Bourgault Annette M, Powers Jan, Aguirre Lillian, Hines Robert B, Sebastian Ansu T, Upvall Michele J
Annette M. Bourgault, PhD, RN, CNL, FAAN, is an associate professor in the College of Nursing, University of Central Florida, and a nurse scientist at Orlando Health. Jan Powers, PhD, RN, CCNS, CCRN, NE-BC, FCCM, is the director of nursing research and professional practice at Parkview Health System, Fort Wayne, Indiana. Lillian Aguirre, DNP, APRN, CCNS, CCRN, is a clinical nurse specialist for the Trauma/Burn Critical Care Services, Orlando Regional Medical Center, a part of Orlando Health, Florida. Robert B. Hines, PhD, is an associate professor at the University of Central Florida College of Medicine, Orlando. Ansu T. Sebastian, MSN, RN, CCRN, PCCN, is a PhD student in the College of Nursing, University of Central Florida, and assistant nurse manager at AdventHealth, Orlando, Florida. Michele J. Upvall, PhD, RN, CNE, FAAN, is vice dean at VinUniversity, College of Health Sciences, Hanoi, Vietnam.
Dimens Crit Care Nurs. 2020 Nov/Dec;39(6):329-338. doi: 10.1097/DCC.0000000000000440.
Harm events such as pneumothoraces and pneumonia continue to be associated with feeding tube insertion. Most bedside verification methods are not accurate to discriminate pulmonary from gastrointestinal system. Evidence-based clinical practice guidelines do not support auscultation of feeding tubes in adults, yet auscultation is the most common method used.
Our survey assessed national feeding tube verification practices used by critical care nurses, including progress in auscultation method deimplementation, and stylet reinsertion and cleansing practices.
A national survey of 408 critical care nurses was performed.
The majority performed auscultation (311 of 408 [76%]) to verify feeding tube placement. In the final multivariable model, nursing education, facility type, observation of colleagues performing auscultation, and awareness of an institutional policy were associated with auscultation of feeding tubes. Thirty-five percent used enteral access devices to verify initial feeding tube placement. Stylet cleansing methods were variable; 38% of reinserted stylets were not cleansed.
Minimal progress has been made in deimplementation of auscultation in the past 7 years despite passive knowledge dissemination in research articles, clinical practice guidelines, and procedure manuals. Although pH measure is used as a first-line feeding tube verification method in the United Kingdom, it is rarely used in the United States. Clinical practice guidelines should be updated to incorporate new research on enteral access systems.
Tradition-based practices such as auscultation and certain stylet cleansing methods should be deimplemented. A focused interdisciplinary, multifaceted program is needed to deimplement auscultation practice for adult feeding tubes.
气胸和肺炎等不良事件仍然与饲管插入相关。大多数床旁验证方法在区分肺部和胃肠道系统方面并不准确。基于证据的临床实践指南不支持对成人饲管进行听诊，但听诊却是最常用的方法。
我们的调查评估了重症护理护士采用的全国性饲管验证做法，包括听诊方法停用的进展情况，以及管芯重新插入和清洁做法。
对408名重症护理护士进行了全国性调查。
大多数人（408名中的311名[76%]）通过听诊来验证饲管位置。在最终的多变量模型中，护理教育、机构类型、观察同事进行听诊以及对机构政策的知晓情况与饲管听诊相关。35%的人使用肠内通路装置来验证初始饲管位置。管芯清洁方法各不相同；38%重新插入的管芯未进行清洁。
尽管在研究文章、临床实践指南和操作手册中进行了被动的知识传播，但在过去7年里，听诊停用方面进展甚微。虽然pH值测量在英国被用作饲管验证的一线方法，但在美国很少使用。临床实践指南应更新，纳入有关肠内通路系统的新研究。
应停用基于传统的做法，如听诊和某些管芯清洁方法。需要一个重点突出的跨学科、多方面的项目来停用成人饲管的听诊做法。
