Gastroenterology Division, Children's Mercy Hospital, Kansas City, Missouri, USA.
Department of Pediatrics & Child Health, HSC Winnipeg Shared Health, Winnipeg, Manitoba, Canada.
Nutr Clin Pract. 2021 Jun;36(3):654-664. doi: 10.1002/ncp.10603. Epub 2020 Dec 21.
Tube feeding via nasogastric tubes (NGTs) and gastrostomy tubes (GTs) is a common practice for children unable to meet their nutrition needs by oral feeding alone. There is currently a lack of evidence-based guidance specific for the process of transitioning from an NGT to GT as a longer-term enteral access device. Uncertainty in the literature about feeding tube choices, practices, and transitions requires clinicians to draw on incomplete and sometimes conflicting evidence, personal experience, economic realities, and compassion to deliver supportive child-centered care.
The ASPEN Enteral Nutrition Task Force Pediatric Work Group designed a survey to explore current practice of enteral access device safety and use among pediatric clinicians practicing in the US and Canada. The survey aimed to define time frames, parameters, and decision points to guide clinicians and families in the transition from NG to GT feeding.
258 clinicians, 55% practicing in an inpatient setting, 17% in-home patient setting, and 28% practicing in both inpatient and outpatient setting. 22% were physicians, 42% were dietitians, 32% were nurses or advanced practice nurses, 2% were pharmacists. The most common feeding tubes used were NGTs followed by GTs. Majority of respondents indicated that they did not have a specific timeline for when an NGT should be changed to a GT. Highest ranked patient factors or clinical considerations prior to recommending changing from an NGT to a GT were exceeding the duration for temporary feeding or the need for an extended duration of tube feeding. Highest physician barriers to GT placement were the reluctance for referral from primary care doctors for GT placement. Majority of respondents reported the use of NGTs for enteral access at home and that parents were taught how to place the NGTs for home use but without consistently being taught the use of pH paper to verify NGT tip location or being provided with the pH paper to perform this task at home.
This survey is the first step to address the knowledge gap surrounding feeding tube choices by ascertaining the current standard of practice regarding enteral access devices and appropriate timing of transitioning from NGT to GT feeding. The results highlight current practice variability and concerns. Information from the survey was used to formulate a decision tree to guide the transition of NGT to GT feeding that nutrition support professionals can use to advocate for best practices in their hospital and community settings.
通过鼻胃管（NGT）和胃造口管（GT）进行管饲是无法通过口服喂养满足营养需求的儿童的常见做法。目前，缺乏针对作为长期肠内进入装置的从 NGT 过渡到 GT 的过程的循证指南。文献中关于喂养管选择、实践和过渡的不确定性要求临床医生利用不完整且有时相互矛盾的证据、个人经验、经济现实和同情心来提供以儿童为中心的支持性护理。
ASPEN 肠内营养工作组儿科工作组设计了一项调查，以探讨美国和加拿大执业儿科临床医生在肠内进入装置安全性和使用方面的当前实践。该调查旨在确定指导临床医生和家庭从 NG 过渡到 GT 喂养的时间框架、参数和决策点。
258 名临床医生，55%在住院环境中，17%在家庭患者环境中，28%在住院和门诊环境中。22%是医生，42%是营养师，32%是护士或高级执业护士，2%是药剂师。最常用的喂养管是 NGT，其次是 GT。大多数受访者表示，他们没有特定的时间框架来确定何时将 NGT 更换为 GT。在建议从 NGT 更改为 GT 之前，排名最高的患者因素或临床考虑因素是超过临时喂养的持续时间或需要延长管饲的持续时间。阻碍 GT 放置的最高医生障碍是不愿接受初级保健医生对 GT 放置的转诊。大多数受访者报告在家中使用 NGT 进行肠内进入，并且教家长如何放置 NGT 用于家庭使用，但没有始终教授使用 pH 试纸来验证 NGT 尖端位置，也没有在家中提供 pH 试纸来执行此任务。
这项调查是解决围绕喂养管选择的知识差距的第一步，通过确定有关肠内进入装置的当前标准实践以及从 NGT 过渡到 GT 喂养的适当时间来确定。结果突出了当前实践的可变性和关注点。调查信息用于制定决策树，以指导 NGT 向 GT 喂养的过渡，营养支持专业人员可以在其医院和社区环境中使用该决策树来倡导最佳实践。
