Nursing Experience of Early Application of Nasoenteric Tube for Enteral Nutrition in Critically Ill ICU Patients

Objective:To investigate the effective nursing measures of early application of nasoenteric tube for enteral nutrition in critically ill patients in ICU,and to summarize the nursing experience.Methods:The study was carried out in June 2023–November 2023.62 samples of ICU critically ill patients were selected,all of whom used enteral nutrition by mesenteric tube and were grouped into an observation group(n=31)and a control group(n=31)by using the numerical table randomization method.The patients in the control group were basic nursing interventions,and the patients in the observation group were comprehensive quality care,comparing the nutritional indexes,complication rates,and nursing satisfaction between the two groups.Results:All nutritional indicators of the observation group were higher than those of the control group after nursing intervention(P<0.05);the complication rate of the observation group was lower than that of the control group(P<0.05);the nursing satisfaction of the observation group was higher than that of the control group(P<0.05).Conclusion:Comprehensive quality nursing care during the early application of a gastroenteric tube for enteral nutrition in critically ill patients in the ICU can improve nutritional indexes,reduce the incidence of complications and improve nursing satisfaction.

The Effect and Nursing of Indwelling Nasal Jejunal Feeding Tube for Enteral Nutrition in Acute Severe Pancreatitis

Objective:To analyze the effect of enteral nutrition and nursing intervention in patients with indwelling nasojejunal tube in acute severe pancreatitis.Methods:Sixty cases of patients with indwelt nasojejunal tubes treated in our hospital from August 2019 to August 2020 were divided into routine group and observation group as research subjects.Patients in both groups received enteral nutrition,patients in the routine group received routine care,and patients in the observation group received quality care.The recovery time of gastrointestinal function,length of hospital stay,hospitalization cost,nutritional indicators and incidence of complications in the two groups were compared.Results:The recovery time of gastrointestinal function in observation group was lower than that in routine group,P<0.05;The length and cost of hospitalization in observation group were lower than those in routine group,P<0.05;The nutritional indexes in observation group were higher than those in routine group,P<0.05;The incidence of complications in observation group was lower than that in routine group,P<0.05.Conclusion:Quality nursing service improve the effect of enteral nutrition,so as to ensure that patients get sufficient nutritional support.Its effect is remarkable and it is worthy of widespread clinical application.

Summary of the Best Evidence for Tube Feeding Intolerance in Critically Ill Children

Objective:To summarize the evidence of tube feeding intolerance in critically ill children,aiming to provide evidence-based information for clinical nursing staff.Methods:Evidence search was done in Chinese and English databases to guide network and professional associations at home and abroad.The search time limit was from January 2014 to January 2024,nearly 10 years of relevant literature,mainly including guidelines,consensus,expert advice,best practice,evidence summary,system evaluation,and meta-analysis.Literature quality evaluation and evidence extraction were independently performed by two researchers.Results:This paper included 13 articles,including three guidelines,three systematic evaluations,three expert opinions,and four expert consensus.Twenty-six pieces of evidence were summarized from 10 aspects of feeding intolerance definition,team building,nutritional assessment,nutritional preparation,feeding protocol,feeding route,feeding management,pipeline management,gastric residual volume,and drug application.Conclusion:This paper summarized the evidence of tube feeding intolerance in critically ill children,which can provide evidence-based information for clinical practice.The abdominal signs should be closely observed when evaluating feeding intolerance,focusing on the prevention and reduction of feeding interruption.

Comparison of the Clinical Outcomes of Early Enteral Nutrition Versus Convenience Diet by Tube Feeding Following Laryngectomy in Chinese Patients

The purpose of the present study was to evaluate the efficiency of early enteral nutritional support in patients undergoing laryngectomy. We retrospectively reviewed and analyzed 329 laryngeal cancer patients who underwent total or partial laryngectomy from November 2003 to July 2013 in our hospital. Of those patients, 278 were given enteral nutrition (EN group) with elemental formulations through a nasogastric tube beginning within 24 hours after the surgery, while 51 chose not to receive the elemental formulations and were on a homogenate diet (convenience diet group, CD group), which was also given through a nasogastric tube. The clinical outcomes were compared between the two groups. Thirteen patients in the EN group (13/278, 4.68%) and six patients in the CD group (6/51, 11.76%) developed fistulas. The difference was statistically significant (P < 0.046). The differences in the post-surgical infection rate, average length of hospitalization and other clinical indicators between the two groups were not statistically significant. In conclusion, early enteral nutrition should be recommended in patients undergoing laryngectomy, and convenience diet is not as effective as the commercial formulation in reducing the risk of fistula formation.

