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Abdelhadi R, Lyman B, Pollard KG, Reddick C, Bonvechio J, Fleming B, Yeselson M. Troubleshooting pediatric gastrostomy-ENFit inaccuracies. Nutr Clin Pract 2024; 39:256-257. [PMID: 37933408 DOI: 10.1002/ncp.11072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 07/26/2023] [Indexed: 11/08/2023] Open
Affiliation(s)
- Ruba Abdelhadi
- Department of Gastroenterology, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Beth Lyman
- Nutrition Support Nurse Consultant, Kansas City, USA
| | | | - Cynthia Reddick
- Home Enteral Nutrition Consultant, Sacremento, California, USA
| | - Jennifer Bonvechio
- Department of Pharmacy, Medication Safety, Akron Children's Hospital, Akron, Ohio, USA
| | - Barbara Fleming
- Neonatal Critical Care Unit, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Molly Yeselson
- Patient Advocate and Home Parenteral and Enteral Nutrition Consumer, Washington, District of Columbia, USA
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Hunt CE, Kemper C, Pauley R, Rempel G, Visscher D, Northington L, Lyman B, Irving SY. Reducing the risk of nasogastric tube misplacement: Nurse leader responsibility in implementing evidence-based practice. Nurs Manag (Harrow) 2023; 54:34-41. [PMID: 37772898 DOI: 10.1097/nmg.0000000000000059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Affiliation(s)
- Cheri Erekson Hunt
- Cheri Erekson Hunt is a nurse consultant, retired pediatric nurse leader, and former senior vice president for Patient Care Services and CNO at Children's Mercy Hospital in Kansas City, Mo. Carol Kemper is the senior vice president performance excellence at Children's Mercy Kansas City in Kansas City, Mo. Rosemary Pauley is an NP in Pediatric Gastroenterology at Boys Town Research Hospital in Boys Town, Neb. Gina Rempel , a neurodevelopmental pediatrician specializing in enteral and oral feeding safety, is an associate professor in Pediatrics and Child Health and a director of nutrition support at Children's Hospital of Winnipeg in Winnipeg, Manitoba, Canada. Deahna Visscher is the mother of an infant, Grant, who passed away in 2008 from complications related to an improperly placed feeding tube, and she is a patient safety advocate. LaDonna Northington is an emeritus professor of nursing at the University of Mississippi School of Nursing in Jackson, Miss. Beth Lyman is a nurse consultant, a semiretired pediatric nutrition support nurse, and the former senior program coordinator for the Nutrition Support Team at Children's Mercy Kansas City in Kansas City, Mo. Sharon Y. Irving is an associate professor in the Department of Family & Community Health at the University of Pennsylvania School of Nursing in Philadelphia, Pa., and the clinical nurse scientist for the Critical Care Center of Evidence and Outcomes at the Children's Hospital of Philadelphia
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Northington L, Kemper C, Rempel G, Lyman B, Pauley R, Visscher D, Moore C, Guenter P. Evaluation of methods used to verify nasogastric feeding tube placement in hospitalized infants and children - A follow-up study. J Pediatr Nurs 2022; 63:72-77. [PMID: 34763985 DOI: 10.1016/j.pedn.2021.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 10/19/2021] [Accepted: 10/22/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Nasogastric (NG) feeding tubes are used to deliver nutrition, hydration, and medications to hospitalized infants and children but the ongoing use of non-evidence-based practice (EBP) methods to confirm NG tube (NGT) placement has been associated with adverse patient events. METHODS A study was undertaken to ascertain if practice changes have occurred since findings from a previous study were published by the New Opportunities for Verification of Enteral tube Location (NOVEL) project. The NOVEL project was an initiative of the American Society of Parenteral and Enteral Nutrition (ASPEN). A survey was distributed to member organizations participating in the NOVEL project. Respondents were also asked if and when a change in practice occurred in the policy for NGT placement verification, if there was variation within the institutional units and if there were barriers to practice change. FINDINGS Respondents were primarily nurses (205/245) from 166 institutions that provided care to combined adult/pediatric/neonatal (122/166) patients. Respondents indicated a radiograph (64%) or pH measurement (24%) were best practice but in actual practice 42% use pH measurement and 23% use a radiograph to verify NGT placement. There was variability within institutions, with the Neonatal Intensive Care Unit (NICU) most often using aspiration and direct eye visualization to verify placement and the other units within the institutions using EBP method(s). DISCUSSION Comparing these results to previous work by the NOVEL project shows an increase toward the use of EBP method(s) to verify NGT placement verification. APPLICATION TO PRACTICE This study demonstrates variation within units at the same facility using methods unsupported by the literature, demonstrating that many centers still rely on non-EBP methods of NG placement confirmation, despite cautions issued by many major healthcare organizations.
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Affiliation(s)
- LaDonna Northington
- University of Mississippi Medical Center School of Nursing, 2500 North State Street, Jackson, MS 39216, United States of America.
| | - Carol Kemper
- Sr. Vice President, Service & Performance Excellence Improvement Center, Children's Mercy Kansas City, United States of America
| | - Gina Rempel
- Pediatric Rehabilitation & Complex Care Department of Pediatrics & Child Health, HSC Winnipeg Shared Health, Canada
| | - Beth Lyman
- Nutrition Support Nurse Consultant, LLC, United States of America
| | - Rosemary Pauley
- Boys Town National Research Hospital, United States of America
| | - Deahna Visscher
- Family Representative NOVEL Project, Patient Safety Advocate, United States of America
| | - Candice Moore
- Ambulatory Gastrointestinal and Liver Transplant Nurse, Cincinnati Children's Hospital, United States of America
| | - Peggi Guenter
- Special Projects Consultant, American Society for Parenteral and Enteral Nutrition (ASPEN), United States of America
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Powers J, Brown B, Lyman B, Escuro AA, Linford L, Gorsuch K, Mogensen KM, Engelbrecht J, Chaney A, McGinnis C, Quatrara BA, Leonard J, Guenter P. Development of a Competency Model for Placement and Verification of Nasogastric and Nasoenteric Feeding Tubes for Adult Hospitalized Patients. Nutr Clin Pract 2021; 36:517-533. [PMID: 34021623 DOI: 10.1002/ncp.10671] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/23/2021] [Accepted: 04/04/2021] [Indexed: 01/15/2023] Open
Abstract
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.
