get it in keep it in keep it running adventures in bedside feeding tube placement and other hands-on...
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Get it inKeep it in
Keep it running
Adventures in bedside feeding tube placement and other hands-on feeding tube
related activities by registered dietitians.
Utah Academy of Nutrition and Dietetics
Annual Meeting, March 20, 2014
Objectives• Describe the experience of one clinical nutrition
team developing a program for hands-on feeding tube placement and care.
• Discuss benefits in terms of patient care of dietitian involvement in feeding tube placement and care, including cost savings.
• Discuss pros and cons for dietitians of taking on the role of feeding tube placement and care.
Participation Activity
What Get it in
Bedside feeding tube placementKeep it in
FT bridle placementKeep it running
FT clog clearing
By Dietitians
Why
• Altruistim (patient care)
• Self interest (job satisfaction)
• Practical reasons (cost containment)
Patient Care
Job Satisfaction
• Avoid burn out• New marketable skill• Increased recognition
Cost Containment
Getting It Done
Data collection Training
EquipmentSupport
Idea
Desire
Inspiration
Idea
Support
• Direct manager• Fellow staff• Nursing • Physicians• Administration• Approving committees• Outside sources
Equipment
Feeding tube bridle
Dobhoff feeding tube
OUCH!
Frederick-Miller feeding tube
Cortrak
Other tubes
Personal Protective Equipment:
a fashion must
Personal Protective Equipment:
a fashion must
Stethescope
TubeClear
Training: bridle placement
• MD champion• Watch one – Do one• Competency check list provided by
manufacturer
Bridle placement method
• Insert probes• Feel & listen for click• Remove stylet• Pull tape through• Clip onto feeding tube• Knot and clip ends
Training: bedside feeding tube placement
• Outside advice• Create training competency• One on one training with multiple RNs• Trained RDs pass off other RDs
FT placement method• Position patient• Measure• Advance to stomach• Assess
o Pull back with syringeo Watch for “pop”o Observe contents for amount, texture, coloro Listen over abdomen middle and side
• Advance using “puff and twist”• Assess again, look for changes• Secure• Confirm placement (abdominal film)• Document
Training: TubeClear• In-house training by manufacturer• Artificial feeding tube clogs provided• Competency checklist provided
Dietitian Pros & Cons• Better understanding of patient experience • Increased empathy• Ability to trouble shoot feeding tube problems• Recognition from RNs and other staff• Improved relationship with caregiver team
Dietitian Pros & Cons
• Exposure to mucous and vomit• Inflict pain or discomfort• Difficult or agitated patients• Increased responsibility/liability • Greater commitment
Data collection• Checklist items• Adverse events• RD time spent• Time from order to insertion•Gastric vs SB placement•Who placed the tube
Reduced total fluoro placement
• Bedside placement by RNs and RDs• Avoid unnecessary replacement
o Bridleso Clearing clogso Avoiding clogs
• Feed stomach when appropriate• Educating MDs on appropriate uses for fluoro• Intraoperative placement
• Feeding tubes placed in fluoro
o 2012: 124 o 2013: 88
• Cost reduced by 29%
Reduced total fluoro placement
ReferencesMcClave et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adjult Critically Ill Patient. JPEN, 2009, 33 (3),:277-316.
Faisy et al. Impact of energy deficit calculated by a predictive method on outcome in medical patients requiring prolonged acute mechanical ventilation. Fr J Nutr. 2009;101:1079-1087.
Bartlett et al. Measurement of metabolism in multiple organ failure. Surgery. 1982;92:771-779.
Villet et al. Negative impact of hypocaloric feeding an denergy balance on clinical outcome in ICU patients. Clin Nutr. 2005;24:502-509.
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