Optimal timing and route of nutritional support after esophagectomy: A review of the literature

Some controversy surrounds the postoperative feeding regimen utilized in patients who undergo esophagectomy.Variation in practices during the perioperative period exists including the type of nutrition started,the delivery route,and its timing.Adequate nutrition is essential for this patient population as these patients often present with weight loss and have altered eating patterns after surgery,which can affect their ability to regain or maintain weight.Methods of feeding after an esophagectomy include total parenteral nutrition,nasoduodenal/nasojejunal tube feeding,jejunostomy tube feeding,and oral feeding.Recent evidence suggests that early oral feeding is associated with shorter LOS,faster return of bowel function,and improved quality of life.Enhanced recovery pathways after surgery pathways after esophagectomy with a component of early oral feeding also seem to be safe,feasible,and cost-effective,albeit with limited data.However,data on anastomotic leaks is mixed,and some studies suggest that the incidence of leaks may be higher with early oral feeding.This risk of anastomotic leak with early feeding may be heavily modulated by surgical approach.No definitive data is currently available to definitively answer this question,and further studies should look at how these early feeding regimens vary by surgical technique.This review aims to discuss the existing literature on the optimal route and timing of feeding after esophagectomy.

Early nasogastric enteral nutrition for severe acute pancreatitis: A systematic review

AIM: To evaluate the effectiveness and safety of early nasogastric enteral nutrition (NGEN) for patients with severe acute pancreatitis (SAP). METHODS: We searched Cochrane Central Register of Controlled Trials (Issue 2, 2006), Pub-Medline (1966-2006), and references from relevant articles. We included randomized controlled trials (RCTs) only, which reported the mortality of SAP patients at least. Two reviewers assessed the quality of each trial and collected data independently. The Cochrane Collaboration’s RevMan 4.2.9 software was used for statistical analysis. RESULTS: Three RCTs were included, involving 131 patients. The baselines of each trial were comparable. Meta-analysis showed no significant differences in mortality rate of SAP patients between nasogastric and conventional routes (RR = 0.76, 95% CI = 0.37 and 1.55, P = 0.45), and in other outcomes, including time of hospital stay (weighted mean difference = -5.87, 95% CI = -20.58 and 8.84, P = 0.43), complication rate of infection (RR = 1.41, 95% CI = 0.62 and 3.23, P = 0.41) or multiple organ defi ciency syndrome (RR = 0.97, 95% CI = 0.27 and 3.47, P = 0.97), rate of admission to ICU (RR = 1.00, 95% CI = 0.48 and 2.09, P = 0.99) or conversion to surgery (RR = 0.66, 95% CI = 0.12 and 3.69, P = 0.64), as well as recurrence of re-feeding pain and adverse events associated with nutrition. CONCLUSION: Early NGEN is a breakthrough in the management of SAP. Based on current studies, early NGEN appears effective and safe. Since the available evidence is poor in quantity, it is hard to make an accurate evaluation of the role of early NGEN in SAP.Before recommendation to clinical practice, further high qualified, large scale, randomized controlled trials are needed.

Endoscopist's approach to nutrition in the patient with pancreatitis

Nutritional therapy has an important role in the management of patient with severe acute pancreatitis.This article reviews the endoscopist's approach to manage nutrition in such cases.Enteral feeding has been clearly validated as the preferred route of feeding,and should be started early on admission.Parenteral nutrition should be reserved for patients with contraindications to enteral feeding such as small bowel obstruction.Moreover,nasogastric feeding is safe and as effective as nasojejunal feeding.If a prolonged course of enteral feeding(>30d) is required,endoscopic placement of feeding gastrostomy or jejunostomy tubes should be considered.

“Timing of percutaneous endoscopic gastrostomy tube placement in post-stroke patients does not impact mortality,complications,or outcomes”:Commentary

In this commentary,we summarize some of the key points of the original paper“Timing of percutaneous endoscopic gastrostomy tube placement in post-stroke patients does not impact mortality,complications,or outcomes”and offer support for the proposed results.Specifically,we address how early percutaneous endoscopic gastrostomy(PEG)tube placement may reduce hospital length of stay and costs.We also discuss topics related to the article including PEG weaning and post-stroke nutritional formulation.However,we note that concerns purported by previous studies that early PEG placement may worsen outcomes are not fully addressed,and further research is needed.