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Affiliation(s)
- Jan Powers
- Parkview Health System, Fort Wayne, Indiana, USA
| | - Britta Brown
- Nutrition Services Hennepin Healthcare Minneapolis, Minneapolis, Minnesota, USA
| | - Beth Lyman
- Nutrition Support Consultant, Smithville, Missouri, USA
| | - Arlene A Escuro
- Center for Human Nutrition, Digestive Disease and Surgery Institute Cleveland Clinic, Cleveland, Ohio, USA
| | - Lorraine Linford
- Nutrition Support/Vascular Team, Intermountain Healthcare Medical Center Murray, Salt Lake City, Utah, USA
| | - Kim Gorsuch
- Interventional GI and Pulmonology, Gastroenterology and Nutrition Support Clinic, Comprehensive Care and Research Center, Chicago, Zion, Illinois, USA
| | - Kris M Mogensen
- Department of Nutrition, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Amanda Chaney
- Department of Transplant, College of Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Carol McGinnis
- Sanford USD Medical Center, Sioux Falls, South Dakota, USA
| | - Beth A Quatrara
- Center of Interprofessional Collaborations School of Nursing, University of Virginia Charlottesville, Charlottesville, Virginia, USA
| | - Jennifer Leonard
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Peggi Guenter
- Clinical Practice, Quality, and Advocacy, American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
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Abstract
A common example of wrong route errors is when parenteral syringes are used to draw up medications that are then inadvertently administered into an intravenous line rather than an enteral feeding tube. With the transition to safer enteral syringes with ENFit connectors in the United States, it is critical that nurses use the correct enteral syringes to prepare and administer medications. These wrong route errors are still happening and the need to move to the safer connectors and use them appropriately is vital.
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Affiliation(s)
- Peggi Guenter
- American Society for Parenteral and Enteral Nutrition
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Lounsbury O, Tatro J, Lyman B, Prosser D, Coffey H. Clinical and Nonclinical Implications of Misplaced Nasogastric Tubes: Tools for Implementation of Standardized Best Practices. PatientSaf 2020. [DOI: 10.33940/med/2020.9.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The consequences of misplaced nasogastric tubes extend far beyond the clinical setting and have implications for the hospital’s reputation and economic stability. A systematic approach for nasogastric tube insertion and verification is necessary in order to prevent misplaced nasogastric tubes which are, indeed, “never events.” The Actionable Patient Safety Solutions (APSS) from the Patient Safety Movement Foundation outline best practices for implementation of nasogastric tube placement protocols in hospitals to ensure consistency across the organization and preserve patient safety at the forefront of all clinical endeavors.
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Lyman B, Cober MP. Letter to the editor regarding dosing accuracy of female low dose syringes. J Clin Pharm Ther 2020; 45:881-882. [DOI: 10.1111/jcpt.13138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 02/25/2020] [Accepted: 03/13/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Beth Lyman
- Children’s Mercy Kansas City Kansas City Missouri
| | - Mary Petrea Cober
- Neonatal Intensive Care Unit Akron Children’s Hospital Akron Ohio
- Pharmacy Practice College of Pharmacy Northeast Ohio Medical University Rootstown Ohio
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Affiliation(s)
- Beth Lyman
- Beth Lyman is currently a nutrition support nurse consultant and was the nutrition support team senior program coordinator at Children's Mercy Hospital in Kansas City, Mo. Lorraine Linford is a nutrition support clinic vascular access and tube team nurse manager at Intermountain Medical Center in Salt Lake City, Utah
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9
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Affiliation(s)
- Beth Lyman
- Beth Lyman is Co-Director of the Nutrition Support Team at Children's Mercy Hospital in Kansas City, Missouri.
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Irving SY, Rempel G, Lyman B, Sevilla WMA, Northington L, Guenter P. Pediatric Nasogastric Tube Placement and Verification: Best Practice Recommendations From the NOVEL Project. Nutr Clin Pract 2018; 33:921-927. [PMID: 30187517 DOI: 10.1002/ncp.10189] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The placement of a nasogastric tube (NGT) in a pediatric patient is a common practice that is generally perceived as a benign bedside procedure. There is potential risk for NGT misplacement with each insertion. A misplaced NGT compromises patient safety, increasing the risk for serious and even fatal complications. There is no standardized method for verification of the initial NGT placement or reverification assessment of NGT location prior to use. Measurement of the acidity or pH of the gastric aspirate is the most frequently used evidence-based method to verify NGT placement. The radiograph, when properly obtained and interpreted, is considered the gold standard to verify NGT location. However, the uncertainty regarding cumulative radiation exposure related to radiographs in pediatric patients is a concern. To minimize risk and improve patient safety, there is a need to identify best practice and to standardize care for initial and ongoing NGT location verification. This article provides consensus recommendations for best practice related to NGT location verification in pediatric patients. These consensus recommendations are not intended as absolute policy statements; instead, they are intended to supplement but not replace professional training and judgment. These consensus recommendations have been approved by the American Society for Parental and Enteral Nutrition (ASPEN) Board of Directors.
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Affiliation(s)
- Sharon Y Irving
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.,Department of Critical Care Nursing, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Gina Rempel
- Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada.,Children's Hospital Winnipeg, Winnipeg, Manitoba, Canada
| | - Beth Lyman
- Nutrition Support Team, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - Wednesday Marie A Sevilla
- Division of Pediatric Gastroenterology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - LaDonna Northington
- University of Mississippi Medical Center School of Nursing, Jackson, Mississippi, USA
| | - Peggi Guenter
- Clinical Practice, Quality, and Advocacy, American Society for Parenteral and Enteral Nutrition (ASPEN), Silver Spring, Maryland, USA
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Johnson J, Abraham T, Sandhu M, Peppers B, Lyman B, Knorzer C, Romanello G, Tcheurekdjian H, Hostoffer R. OR003 Common misconceptions in the recognition and treatment of anaphylaxis in community hospital based medical professionals. Ann Allergy Asthma Immunol 2017. [DOI: 10.1016/j.anai.2017.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
There is a lack of knowledge on the part of caregivers who need to place nasogastric (NG) tubes in children for enteral nutrition therapy. This article provides the rationale, best practices, and a template for caregiver education. Canadian and Australian programs have excellent patient education materials. They have shared these step-by-step procedures for healthcare professionals to provide to caregivers to whom they are teaching placement and care of NG tubes.
