Morristown Medical Center Intensive Care Unit, Morristown, NJ, USA.
Morristown Medical Center, Seton Hall University College of Nursing, Nutley, NJ, USA.
Worldviews Evid Based Nurs. 2021 Aug;18(4):311-313. doi: 10.1111/wvn.12507. Epub 2021 May 14.
Many patients in intensive care units (ICU) require nasogastric (NG) or orogastric (OG) tubes. These patients often require a combination of sedatives that can alter level of consciousness and impair cough or gag reflexes. Such factors can lead to NG/OG tube displacement. Using a misplaced tube can lead to aspiration, lung injury, infection, and even death.
To standardize ongoing verification of NG tube placement practices in our 34-bed Medical-Surgical ICU.
The Johns Hopkins Nursing Model was utilized to guide this project. A literature review and critical appraisal were performed to establish NG/OG tube best practices. Best practices were implemented and assessed (via a survey and charting audits).
Fifteen publications were identified and appraised as Level 4 and 5 sources. Best evidence supported that at the time of radiographic confirmation of the tube site, it should be marked with inedible ink or adhesive tape where it exits the nares; tube location should be checked at 4-hour intervals; and placement/patency should be checked in patients who complain of pain, vomiting, or coughing. Following the practice change, N = 40 nurses indicated improvement in verification of NG/OG tube knowledge, "OK to use" order was verified for 89% of patients, and 63% of tubes were marked with tape at the exit site.
Adherence to current, evidence-based strategies for NG/OG tube verification promotes patient safety. Monitoring practice changes is critical to determine whether a best practice is sustained. Electronic health records must be current to guide and support evidence-based nursing practice.
许多重症监护病房（ICU）的患者需要鼻胃管（NG）或口胃管（OG）。这些患者通常需要联合使用镇静剂，这可能会改变意识水平并损害咳嗽或呕吐反射。这些因素可能导致 NG/OG 管移位。使用错位的管子会导致吸入、肺损伤、感染，甚至死亡。
标准化我们 34 张床位的内科-外科 ICU 中持续验证 NG 管放置实践的方法。
利用约翰霍普金斯护理模式指导该项目。进行文献回顾和批判性评估，以确定 NG/OG 管的最佳实践。实施最佳实践并进行评估（通过调查和图表审计）。
确定并评估了 15 篇出版物，这些出版物被评为 4 级和 5 级资源。最佳证据支持在放射确认管位置时，应在管从鼻腔出来的地方用不可食用的墨水或胶带标记；应每 4 小时检查一次管位置；对于抱怨疼痛、呕吐或咳嗽的患者，应检查放置/通畅情况。在实践改变后，N=40 名护士表示对 NG/OG 管知识验证的改进，89%的患者的“可使用”医嘱得到验证，63%的管在出口处用胶带标记。
坚持当前基于证据的 NG/OG 管验证策略可促进患者安全。监测实践变化对于确定最佳实践是否持续至关重要。电子病历必须是最新的，以指导和支持基于证据的护理实践。
