AJCC Patient Care Page The AJCC Patient Care Page is a service of the American Journal of Critical Care and the American Association of Critical-Care Nurses. Designed to elaborate AACN practice guidelines based on content in select articles, this page may be photocopied noncommercially for use by readers in their workplace, in continuing education programs, or for distribution to colleagues, patients, or patients’ families. To purchase bulk reprints, call (800) 899-1712.
CARING FOR PATIENTS WITH ENTERAL FEEDINGS By Linda Bell, RN, MSN
T
he withholding of enteral feedings during repositioning of critically ill patients receiving mechanical ventilation is based on tradition. However, DiLibero et al1 remind us that there is no consistent standard for managing continuous enteral feedings while repositioning patients. This matter weighs the risk of aspiration against the potential interruption of nutrition that will negatively impact the patient. It is important that all patients receiving enteral feedings, whether continuously or in intermittent bolus feedings, are assessed for feeding tube positioning and feeding tolerance before making any repositioning practice a standard for the unit. It should not be assumed that one standard protects all patients equally.
Here’s what you can do: • Survey the staff on your unit for their understanding of safety practices during enteral feedings including assessment for feeding tube positioning and feeding tolerance. • Collaborate with an interprofessional team of nurses, physicians, respiratory therapists, speech therapists and nutritional support to determine needs of your patients. • Consider the needs of patients who are receiving mechanical ventilation and those who aren’t. • Include your medical librarian in a literature search to find current practice recommendations. • Evaluate the literature based on your patient population. • Develop process standards based on recommendations established in the literature. • Establish processes for patients who are receiving mechanical ventilation and those who aren’t. • Organize an inservice for the interprofessional staff on the process developed for your patients.
Illustration by Steve Oh
Other helpful resources: • AACN Practice Alert. Prevention of Aspiration. http://www.aacn.org/wd/practice/docs/practicealerts /prevention-aspiration-practice-alert.pdf?menu=aboutus • AACN Protocols for Practice: Care of the Patient With Mechanical Ventilation, 2nd Edition. http://www.aacn.org /dm/products/ProductDetails.aspx?productid=170685 &prodtyp= product&subsystem=ORD • American Society for Parenteral and Enteral Nutrition (ASPEN), www.nutritioncare.org REFERENCES 1. DiLibero J, Lavieri M, O’Donoghue S, DeSanto-Madeya S. Withholding or continuing enteral feedings during repositioning and the incidence of aspiration. Am J Crit Care. 2015;24:258-262.
©2015 American Association of Critical-Care Nurses doi: http://dx.doi.org/10.4037/ajcc2015543
Based on material from and published as a supplement to the article by DiLibero et al, “Withholding or Continuing Enteral Feedings During Repositioning and the Incidence of Aspiration” (American Journal of Critical Care. 2015;24:258-262).
www.ajcconline.org
AJCC AMERICAN JOURNAL OF CRITICAL CARE, May 2015, Volume 24, No. 3
Downloaded from ajcc.aacnjournals.org at University of Pittsburgh, HSLS on November 21, 2015
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Caring for Patients with Enteral Feedings Linda Bell Am J Crit Care 2015;24:263 doi: 10.4037/ajcc2015543 © 2015 American Association of Critical-Care Nurses Published online http://www.ajcconline.org Personal use only. For copyright permission information: http://ajcc.aacnjournals.org/cgi/external_ref?link_type=PERMISSIONDIRECT
Subscription Information http://ajcc.aacnjournals.org/subscriptions/ Information for authors http://ajcc.aacnjournals.org/misc/ifora.xhtml Submit a manuscript http://www.editorialmanager.com/ajcc Email alerts http://ajcc.aacnjournals.org/subscriptions/etoc.xhtml
AJCC, the American Journal of Critical Care, is the official peer-reviewed research journal of the American Association of Critical-Care Nurses (AACN), published bimonthly by The InnoVision Group, 101 Columbia, Aliso Viejo, CA 92656. Telephone: (800) 899-1712, (949) 362-2050, ext. 532. Fax: (949) 362-2049. Copyright © 2015 by AACN. All rights reserved.