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Affiliation(s)
- Beth Lyman
- 1 Children's Mercy Kansas City, Kansas City, Missouri, USA
| | - Gina Rempel
- 2 Rady Faculty of Health Sciences, Max Rady College of Medicine University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kerrin Windsor
- 3 RN Delegation of Care Program-Northern Region Disability Services, Disability and Complex Care, Women's and Children's Health Network, Hilton, South Australia, Australia
| | - Peggi Guenter
- 4 American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
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Northington L, Lyman B, Guenter P, Irving SY, Duesing L. Current Practices in Home Management of Nasogastric Tube Placement in Pediatric Patients: A Survey of Parents and Homecare Providers. J Pediatr Nurs 2017; 33:46-53. [PMID: 28188079 DOI: 10.1016/j.pedn.2017.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 12/29/2016] [Accepted: 01/18/2017] [Indexed: 12/31/2022]
Abstract
UNLABELLED Enteral feeding tubes are used in pediatric patients to deliver nutrition, fluids or medications. The literature related to short-term feeding tube (nasogastric [NG], hereafter known as NGT, or orogastric [OGT],) use in pediatric homecare patients is sparse. This descriptive study sought to gather baseline information about these children and how their feeding tubes are managed at home. Specifically, we sought to better understand how the tubes are placed and the method(s) used for tube placement verification. Two surveys were distributed: one to parents and one to homecare providers who have direct patient contact. RESULTS Responses were obtained from 144 parents and 66 homecare providers. Over half of the children were 12months of age or younger and had a 6 Fr feeding tube. Over 75% (108) had an NGT for 1year or less. Predominantly parents replaced the NGT but a few children self-inserted their tubes. Feeding tube placement was verified by auscultation (44%) or measurement of gastric pH (25%) in the parent's survey. Twenty-six percent of parents indicated they had misplaced an NGT at least once and 35 parents described symptoms of pulmonary misplacement. The homecare provider data indicated auscultation (39%) and pH measurement of gastric contents (28%) to verify NG tube placement location. Study results confirms a need for consistency of practice among health care professionals and in parent education for those children who require NGTs at home. It is troubling that auscultation is still widely used for NGT location confirmation despite practice alerts that warn against its use.
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Affiliation(s)
- LaDonna Northington
- University of Mississippi Medical Center School of Nursing, 2500 North State Street, Jackson, MS 39216, USA.
| | - Beth Lyman
- Children's Mercy Hospital, 2401 Gillham Rd, Kansas City, MO 64108, USA.
| | - Peggi Guenter
- American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), 8630 Fenton St. Suite 412, Silver Spring, MD 20910, USA.
| | - Sharon Y Irving
- University of Pennsylvania, School of Nursing, Claire M. Fagin Hall, 418 Curie Blvd., RM 427, Philadelphia, PA 19104, USA.
| | - Lori Duesing
- Pediatric Neurosurgery, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
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Affiliation(s)
- Beth Lyman
- Children’s Mercy Hospital, Kansas City, Missouri, USA
| | | | | | - Ashley Hayden
- Children’s Mercy Hospital, Kansas City, Missouri, USA
| | - Pam Hensley
- Children’s Mercy Hospital, Kansas City, Missouri, USA
| | - Hongying Dai
- Children’s Mercy Hospital, Kansas City, Missouri, USA
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15
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Abstract
New enteral connectors are now available based on the development of standards using the International Organization of Standardization process to prevent misconnections between systems that should not connect. Enteral devices with the new patient access connectors, called ENFit, are being now introduced for the purpose of improving patient safety. Transitioning to these new connectors poses benefits and challenges for facilities or agencies implementing these new devices. Information from appropriate resources should be sought by clinicians who need to partner with their suppliers and clinical organizations to see how best to meet these challenges.
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Affiliation(s)
- Peggi Guenter
- 1 American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| | - Beth Lyman
- 2 Children's Mercy Hospital, Kansas City, Missouri, USA
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16
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Affiliation(s)
- Ruba A. Abdelhadi
- Enteral Access Team, Children’s Mercy Kansas City, Kansas City, Missouri, USA
| | - Katina Rahe
- Enteral Access Team, Children’s Mercy Kansas City, Kansas City, Missouri, USA
| | - Beth Lyman
- Nutrition Support Team, Children’s Mercy Kansas City, Kansas City, Missouri, USA
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Winkler MF, DiMaria-Ghalili RA, Guenter P, Resnick HE, Robinson L, Lyman B, Ireton-Jones C, Banchik LH, Steiger E. Characteristics of a Cohort of Home Parenteral Nutrition Patients at the Time of Enrollment in the Sustain Registry. JPEN J Parenter Enteral Nutr 2016; 40:1140-1149. [DOI: 10.1177/0148607115586575] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 04/21/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Marion F. Winkler
- Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | - Peggi Guenter
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| | - Helaine E. Resnick
- American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
| | | | - Beth Lyman
- Department of Gastroenterology, Children’s Mercy Hospital, Kansas City, Missouri, USA
| | | | | | - Ezra Steiger
- Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Patterson ML, Dominguez JM, Lyman B, Cuddy P, Pemberton LB. Response to Dr. Buchman's Letter. JPEN J Parenter Enteral Nutr 2016. [DOI: 10.1177/014860719101500630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Lyman B. Immediate postoperative enteral feeding decreases weight loss and improves wound healing after abdominal surgery in rats GARY P. ZALOGA, LARRY BORTENSCHLAGER, KIMBERLY WARD BLACK, ET AL Bowman Gray School of Medicine, Winston-Salem, North Carolina. Nutr Clin Pract 2016. [DOI: 10.1177/088453369200700607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lyman B. Methodological issues in the Development and Use of Instruments to Assess Patient Nutritional Status or the Level of Risk of Nutritional Compromise. Nutr Clin Pract 2016. [DOI: 10.1177/088453360001500412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Lyman B. Assessing hypermetabolism and hypometabolism in the postoperative critically ill patient C WEISSMAN, M KEMPER Columbia University, New York. Nutr Clin Pract 2016. [DOI: 10.1177/088453369300800415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Edwards S, Davis AM, Bruce A, Mousa H, Lyman B, Cocjin J, Dean K, Ernst L, Almadhoun O, Hyman P. Caring for Tube-Fed Children: A Review of Management, Tube Weaning, and Emotional Considerations. JPEN J Parenter Enteral Nutr 2015. [PMID: 25791833 DOI: 10.1177/0148607115577449.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Enteral nutrition is the practice of delivering nutrition to the gut either orally or through a tube or other device. Many children are reliant on enteral feedings to either supplement their nutrition or as a complete source of their nutrition. Managing children on tube feedings requires a team of providers to work through such dilemmas as feeding schedules, weaning from tube feeding, sensory implications of tube feeding, treatment of pain or nausea associated with eating, oral-motor issues, and behavioral issues in the child and family. The purpose of the current review is to summarize the multidisciplinary aspects of enteral feeding. The multidisciplinary team consists of a variable combination of an occupational therapist, speech-language pathologist, gastroenterologist, psychologist, nurse, pharmacist, and dietitian. Children who have minimal oral feeding experience and are fed via a nasogastric or gastrostomy tube often develop oral aversions. Limited data support that children with feeding disorders are more likely to have sensory impairment and that early life pain experiences contribute to feeding refusal. There are inpatient and outpatient programs for weaning patients from tube feeding to eating. The parent-child interaction is an important part of the assessment and treatment of the tube-fed child. This review also points out many information gaps, including data on feeding schedules, blenderized tube feedings, the best methods for weaning children off enteral feedings, the efficacy of chronic pain medications with tube-fed children, and, finally, the necessity of the assessment of parental stress among all parents of children who are tube fed.
