The American Association of Critical-Care Nurses has updated its Practice Alert for feeding tube insertion and created a new Practice Alert covering aspiration prevention practices for tube-fed intensive care unit patients.
AACN's Practice Alerts are directives supported by authoritative evidence and are available to download free.
Here are six things to know about the new updates.
Feeding tube insertion
1. Feeding tube insertion happens frequently in the ICU, so it is easy to forget it can lead to dangerous complications if not done properly, according to Norma Metheny, PhD, RN, associate dean of research at St. Louis University School of Nursing. "It's important for nurses and other providers to stay up to date on evidence-based practice, especially for the most common procedures," she said.
2. The new Practice Alert focuses on blind insertions and placements with an electromagnetic device.
3. The updated Practice Alert includes the following recommendations:
- Use two or more of the following bedside methods should be used to predict tube location during insertion:
- Watching for respiratory distress
- Using capnography
- Measuring pH of aspirate from tube
- Observing visual characteristics of aspirate from the tube
- The air bolus method and the water bubbling method should not be used to determine tube location
- Nurses should recommend radiographic confirmation of correct placement prior to initial use
- Feeding tubes should be checked
Prevention of aspiration in adults
4. Microaspirations, or small-volume aspirations of gastric content, are fairly common — one study found roughly half of critically ill, mechanically ventilated tube-fed patients experienced them frequently. However, microaspirations greatly increase a patient's risk of developing pneumonia.
5. Microaspirations are difficult to detect because no bedside diagnostic test exists.
6. The new Practice Alert offers a checklist for aspiration prevention, including the following points:
- Maintaining bed elevation at an angle of 30 to 45 degrees
- Using sedatives as little as possible
- Assessing feeding tube placement every four hours
- Avoiding bolus feedings for tube-fed patients