Exfoliative esophageal bleeding caused by blind placement of a nasogastric tube:Two cases and a literature review

Transnasal intubation is a clinical operation usually performed blindly at the bedside.Mild adverse events,such as epistaxis and tube misplacement,are relatively common.Esophageal bleeding or perforation and other serious adverse events are rare.In the present study,two cases of severe diffuse esophageal bleeding caused by the blind placement of a nasogastric tube are described.These cases were successfully treated using a covered metal stent or Sengstaken-Blakemore tube.A review of the literature regarding the possible causes of such adverse events and the potential endoscopic treatments for severe hemorrhage are discussed.

神经重症患者留置双腔胃肠营养管护理专家共识

目的形成神经重症患者留置双腔胃肠营养管护理专家共识,推动护士规范、安全、有效地实施双腔胃肠营养管喂养,满足患者营养需求。方法检索、评价和汇总神经重症患者胃肠营养管护理的相关证据,提取相关的推荐意见,形成专家共识初稿,通过1轮专家函询和2轮专家论证会,结合专家意见修改、完善各条目内容,形成专家共识终稿。结果最终形成的专家共识包括神经重症患者双腔胃肠营养管喂养的操作性定义、置管适应证、置管禁忌证、置管及维护、拔管指征5个方面。结论形成的专家共识实用性较强,可为神经重症患者双腔胃肠营养管的临床护理实践和质量控制提供指导依据。

重力引导螺旋型鼻肠管空肠置管操作流程及教学歌诀

为了提高鼻肠管床旁定位的有效性和空肠置管的成功率,根据经典文献,结合自己的操作实践,编写了一个重力引导螺旋型鼻肠管空肠置管的操作流程及教学歌决。歌决内容:肠内营养寓胜算,空肠置管莫等闲。方法多样各神通,大力推广路漫长。半坐吞咽进食管,回抽自如识胃腔。右卧轻张过幽门,左卧低阻到空肠。胃内折返何征象?导管反弹最先见,充气受阻“折返征”,染色定位胜影像。真空试验最敏感,酸碱序变特异强,美蓝试验神答问,三法联用共导航。腹部平片金标准,超声时代仍可参。立体影像整体观,更有断层解疑难。此教学歌决以简明扼要、易于记忆的形式,成为临床手把手鼻肠管置管教学的有力工具。

鼻肠管管饲法在晚期帕金森病患者肠内营养支持治疗中的应用研究

目的探讨保留鼻肠管进行肠内营养支持治疗对晚期帕金森病患者营养状况及并发症的影响。方法2020年2月至2023年3月某三甲医院及医联体医院收治的32例晚期帕金森病患者,采用留置鼻肠管管饲法进行肠内营养支持治疗,二周后,观察血红蛋白、总蛋白、白蛋白、球蛋白实验室检查指标、肌张力评分以及胃食道返流、误吸和吸入性肺炎并发症发生例次,运用SF-36评分评估患者生活质量,比较干预前后上述指标的变化情况。结果留置鼻肠管管饲法行肠内营养的患者血清血红蛋白、总蛋白、白蛋白水平较前显著升高(P<0.05),球蛋白有上升但较干预前差异无统计学意义(P>0.05);干预后肌张力降低,胃食道返流、误吸和吸入性肺炎发生例数明显降低(P<0.05),生活质量评分差异无统计学意义(P>0.05)。结论采用鼻肠管管饲法对晚期帕金森病患者进行肠内营养支持治疗,患者营养状况有明显改善,能减少因进食引发的并发症发生,有临床应用价值。

间歇经口至食管管饲法联合自创吞咽功能训练在脑卒中吞咽障碍患者的应用研究

目的探讨间歇经口至食管管饲法与自创吞咽功能训练联合应用于脑卒中吞咽障碍患者的效果。方法选取河南大学淮河医院2022年1月—2023年12月收治的50例脑卒中吞咽障碍患者,应用随机数字表法将其分为两组,每组各25例。对照组采取持续留置鼻饲的同时应用自创吞咽功能训练进行训练,观察组采取间歇经口至食管管饲的同时应用自创吞咽功能训练进行训练。对比两组吞咽障碍改善情况、干预前后营养状况指标及生活质量变化,比较两组并发症发生率。结果观察组总有效率高于对照组(P<0.05)。干预后两组血清总蛋白、白蛋白和血红蛋白水平和体质量指数均升高,观察组高于对照组(P<0.05)。干预后两组生活质量综合评定量表评分升高,观察组高于对照组(P<0.05)。观察组并发症发生率低于对照组(P<0.05)。结论对脑卒中吞咽功能障碍患者采取间歇经口至食管管饲法与自创吞咽功能训练,能够更有效改善患者吞咽功能,提升其生活质量,且可降低留置饲管营养支持过程中的并发症发生率。