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Affiliation(s)
- Sarah Edwards
- Children's Mercy Hospital and Clinics, Kansas City, MO
| | - Ann M Davis
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas Center for Children's Healthy Lifestyles & Nutrition, Kansas City, Missouri
| | - Amanda Bruce
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas Center for Children's Healthy Lifestyles & Nutrition, Kansas City, Missouri
| | | | - Beth Lyman
- Children's Mercy Hospital and Clinics, Kansas City, MO
| | - Jose Cocjin
- Children's Mercy Hospital and Clinics, Kansas City, MO
| | - Kelsey Dean
- Children's Mercy Hospital and Clinics, Kansas City, MO
| | - Linda Ernst
- Children's Mercy Hospital and Clinics, Kansas City, MO
| | - Osama Almadhoun
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas
| | - Paul Hyman
- New Orleans Children's Hospital, New Orleans, Louisiana
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Edwards S, Davis AM, Bruce A, Mousa H, Lyman B, Cocjin J, Dean K, Ernst L, Almadhoun O, Hyman P. Caring for Tube-Fed Children. JPEN J Parenter Enteral Nutr 2015; 40:616-22. [PMID: 25791833 DOI: 10.1177/0148607115577449] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 02/10/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Sarah Edwards
- Children’s Mercy Hospital and Clinics, Kansas City, MO
| | - Ann M. Davis
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas
- Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, Missouri
| | - Amanda Bruce
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas
- Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, Missouri
| | | | - Beth Lyman
- Children’s Mercy Hospital and Clinics, Kansas City, MO
| | - Jose Cocjin
- Children’s Mercy Hospital and Clinics, Kansas City, MO
| | - Kelsey Dean
- Children’s Mercy Hospital and Clinics, Kansas City, MO
| | - Linda Ernst
- Children’s Mercy Hospital and Clinics, Kansas City, MO
| | - Osama Almadhoun
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas
| | - Paul Hyman
- New Orleans Children’s Hospital, New Orleans, Louisiana
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Lyman B, Kemper C, Northington L, Yaworski JA, Wilder K, Moore C, Duesing LA, Irving S. Use of Temporary Enteral Access Devices in Hospitalized Neonatal and Pediatric Patients in the United States. JPEN J Parenter Enteral Nutr 2015; 40:574-80. [PMID: 25567784 DOI: 10.1177/0148607114567712] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 12/07/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND Temporary enteral access devices (EADs), such as nasogastric (NG), orogastric (OG), and postpyloric (PP), are used in pediatric and neonatal patients to administer nutrition, fluids, and medications. While the use of these temporary EADs is common in pediatric care, it is not known how often these devices are used, what inpatient locations have the highest usage, what size tube is used for a given weight or age of patient, and how placement is verified per hospital policy. MATERIALS AND METHODS This was a multicenter 1-day prevalence study. Participating hospitals counted the number of NG, OG, and PP tubes present in their pediatric and neonatal inpatient population. Additional data collected included age, weight and location of the patient, type of hospital, census for that day, and the method(s) used to verify initial tube placement. RESULTS Of the 63 participating hospitals, there was an overall prevalence of 1991 temporary EADs in a total pediatric and neonatal inpatient census of 8333 children (24% prevalence). There were 1316 NG (66%), 414 were OG (21%), and 261 PP (17%) EADs. The neonatal intensive care unit (NICU) had the highest prevalence (61%), followed by a medical/surgical unit (21%) and pediatric intensive care unit (18%). Verification of EAD placement was reported to be aspiration from the tube (n = 21), auscultation (n = 18), measurement (n = 8), pH (n = 10), and X-ray (n = 6). CONCLUSION The use of temporary EADs is common in pediatric care. There is wide variation in how placement of these tubes is verified.
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Affiliation(s)
- Beth Lyman
- Children's Mercy Hospital, Kansas City, Missouri
| | - Carol Kemper
- Children's Mercy Hospital, Kansas City, Missouri
| | - LaDonna Northington
- University of Mississippi Medical Center School of Nursing, Jackson, Mississippi
| | | | - Kerry Wilder
- Children's Medical Center of Dallas Neonatal Intensive Care Unit, Dallas, Texas
| | | | | | - Sharon Irving
- University of Pennsylvania School of Nursing and Children's Hospital of Pennsylvania, Philadelphia, Pennsylvania
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Yang M, Chen PY, Gong ST, Lyman B, Geng LL, Liu LY, Liang CP, Xu ZH, Li HW, Fang TF, Li DY. Cost-effectiveness analysis of an enteral nutrition protocol for children with common gastrointestinal diseases in China: good start but still a long way to go. JPEN J Parenter Enteral Nutr 2014; 38:72S-6S. [PMID: 25233944 DOI: 10.1177/0148607114550002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A standard nutrition screening and enteral nutrition (EN) protocol was implemented in January 2012 in a tertiary children's center in China. The aims of the present study were to evaluate the cost-effectiveness of a standard EN protocol in hospitalized patients. METHODS A retrospective chart review was performed in the gastroenterology inpatient unit. We included all inpatient children requiring EN from January 1, 2010, to December 31, 2013, with common gastrointestinal (GI) diseases. Children from January 1, 2012, to December 31, 2013, served as the standard EN treatment group, and those from January 1, 2010, to December 31, 2011, were the control EN group. Pertinent patient information was collected. We also analyzed the length of hospital stay, cost of care, and in-hospital infection rates. RESULTS The standard EN treatment group received more nasojejunal tube feedings. There was a tendency for the standard EN treatment group to receive more elemental and hydrolyzed protein formulas. Implementation of a standard EN protocol significantly reduced the time to initiate EN (32.38 ± 24.50 hours vs 18.76 ± 13.53 hours; P = .011) and the time to reach a targeted calorie goal (7.42 ± 3.98 days vs 5.06 ± 3.55 days; P = .023); length of hospital stay was shortened by 3.2 days after implementation of the standard EN protocol but did not reach statistical significance. However, the shortened length of hospital stay contributed to a significant reduction in the total cost of hospital care (13,164.12 ± 6722.95 Chinese yuan [CNY] vs 9814.96 ± 4592.91 CNY; P < .032). CONCLUSIONS Implementation of a standard EN protocol resulted in early initiation of EN, shortened length of stay, and significantly reduced total cost of care in hospitalized children with common GI diseases.