Downloaded from ajcc.aacnjournals.org at University of Pittsburgh, HSLS on November 21, 2015
CARING FOR PATIENTS WITH ENTERAL FEEDINGS By Linda Bell, RN, MSN
T
he withholding of enteral feedings during repositioning of critically ill patients receiving mechanical ventilation is based on tradition. However, DiLibero et al1 remind us that there is no consistent standard for managing continuous enteral feedings while repositioning patients. This matter weighs the risk of aspiration against the potential interruption of nutrition that will negatively impact the patient. It is important that all patients receiving enteral feedings, whether continuously or in intermittent bolus feedings, are assessed for feeding tube positioning and feeding tolerance before making any repositioning practice a standard for the unit. It should not be assumed that one standard protects all patients equally.
Here’s what you can do: • Survey the staff on your unit for their understanding of safety practices during enteral feedings including assessment for feeding tube positioning and feeding tolerance. • Collaborate with an interprofessional team of nurses, physicians, respiratory therapists, speech therapists and nutritional support to determine needs of your patients. • Consider the needs of patients who are receiving mechanical ventilation and those who aren’t. • Include your medical librarian in a literature search to find current practice recommendations. • Evaluate the literature based on your patient population. • Develop process standards based on recommendations established in the literature. • Establish processes for patients who are receiving mechanical ventilation and those who aren’t. • Organize an inservice for the interprofessional staff on the process developed for your patients.
Illustration by Steve Oh
Other helpful resources: • AACN Practice Alert. Prevention of Aspiration. http://www.aacn.org/wd/practice/docs/practicealerts /prevention-aspiration-practice-alert.pdf?menu=aboutus • AACN Protocols for Practice: Care of the Patient With Mechanical Ventilation, 2nd Edition. http://www.aacn.org /dm/products/ProductDetails.aspx?productid=170685 &prodtyp= product&subsystem=ORD • American Society for Parenteral and Enteral Nutrition (ASPEN), www.nutritioncare.org REFERENCES 1. DiLibero J, Lavieri M, O’Donoghue S, DeSanto-Madeya S. Withholding or continuing enteral feedings during repositioning and the incidence of aspiration. Am J Crit Care. 2015;24:258-262.
©2015 American Association of Critical-Care Nurses doi: http://dx.doi.org/10.4037/ajcc2015543
Based on material from and published as a supplement to the article by DiLibero et al, “Withholding or Continuing Enteral Feedings During Repositioning and the Incidence of Aspiration” (American Journal of Critical Care. 2015;24:258-262).
www.ajcconline.org
AJCC AMERICAN JOURNAL OF CRITICAL CARE, May 2015, Volume 24, No. 3
Downloaded from ajcc.aacnjournals.org at University of Pittsburgh, HSLS on November 21, 2015
263
Caring for Patients with Enteral Feedings Linda Bell Am J Crit Care 2015;24:263 doi: 10.4037/ajcc2015543 © 2015 American Association of Critical-Care Nurses Published online http://www.ajcconline.org Personal use only. For copyright permission information: http://ajcc.aacnjournals.org/cgi/external_ref?link_type=PERMISSIONDIRECT
Subscription Information http://ajcc.aacnjournals.org/subscriptions/ Information for authors http://ajcc.aacnjournals.org/misc/ifora.xhtml Submit a manuscript http://www.editorialmanager.com/ajcc Email alerts http://ajcc.aacnjournals.org/subscriptions/etoc.xhtml
AJCC, the American Journal of Critical Care, is the official peer-reviewed research journal of the American Association of Critical-Care Nurses (AACN), published bimonthly by The InnoVision Group, 101 Columbia, Aliso Viejo, CA 92656. Telephone: (800) 899-1712, (949) 362-2050, ext. 532. Fax: (949) 362-2049. Copyright © 2015 by AACN. All rights reserved.
Downloaded from ajcc.aacnjournals.org at University of Pittsburgh, HSLS on November 21, 2015