鼻肠管及鼻胃管的营养干预护理对脑血管意外患者发生吸入性肺炎并发症及睡眠质量的影响

目的:探讨研究脑血管意外患者用鼻肠管营养干预效果。方法:选取2021年4月至2022年4月厦门大学附属第一医院神经内科收治的脑血管意外患者100例作为研究对象,按照随机数字表法分为对照组和观察组,每组50例。2组患者均予以常规护理,对照组给予常规鼻胃管营养干预,观察组给予鼻肠管营养干预。比较2组患者的吸入性肺炎发生率、睡眠质量评分及营养状况。结果:观察组吸入性肺炎发生率低于对照组,差异有统计学意义(P<0.05);观察组入睡潜伏期、PSQI评分低于对照组,实际睡眠时长高于对照组,差异有统计学意义(P<0.05);观察组血红蛋白(Hb)、血清白蛋白(Alb)、血清总蛋白(TP)均高于对照组,差异有统计学意义(P<0.05)。结论:鼻肠管营养干预护理可降低脑血管意外患者吸入性肺炎发生率,改善患者睡眠质量及营养状况,值得临床推广应用。

肠内营养安全输注核查单的设计及应用效果研究

目的:设计肠内营养安全输注核查单并应用于临床,以期提高肠内营养输注的安全性和高效性。方法:通过文献回顾、小组讨论和专家函询,设计肠内营养安全输注核查单,比较该核查单应用于临床前后患者的营养状况、管道堵塞、管道移位/滑脱、误吸、血糖异常等不良事件发生率及肠内营养不耐受发生率。结果:应用核查单后,患者的管道堵塞、管道位移/滑脱、血糖异常发生率及肠内营养不耐受发生率均低于对照组(P<0.05),患者出院时的营养状况优于对照组(P<0.05)。结论:肠内营养安全输注核查单的应用可规范护士操作行为,提高护士决策能力和工作质量,有效降低肠内营养不良事件和肠内营养不耐受发生率,改善患者的营养状况。

鼻空肠管与鼻胃管肠内营养支持在急诊ICU机械通气患者中的应用效果对比

目的对比鼻空肠管与鼻胃管肠内营养支持在急诊ICU机械通气患者中的应用效果。方法70例急诊ICU机械通气患者随机分为两组。对照组留置鼻胃管进行肠内营养支持,观察组留置鼻空肠管进行肠内营养支持。比较两组的营养状况和并发症。结果观察组的达目标喂养量所需时间短于对照组(P<0.05)。干预后,观察组的HB、PAB和ALB水平均高于对照组(P<0.05)。观察组的胃肠道并发症总发生率为5.71%,低于对照组的28.57%(P<0.05)。结论与鼻胃管肠内营养支持相比,鼻空肠管肠内营养支持能够快速改善急诊ICU机械通气患者的营养状况,减少胃肠道并发症的发生。

危重症患者肠内营养治疗后管饲依赖症状发生现况及影响因素研究

目的多中心调查国内危重症患者肠内营养治疗后管饲依赖症状发生现况,并对其影响因素展开系统分析。方法于2023年7月10日—20日,采用横断面调查法,对四川省、浙江省、江苏省、贵州省、重庆市等8个省市、12所三级综合医院内行肠内营养治疗结束后的危重症患者,使用一般资料调查表、管饲依赖症状评估量表展开问卷调查。结果该次调查共回收问卷225份,有效问卷221份,有效回收率为98%。危重症患者肠内营养治疗后管饲依赖症状发生率为64%。多因素Logistic回归分析结果显示,合并系统功能障碍数量[OR=4.605,95%CI(1.831~11.581)]、镇静与(或)镇痛药物使用天数[OR=1.578,95%CI(1.031~2.416)]、管饲进食天数[OR=1.634,95%CI(1.139~2.345)]以及促胃动力药物使用天数[OR=1.908,95%CI(1.089~3.345)]是危重症患者肠内营养治疗后管饲依赖症状发生的独立危险因素。结论危重症患者肠内营养治疗后,管饲依赖症状发生率较高,医护人员须建立和完善适用于危重症患者肠内营养治疗后管饲依赖症状的预防及管理机制。