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Affiliation(s)
- Min Yang
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Pei-Yu Chen
- Graduate School of Jinan University, Guangzhou, China
| | - Si-Tang Gong
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Beth Lyman
- Division of Gastroenterology, Children's Mercy Hospital, University of Missouri School of Medicine, Kansas City, Missouri
| | - Lan-Lan Geng
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Li-Ying Liu
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Cui-Ping Liang
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Zhao-Hui Xu
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Hui-Wen Li
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Tie-Fu Fang
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Ding-You Li
- Division of Gastroenterology, Children's Mercy Hospital, University of Missouri School of Medicine, Kansas City, Missouri
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Irving SY, Lyman B, Northington L, Bartlett JA, Kemper C. Nasogastric tube placement and verification in children: review of the current literature. Nutr Clin Pract 2014; 29:267-76. [PMID: 24737681 DOI: 10.1177/0884533614531456] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Placement of a nasogastric enteral access device (NG-EAD), often referred to as a nasogastric tube, is a common practice and largely in the domain of nursing care. Most often an NG-EAD is placed at the bedside without radiographic assistance. Correct initial placement and ongoing location verification are the primary challenges surrounding NG-EAD use and have implications for patient safety. Although considered an innocuous procedure, placement of an NG-EAD carries risk of serious and potentially lethal complications. Despite acknowledgment that an abdominal radiograph is the gold standard, other methods of verifying placement location are widely used and have success rates from 80% to 85%. The long-standing challenges surrounding bedside placement of NG-EADs and a practice alert issued by the Child Health Patient Safety Organization on this issue were the stimuli for the conception of The New Opportunities for Verification of Enteral Tube Location Project sponsored by the American Society for Parenteral and Enteral Nutrition. Its mission is to identify and promote best practices with the potential of technology development that will enable accurate determination of NG-EAD placement for both the inpatient and outpatient pediatric populations. This article presents the challenges of bedside NG-EAD placement and ongoing location verification in children through an overview of the current state of the science. It is important for all healthcare professionals to be knowledgeable about the current literature, to be vigilant for possible complications, and to avoid complacency with NG-EAD placement and ongoing verification of tube location.
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Affiliation(s)
- Sharon Y Irving
- Children's Hospital of Philadelphia, University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania
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Irving SY, Lyman B, Northington L, Bartlett JA, Kemper C. Nasogastric tube placement and verification in children: review of the current literature. Crit Care Nurse 2014; 34:67-78. [PMID: 24735587 DOI: 10.4037/ccn2014606] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Placement of a nasogastric enteral access device (NG-EAD), often referred to as a nasogastric tube, is common practice and largely in the domain of nursing care. Most often an NG-EAD is placed at the bedside without radiographic assistance. Correct initial placement and ongoing location verification are the primary challenges surrounding NG-EAD use and have implications for patient safety. Although considered an innocuous procedure, placement of an NG-EAD carries risk of serious and potentially lethal complications. Despite acknowledgment that an abdominal radiograph is the gold standard, other methods of verifying placement location are widely used and have success rates from 80% to 85%. The long-standing challenges surrounding bedside placement of NG-EADs and a practice alert issued by the Child Health Patient Safety Organization on this issue were the stimuli for the conception of The New Opportunities for Verification of Enteral Tube Location Project sponsored by the American Society for Parenteral and Enteral Nutrition. Its mission is to identify and promote best practices with the potential of technology development that will enable accurate determination of NG-EAD placement for both the inpatient and outpatient pediatric populations. This article presents the challenges of bedside NG-EAD placement and ongoing location verification in children through an overview of the current state of the science. It is important for all health care professionals to be knowledgeable about the current literature, to be vigilant for possible complications, and to avoid complacency with NG-EAD placement and ongoing verification of tube location.
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Affiliation(s)
- Sharon Y Irving
- Sharon Y. Irving is a pediatric critical care nurse practitioner at The Children's Hospital of Philadelphia and an assistant professor at the University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania. She is the AACN liaison for the New Opportunities for Verification of Enteral Tube Location (NOVEL) project sponsored by the American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.).Beth Lyman is a senior program coordinator for the nutrition support team at Children's Mercy Hospital in Kansas City, Missouri, and is the chair of the NOVEL project sponsored by A.S.P.E.N.LaDonna Northington is director of the traditional undergraduate program at the University of Mississippi, School of Nursing, in Jackson, and a member of the Society of Pediatric Nursing.Jacqueline A. Bartlett is director of evidence-based practice at Children's Mercy Hospital in Kansas City, Missouri.Carol Kemper is vice president of quality and safety at Children's Mercy Hospital in Kansas City, Missouri and a steering committee member for the Children Health Patient Safety Organization/Children's Hospital Association.
