Brazier Sophie, Taylor Stephen J, Allan Kaylee, Clemente Rowan, Toher Deirdre
Department of Nutrition and Dietetics, Southmead Hospital, Bristol.
Applied Statistics Group, Department of Engineering Design and Mathematics, University of the West of England, Bristol.
Br J Nurs. 2017 Jun 22;26(12):656-663. doi: 10.12968/bjon.2017.26.12.656.
Stroke patients with dysphagia often depend on nutrition, hydration and medication via nasogastric (NG) feeding tubes. Securing tubes using tape is associated with repeated tube loss. In this study, the authors determined cause and effect by auditing tube placement methods, delays incurred, duration and costs. Of 202 NG tube placements in 75 patients, 67 placements occurred in 17 patients over a full course of enteral nutrition (EN) and 40 of these placements were tracked. Tubes were secured by tape in 100%, mittens 31% and special observation 5.4%. However, over an EN course, inadvertent tube loss occurred in 82% of patients and was associated with age (p=0.049) and mitten use (p<0.001): 64% of tubes were lost due to patients and 9% slipped. Average 'tube life' was 2 days, less than 25% of the EN episode (p<0.001). While tube placement occurred within 2.55 hours of request, X-ray confirmation led to a delay in feed and drugs of 8-9 hours per tube placement and loss of 18.8% of feeding time per EN episode. Delays exceeded the 1-hour and 4-hour limits for antibiotics and other medicines in 20% and 80%, respectively. In the 17 tracked patients, it was estimated that 55% of the £5979 direct costs could be saved by nasal bridle use. In conclusion, most tubes studied were lost to inadvertent tube removal, leading to clinically significant delays to nutrition, hydration and drug treatments; this may impair recovery. Reducing tube loss is likely to reduce patient distress, treatment cost and enhance recovery.
吞咽困难的中风患者通常依靠鼻胃管进行营养、补水和用药。用胶带固定管道常导致管道反复脱落。在本研究中，作者通过审查管道放置方法、产生的延误、持续时间和成本来确定因果关系。75名患者共进行了202次鼻胃管放置，其中17名患者在整个肠内营养（EN）疗程中进行了67次放置，对其中40次放置进行了跟踪。100%的管道用胶带固定，31%用手套固定，5.4%采用特殊观察。然而，在整个EN疗程中，82%的患者出现了意外管道脱落，这与年龄（p=0.049）和使用手套（p<0.001）有关：64%的管道因患者原因脱落，9%的管道滑落。平均“管道使用期”为2天，不到EN疗程的25%（p<0.001）。虽然管道放置在接到请求后的2.55小时内完成，但X射线确认导致每次管道放置的喂食和用药延迟8 - 9小时，每次EN疗程损失18.8%的喂食时间。延迟分别超过了抗生素和其他药物1小时和4小时的限制，比例分别为20%和80%。在17名跟踪患者中，估计使用鼻系带可节省5979英镑直接成本的55%。总之，研究中的大多数管道因意外拔除而丢失，导致营养、补水和药物治疗出现临床上显著的延误；这可能会影响康复。减少管道丢失可能会减轻患者痛苦、降低治疗成本并促进康复。
