National Survey of Feeding Tube Verification Practices An Urgent Call for Auscultation Deimplementation
National Survey of Feeding Tube Verification Practices An Urgent Call for Auscultation Deimplementation
复制标题
DOI：
10.1097/dcc.0000000000000440
复制
发表时间：
2020-11-01
影响因子：
1.7
通讯作者：
Upvall, Michele J.
中科院分区：
文献类型：
--
作者：
Bourgault, Annette M.;Powers, Jan;Upvall, Michele J.
背景：气胸和肺炎等危害事件仍然与饲管插入有关。大多数床边验证方法不能准确区分肺部和胃肠系统。循证临床实践指南不支持成人听诊喂食管，但听诊是最常用的方法。 目标：我们的调查评估了重症监护护士使用的国家喂食管验证实践，包括听诊方法的废除、管心针重新插入和清洁实践的进展。方法：对 408 名重症监护护士进行了全国调查。结果：大多数人进行听诊（408176% 中的 311 人）来验证饲管的放置情况。在最终的多变量模型中，护理教育、设施类型、对进行听诊的同事的观察以及对机构政策的认识与饲管听诊相关。百分之三十五的人使用肠内接入装置来验证初始饲管的放置。管心针清洁方法多种多样； 38% 重新插入的管心针没有被清洗。讨论：尽管在研究文章、临床实践指南和手术手册中进行了被动的知识传播，但在过去 7 年里，在听诊的取消方面取得的进展甚微。尽管 pH 测量在英国被用作一线饲管验证方法，但在美国很少使用。应更新临床实践指南，以纳入有关肠内通路系统的新研究。结论：应取消基于传统的实践，例如听诊和某些管心针清洁方法。需要一个有重点的跨学科、多方面的计划来取消成人饲管的听诊实践。
Background: Harm events such as pneumothoraces and pneumonia continue to be associated with feeding tube insertion. Most bedside verification methods are not accurate to discriminate pulmonary from gastrointestinal system. Evidence-based clinical practice guidelines do not support auscultation of feeding tubes in adults, yet auscultation is the most common method used.Objectives: Our survey assessed national feeding tube verification practices used by critical care nurses, including progress in auscultation method deimplementation, and stylet reinsertion and cleansing practices.Methods: A national survey of 408 critical care nurses was performed. Results: The majority performed auscultation (311 of 408176%]) to verify feeding tube placement. In the final multivariable model, nursing education, facility type, observation of colleagues performing auscultation, and awareness of an institutional policy were associated with auscultation of feeding tubes. Thirty-five percent used enteral access devices to verify initial feeding tube placement. Stylet cleansing methods were variable; 38% of reinserted stylets were not cleansed.Discussion: Minimal progress has been made in deimplementation of auscultation in the past 7 years despite passive knowledge dissemination in research articles, clinical practice guidelines, and procedure manuals. Although pH measure is used as a first-line feeding tube verification method in the United Kingdom, it is rarely used in the United States. Clinical practice guidelines should be updated to incorporate new research on enteral access systems.Conclusions: Tradition-based practices such as auscultation and certain stylet cleansing methods should be deimplemented. A focused interdisciplinary, multifaceted program is needed to deimplement auscultation practice for adult feeding tubes.