Optimizing Nutritional Support in the Critically Ill: Evaluation of a Dedicated Team Approach to Placement of Nasojejunal Feeding Tubes

Document Type

Conference Proceeding

Publication Date

5-2024

Publication Title

American Journal of Respiratory and Critical Care Medicine

Abstract

Introduction: Malnutrition remains a common issue amongst the critically ill. It has been estimated that malnutrition affects a high percentage of intensive care unit (ICU) patients and is associated with increased morbidity, mortality, and hospital length of stay. Current literature and societal guidelines recommend the use of early enteral nutrition (EEN) for specific patients to reduce complications associated with malnutrition in critically ill individuals. Nasojejunal tubes have become the preferred route of enteral nutrition. Despite new technology with electromagnetic devices (i.e. CORTRAK® 2 Enteral Access System (EAS™)), these tubes remain difficult to place. Our study aims to evaluate the effectiveness of a dedicated team for the placement of these feeding tubes in comparison to bedside nursing. Methods: We conducted a retrospective review of 5081 patients admitted to ICU from January 2015 to June 2023 at a tertiary university hospital. We included ICU patients aged 18 and above who received nasojejunal feeding tubes using the CORTRAK® 2 Enteral Access System (EAS™) after an order was placed through our institution's EMR. Groups were then separated into Dedicated Team (DT), and Bedside Nursing(BN) based on a specified date. Time to tube placement, number of abdominal x-rays taken within 48 hours, administration of prokinetic medications, and consultation with interventional radiology were recorded and analyzed using means, standard deviations, and ranges. Results: DT treated 3333 patients, while BN treated 1748 patients. The median time to tube placement was significantly shorter in DT (542, 170-1558 minutes) as compared to BN (878.5, 274-1886 minutes) (p < 0.0001). BN utilized more prokinetic medication compared to DT, with 82(4.4%) and 54(1.7%) patients, respectively (P<0.0001). BN had twice the amount of post-placement abdominal X-rays performed within 48 hours with 1138 (60.7%) patients as compared to DT's 472 (14.7%) patients (p < 0.0001). The two groups had no significant difference in the need for consultation with interventional radiology (P=0.441). Conclusion: The findings of our study strongly advocate for the use of a dedicated team approach with the placement of nasojejunal feeding tubes. The significant reduction in time to placement, coupled with a decreased reliance on adjuncts, underlines the efficiency and effectiveness of such a team. This approach expedites the placement process and accelerates the time to initiation of enteral nutrition.

Volume

209

Issue

Suppl

First Page

A1563

Comments

International Conference of the American Thoracic Society, May 17-22, 2024, San Diego, CA

DOI

10.1164/ajrccm-conference.2024.209.1_MeetingAbstracts.A1563

Link to Full Text

Share

COinS