| | - Beth Lyman
- Sharon Y. Irving is a pediatric critical care nurse practitioner at The Children's Hospital of Philadelphia and an assistant professor at the University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania. She is the AACN liaison for the New Opportunities for Verification of Enteral Tube Location (NOVEL) project sponsored by the American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.).Beth Lyman is a senior program coordinator for the nutrition support team at Children's Mercy Hospital in Kansas City, Missouri, and is the chair of the NOVEL project sponsored by A.S.P.E.N.LaDonna Northington is director of the traditional undergraduate program at the University of Mississippi, School of Nursing, in Jackson, and a member of the Society of Pediatric Nursing.Jacqueline A. Bartlett is director of evidence-based practice at Children's Mercy Hospital in Kansas City, Missouri.Carol Kemper is vice president of quality and safety at Children's Mercy Hospital in Kansas City, Missouri and a steering committee member for the Children Health Patient Safety Organization/Children's Hospital Association
| | - LaDonna Northington
- Sharon Y. Irving is a pediatric critical care nurse practitioner at The Children's Hospital of Philadelphia and an assistant professor at the University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania. She is the AACN liaison for the New Opportunities for Verification of Enteral Tube Location (NOVEL) project sponsored by the American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.).Beth Lyman is a senior program coordinator for the nutrition support team at Children's Mercy Hospital in Kansas City, Missouri, and is the chair of the NOVEL project sponsored by A.S.P.E.N.LaDonna Northington is director of the traditional undergraduate program at the University of Mississippi, School of Nursing, in Jackson, and a member of the Society of Pediatric Nursing.Jacqueline A. Bartlett is director of evidence-based practice at Children's Mercy Hospital in Kansas City, Missouri.Carol Kemper is vice president of quality and safety at Children's Mercy Hospital in Kansas City, Missouri and a steering committee member for the Children Health Patient Safety Organization/Children's Hospital Association
| | - Jacqueline A Bartlett
- Sharon Y. Irving is a pediatric critical care nurse practitioner at The Children's Hospital of Philadelphia and an assistant professor at the University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania. She is the AACN liaison for the New Opportunities for Verification of Enteral Tube Location (NOVEL) project sponsored by the American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.).Beth Lyman is a senior program coordinator for the nutrition support team at Children's Mercy Hospital in Kansas City, Missouri, and is the chair of the NOVEL project sponsored by A.S.P.E.N.LaDonna Northington is director of the traditional undergraduate program at the University of Mississippi, School of Nursing, in Jackson, and a member of the Society of Pediatric Nursing.Jacqueline A. Bartlett is director of evidence-based practice at Children's Mercy Hospital in Kansas City, Missouri.Carol Kemper is vice president of quality and safety at Children's Mercy Hospital in Kansas City, Missouri and a steering committee member for the Children Health Patient Safety Organization/Children's Hospital Association
| | - Carol Kemper
- Sharon Y. Irving is a pediatric critical care nurse practitioner at The Children's Hospital of Philadelphia and an assistant professor at the University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania. She is the AACN liaison for the New Opportunities for Verification of Enteral Tube Location (NOVEL) project sponsored by the American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.).Beth Lyman is a senior program coordinator for the nutrition support team at Children's Mercy Hospital in Kansas City, Missouri, and is the chair of the NOVEL project sponsored by A.S.P.E.N.LaDonna Northington is director of the traditional undergraduate program at the University of Mississippi, School of Nursing, in Jackson, and a member of the Society of Pediatric Nursing.Jacqueline A. Bartlett is director of evidence-based practice at Children's Mercy Hospital in Kansas City, Missouri.Carol Kemper is vice president of quality and safety at Children's Mercy Hospital in Kansas City, Missouri and a steering committee member for the Children Health Patient Safety Organization/Children's Hospital Association
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Mehta NM, Corkins MR, Lyman B, Malone A, Goday PS, Carney LN, Monczka JL, Plogsted SW, Schwenk WF. Defining pediatric malnutrition: a paradigm shift toward etiology-related definitions. JPEN J Parenter Enteral Nutr 2013; 37:460-81. [PMID: 23528324 DOI: 10.1177/0148607113479972] [Citation(s) in RCA: 365] [Impact Index Per Article: 33.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Lack of a uniform definition is responsible for underrecognition of the prevalence of malnutrition and its impact on outcomes in children. A pediatric malnutrition definitions workgroup reviewed existing pediatric age group English-language literature from 1955 to 2011, for relevant references related to 5 domains of the definition of malnutrition that were a priori identified: anthropometric parameters, growth, chronicity of malnutrition, etiology and pathogenesis, and developmental/ functional outcomes. Based on available evidence and an iterative process to arrive at multidisciplinary consensus in the group, these domains were included in the overall construct of a new definition. Pediatric malnutrition (undernutrition) is defined as an imbalance between nutrient requirements and intake that results in cumulative deficits of energy, protein, or micronutrients that may negatively affect growth, development, and other relevant outcomes. A summary of the literature is presented and a new classification scheme is proposed that incorporates chronicity, etiology, mechanisms of nutrient imbalance, severity of malnutrition, and its impact on outcomes. Based on its etiology, malnutrition is either illness related (secondary to 1 or more diseases/injury) or non-illness related, (caused by environmental/behavioral factors), or both. Future research must focus on the relationship between inflammation and illness-related malnutrition. We anticipate that the definition of malnutrition will continue to evolve with improved understanding of the processes that lead to and complicate the treatment of this condition. A uniform definition should permit future research to focus on the impact of pediatric malnutrition on functional outcomes and help solidify the scientific basis for evidence-based nutrition practices.
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Affiliation(s)
- Nilesh M Mehta
- Department of Anesthesiology, Pain and Perioperative Medicine, Boston Children's Hospital, MSICU Office, Bader 634 Children’s Hospital, Boston, Massachusetts 2115, USA.
