide existing NAPIs in 2015. A pilot QI project of the NAPI Bundle was implemented in the surgical intensive care unit (SICU) from January 2016 to May 2016 and then hospital-wide implementation began in June 2016. Data were collected on the incidence of NAPIs, and documentation of hydrocolloid dressing on the nose and intact, incidence of adverse events with hydrocolloid dressing, and hydrocolloid dressing changed every 3 days were evaluated.

RESULTS

In 2015, the house-wide baseline NAPI incidence rate was 4.9%. Data from the SICU pilot confirmed Bundle effectiveness, as zero NAPIs occurred during the pilot period. The hospital-wide expanded pilot in 2016 showed the NAPI rate to be 3.2%, and in 2017, the incidence rate was reduced to 1.4%, well below the 3% goal.

CONCLUSION

The NAPI Bundle implemented in our organization by RNs substantially reduced the incidence of adult inpatient NAPIs.