电磁导航鼻肠管置入技术在神经外科重症患者中的应用

目的观察电磁导航鼻肠管置入技术在神经外科重症患者中的应用效果。方法采用便利抽样法,选取2023年1月至2023年12月解放军总医院第一医学中心收治的60例神经外科重症患者,采用随机数字表法将其分为试验组和对照组各30例。试验组采用电磁导航鼻肠管置管技术留置鼻肠管,对照组采用盲插法留置鼻肠管,比较两组的总置管成功率、一次置管成功率、置管用时、置管相关不良事件的发生情况,分析并比较两组干预前、干预10 d后营养指标[血红蛋白(Hb)、血清白蛋白(Alb)]。结果试验组总置管成功率为96.7%,对照组为80.0%;试验组一次置管成功率为93.33%,对照组为73.33%;试验组置管用时为(16.20±5.65)min,对照组为(34.13±13.60)min;以上数据两组比较,差异均具有统计学意义(P<0.05)。在置管相关不良事件发生方面,试验组鼻黏膜出血1例、呛咳1例,对照组鼻黏膜出血4例、呛咳5例、恶心呕吐3例,两组比较,差异具有统计意义(P=0.036);两组均未发生气胸、穿孔、消化道出血等并发症。在营养指标方面,两组患者比较置管后10 d营养指标改善情况无统计学差异,试验组患者置管前后营养指标差异有统计学意义(P<0.05)。结论采用电磁导航鼻肠管置管技术为神经外科重症患者留置鼻肠管的成功率高,操作用时短,能够为神经外科重症患者提供早期营养支持,且置管相关不良事件的发生率较低。

间歇性经口管饲联合精细化营养管理在脑卒中吞咽功能障碍患者中的应用

目的 探讨脑卒中吞咽功能障碍患者采用间歇性经口管饲联合精细化营养管理的临床效果。方法 本文的观察对象为我院2021年12月至2023年12月收治的50例脑卒中吞咽功能障碍患者,通过随机数字表法将观察对象均匀分为两组,分组后分别命名为对照组与观察组,各组的患者例数均为25例。对照组采用持续性鼻饲管饲联合精细化营养管理,观察组采用间歇性经口管饲联合精细化营养管理。对比两组的容积-黏度吞咽测试(V-VST)、护理前后的营养水平和生活质量及鼻胃管综合征发生率。结果 在容积-黏度吞咽测试分级的比较上,观察组优于对照组(P <0.05)。护理后,在前白蛋白(PA)、血清白蛋白(ALB)的比较上,观察组高于对照组(P <0.05)。在吞咽障碍患者生活质量量表(EDQo L)比较上,观察组低于对照组(P <0.05)。在鼻胃管综合征发生率的比较上,与对照组相比,观察组相对较低(P <0.05)。结论 脑卒中吞咽功能障碍患者采用间歇性经口管饲联合精细化营养管理的效果较显著,不仅可以有效改善其吞咽功能,还可以提高其营养水平,减少鼻胃管综合征的发生,提升其生活质量。

延长鼻胃管置入深度在重症患者肠内营养治疗中的应用价值

目的观察延长鼻胃管置入深度在重症患者肠内营养支持治疗中的应用价值。方法选择2023年4~9月在三明市第二医院重症医学科经鼻胃管肠内营养治疗的100例患者,按随机数字表法分为对照组和观察组,每组50例。两组均给予肠内营养治疗。对照组鼻胃管置入深度为45~55 cm,观察组鼻胃管置入深度为60~65 cm。比较两组干预前及干预7 d后的胃潴留、胃食管反流、呕吐、显性误吸等并发症的发生率及血红蛋白(Hb)、血清白蛋白(Alb)、前白蛋白(PAB)水平改善情况。结果观察组的胃潴留、胃食管反流、呕吐、显性误吸发生率均低于对照组,差异均有统计学意义(均P<0.05)。观察组的Hb、Alb、PAB水平均显著高于对照组,差异均有统计学意义(均P<0.05)。结论延长鼻胃管置入深度可以减少患者肠内营养并发症的发生,有效改善患者营养状况。