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30
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Affiliation(s)
| | | | | | - Beth Lyman
- Childrens Mercy Hospital, Kansas City, Missouri
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31
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Lyman B, Gebhards S, Hensley C, Roberts C, San Pablo W. Safety of Decanted Enteral Formula Hung for 12 Hours in a Pediatric Setting. Nutr Clin Pract 2011; 26:451-6. [DOI: 10.1177/0884533611413891] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Beth Lyman
- Children’s Mercy Hospital, Kansas City, Missouri
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Davidson DJ, Lyman B. Book Review: Fluids and Electrolytes: A 2-in-1 Reference for NursesMundenJ (editor). Fluids and Electrolytes: A 2-in-1 Reference for Nurses. Baltimore, MD: Lippincott Williams & Wilkins; 2006. 310 pp; $46.95. ISBN 1-58255-425-0. Nutr Clin Pract 2010. [DOI: 10.1177/0884533610373614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Beth Lyman
- Children’s Mercy Hospital Kansas City, MO
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Bankhead R, Boullata J, Brantley S, Corkins M, Guenter P, Krenitsky J, Lyman B, Metheny NA, Mueller C, Robbins S, Wessel J. Enteral nutrition practice recommendations. JPEN J Parenter Enteral Nutr 2009; 33:122-67. [PMID: 19171692 DOI: 10.1177/0148607108330314] [Citation(s) in RCA: 311] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Popa EC, Luo W, Hochster H, Lyman B, Mulcahy M, Beatty P, Benson AB. A phase II study of orzel (UFT+leucovorin) in elderly (≥75 years old) patients with colorectal cancer: Results of ECOG 1299. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.3608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- E. C. Popa
- NYU Cancer Institute, New York, NY; Dana-Farber Cancer Inst, Boston, MA; Capitol District Hematology/Oncology, Latham, NY; Northwestern Univ, Chicago, IL; Meriter Hosp, Madison, WI
| | - W. Luo
- NYU Cancer Institute, New York, NY; Dana-Farber Cancer Inst, Boston, MA; Capitol District Hematology/Oncology, Latham, NY; Northwestern Univ, Chicago, IL; Meriter Hosp, Madison, WI
| | - H. Hochster
- NYU Cancer Institute, New York, NY; Dana-Farber Cancer Inst, Boston, MA; Capitol District Hematology/Oncology, Latham, NY; Northwestern Univ, Chicago, IL; Meriter Hosp, Madison, WI
| | - B. Lyman
- NYU Cancer Institute, New York, NY; Dana-Farber Cancer Inst, Boston, MA; Capitol District Hematology/Oncology, Latham, NY; Northwestern Univ, Chicago, IL; Meriter Hosp, Madison, WI
| | - M. Mulcahy
- NYU Cancer Institute, New York, NY; Dana-Farber Cancer Inst, Boston, MA; Capitol District Hematology/Oncology, Latham, NY; Northwestern Univ, Chicago, IL; Meriter Hosp, Madison, WI
| | - P. Beatty
- NYU Cancer Institute, New York, NY; Dana-Farber Cancer Inst, Boston, MA; Capitol District Hematology/Oncology, Latham, NY; Northwestern Univ, Chicago, IL; Meriter Hosp, Madison, WI
| | - A. B. Benson
- NYU Cancer Institute, New York, NY; Dana-Farber Cancer Inst, Boston, MA; Capitol District Hematology/Oncology, Latham, NY; Northwestern Univ, Chicago, IL; Meriter Hosp, Madison, WI
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Abstract
Parenteral nutrition is an accepted medical therapy for individuals with gastrointestinal tract dysfunction. It also uses one of the most complex intravenous solutions, which contains all the nutrients needed for a patient's nutritional requirements. Metabolic complications may result from intolerance of glucose, overfeeding, electrolyte shifts, and fluid imbalances. This article describes how to anticipate, identify, and treat such complications so they do not become life threatening.
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Affiliation(s)
- Beth Lyman
- Section of Pediatric Gastroenterology, Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108-4698, USA.
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Abstract
Caring for individuals with nutritional problems is a part of nursing practice. Nurses often struggle with how to categorize nutrition-related maladies. Signature Home Care (now a subsidiary of Integrated Health Services) modified an existing tool to assist nurses in their assessment of nutrition status. This article describes the process of adapting the Nutrition Screening Initiative and implementing the screening tool.
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Lyman B. Peripheral intravenous catheter complications in critically ill children: a prospective study JS GARLAND, WM DUNNE JR, P HAVENS, ET AL Department of Pediatrics and Department of Pathology, Medical College of Wisconsin and Department of Nursing, Children's Hospital of Wisconsin, Milwaukee. Nutr Clin Pract 1993. [DOI: 10.1177/088453369300800207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Davenport ML, Isley WL, Pucilowska JB, Pemberton LB, Lyman B, Underwood LE, Clemmons DR. Insulin-like growth factor-binding protein-3 proteolysis is induced after elective surgery. J Clin Endocrinol Metab 1992; 75:590-5. [PMID: 1379257 DOI: 10.1210/jcem.75.2.1379257] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The insulin-like growth factors (IGFs) are bound to several binding proteins (IGFBPs) that appear to regulate IGF transport, receptor binding, and action. The concentrations of these peptides are altered by catabolic conditions. To determine if IGF-I and IGFBP levels change after surgery, sera were obtained from 16 patients before and after cholecystectomy. Immunoreactive IGF-I measured in plasma samples from which IGFBPs had been extracted did not change postoperatively. In contrast, IGF-I determined in unextracted samples increased roughly 3-fold postoperatively, presumably due to changes in IGFBPs. Two days postoperatively, IGFBP-3 levels, determined by ligand blot, averaged 36% of preoperative values, whereas levels of IGFBP-2 and a 24,000 mol wt IGFBP did not change significantly. Similarly, by immunoblot, intact IGFBP-3 was decreased 84.2 +/- 20.2%, and a 31,000 mol wt IGFBP-3 fragment increased 57.5 +/- 47.4% postoperatively. Coincubation of postoperative, but not preoperative, sera with control sera resulted in a significant decrease in IGFBP-3 and production of proteolytic fragments. IGFBP-3 proteolytic activity in postoperative sera was markedly inhibited by antipain, Na-p-tosyl-L-lysine chloromethyl ketone, phenylmethylsulfonylfluoride, aprotinin, o-phenanthroline, and EDTA, but not by leupeptin or N-tosyl-L-phenylalanine chloromethyl ketone. This pattern of inhibition is consistent with a metal-dependent trypsin-like serine protease. We speculate that proteolysis of IGFBP-3 may alter tissue uptake of IGF-I and thereby help to counteract the catabolic state caused by surgery.
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Affiliation(s)
- M L Davenport
- Department of Pediatrics, University of North Carolina, Chapel Hill 27599
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Abstract
Previous studies have correlated intolerance of isotonic, intact protein enteral solutions with hypoalbuminemia. The purpose of this retrospective study was to determine whether the level of serum albumin (SA) influenced tolerance of such an enteral nutrient solution (ENS). All patients who received Entrition during 1987 for a minimum of 48 hr were studied for the first 10 days of enteral feeding. Documentation included SA, medications, stool frequency, gastric residuals (GR), and daily caloric intake. ENS intolerance was defined as greater than 3 stools/day for greater than 48 hr or GR greater than twice the hourly infusion rate for greater than 48 hr. Patients were categorized into two groups: those with SA greater than or equal to 2.5 g/dl (group I) and those with SA less than 2.5 g/dl (group II). Of 88 patients studied, 48 (86%) in group I and 28 (88%) in group II tolerated the ENS. Eight (14%) in group I and 4 (12%) in group II experienced ENS intolerance. There was no statistically significant difference in the frequency of ENS intolerance between these two groups (p less than 0.05). Also, 97% of all those with a SA less than 2.5 g/dl were fed 80% or more of their estimated caloric requirements. We concluded that ENS tolerance was not affected by the SA level and patients with hypoalbuminemia (SA less than 2.5 g/dl) could be fed enterally.
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Affiliation(s)
- M L Patterson
- Metabolic Support Service, Truman Medical Center, Kansas City, Missouri 64108
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Lyman B, Pendleton SH, Pemberton LB. The role of the nutritional support team in preventing and identifying complications of parenteral and enteral nutrition. QRB Qual Rev Bull 1987; 13:232-40. [PMID: 3116482 DOI: 10.1016/s0097-5990(16)30139-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
As the technology of parenteral and enteral nutrition advances, a multidisciplinary nutritional support team (NST) can be used to assure quality care. NST functions include developing and using standard protocols and solutions, monitoring patients, and preventing complications. Interventions by NSTs can save money for the hospital as well. Examples from Truman Medical Center (Kansas City, Missouri) illustrate how the NST can perform these functions.
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Affiliation(s)
- B Lyman
- Metabolic Support Service, Truman Medical Center, Kansas City, Missouri 64108
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Pemberton LB, Lyman B, Lander V, Covinsky J. Sepsis from triple- vs single-lumen catheters during total parenteral nutrition in surgical or critically ill patients. Arch Surg 1986; 121:591-4. [PMID: 3085637 DOI: 10.1001/archsurg.1986.01400050109014] [Citation(s) in RCA: 101] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We prospectively studied the infection rates for 59 triple-lumen (TLC) and 68 single-lumen (SLC) subclavian catheters during the administration of total parenteral nutrition (TPN) to surgical or critically ill patients. A standard protocol was used for catheter insertion and maintenance. The infection control committee determined independently whether patients had catheter-related sepsis, an infected insertion site only, or no catheter infection. The TLCs had an increased incidence of catheter sepsis (19%) compared with the SLCs (3%). Low rates (5% for TLCs and 3% for SLCs) of infected catheter sites only indicated that the catheter care was comparable for both groups. The patients in the two groups were similar but not identical; those with TLCs appeared to be sicker and, therefore, at greater risk to develop catheter sepsis than patients with SLC. However, since TLCs were involved in six times more catheter sepsis than were SLCs, limiting the use of a subclavian catheter to giving TPN only and strict adherence to a TPN protocol are necessary to minimize the risk of catheter sepsis.
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Pemberton LB, Lyman B, Mandal J, Covinsky J. Outbreak of Staphylococcus epidermidis nosocomial infections in patients receiving total parenteral nutrition. JPEN J Parenter Enteral Nutr 1984; 8:325-6. [PMID: 6429373 DOI: 10.1177/0148607184008003325] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Pemberton LB, Mandal J, Lyman B, Covinsky JO. Developing a metabolic support service. Mo Med 1983; 80:635-40. [PMID: 6417463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Abstract
One hundred university students were asked to indicate the foods they would prefer when experiencing 22 common emotions. The preferences were categorized in terms of nutritional values and were also tallied in terms of the four basic food groups. Application of Cochran's Q Test showed that there were highly significant differences among emotions in the frequencies of preferences for foods of different nutritional values and the frequencies of preferences among the food groups. The chi square test showed that for all but eight emotions, the frequencies were significantly larger for healthy than for junk foods. The results are discussed with reference to emotional needs and diet selection.
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Abstract
Using curved and angular line drawings, several investigators found a relation between form and meaning in individuals reared before the age of television. In the present study 60 university students who had been exposed to television from earliest childhood were asked to indicate whether a curved or angular figure best represented each of 40 emotion or abstract concepts. For 36 of the concepts the frequencies were significantly different from a chance level, and it was concluded that television viewing had no adverse effect on the fittingness of form and meaning. Several possible explanations for the phenomenon are discussed.
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Abstract
A method has been developed for measuring the adhesion of platelets to purified collagen fibers obtained from bovine tendon. This method differs from others in that: (a) platelet adhesion is measured in the absence of platelet aggregation; (b) platelet-rich plasma collected in ACD (acid citrate dextrose) or EDTA, or washed platelets can be employed; (c) adherent platelets are enumerated directly; (d) erythrocytes and leukocytes do not adhere. Washed platelets suspended in human Ringer solution exhibit negligible adhesion (at the platelet concentrations employed) in contrast to washed platelets suspended in plasma. Addition of purified human fibrinogen (95% clottable, 2-4 mg/ml) to human Ringer solution completely restores the ability of washed platelets to adhere to collagen fibers. Albumin (fatty acid free, 50 mg/ml) is also capable of restoring adhesion. Albumin and seven other proteins at concentrations of 5-10 mg/ml, with varying molecular weights, isoelectric points, and frictional coefficients are incapable of supporting the adhesion of washed platelets. The proteins tested were human globulin, hexokinase, hemoglobin, cytochrome-C, insulin, thyroglobulin, and muramidase. Platelet adhesion is proportional to both platelet concentration and fibrinogen concentration, but is independent of temperature or glycogen stores. Modification of fibrinogen by acylation of amino groups or removal of sialic acid has no effect on its ability to support platelet adhesion. Degradation of fibrinogen with purified plasmin results in decreased support of platelet adhesion. This accompanied formation of early breakdown products with clottability ranging from 84-0%. Formation of fibrinogen degradation products was monitored by SDS-polyacrylamide gel electrophoresis of the corresponding fibrins after reduction of disulfide bonds (a method capable of distinguishing alpha-, beta- and gamma-chains). Decreased support of platelet adhesion is associated with the disappearance of intact alpha- chains and early modification of the beta-chains. Purified proteinpolysaccharide macromolecules obtained from bovine nasal and humeral cartilage, and from nucleosus pulposus are as effective as fibrinogen on a weight basis and ten to thirty times more effective on a molar basis in supporting platelet adhesion. The purified mucopolysaccharide side chains: chondroitin-4-sulfate, chondroitin-6-sulfate, and keratan-sulfate are incapable of supporting platelet adhesion.
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