Development of a Competency Model for Placement and Verification of Nasogastric and Nasoenteric Feeding Tubes for Adult Hospitalized Patients. ASPEN, May 21

Highlights from a new Competency Model for Placement and Verification of Nasogastric and Nasoenteric Feeding Tubes for Adult Hospitalized Patients (ASPEN )

 

  • For over 400 years, tubes placed within the gastrointestinal (GI) tract have been used to improve patient care. Nasogastric (NG) and nasoenteric (NE) tubes are used in hospitals, rehabilitation centers, nursing care facilities, and home settings.
  • Although NG and NE tubes are significant adjuncts to patient care with many positive outcomes, these temporary enteral access devices are also associated with complications upon insertion such as malposition and misplacement.
  • Blind placements infer that the tip of the enteral access device is inserted nasally (or orally) with the intention of placing the tip in either the stomach, duodenum, or jejunum. However, the clinician is unable to visualize the tip during the insertion and placement process; therefore, blind placements pose the greatest risk of malposition.
  • Blind placement: Malposition (reported 10% overall) complication rate with 1%–4% placement into bronchial tree); patients who have decreased consciousness or gag reflex or are uncooperative during the procedure are at increased risk
  • Ideally, electromagnetic technology allows the user to recognize inadvertent lung malposition as it occurs, and it assists the user to correct the placement immediately, rather than waiting for radiograph confirmation. In research studies focusing on agreement between radiographs and clinician interpretation of EMPD tracing, EMPD has been shown to provide 97%–100% accuracy.
  • ENvue described as Real-time indirect visualization placement techniques with the following advantages
    • Expedited placement at bedside
    • RNs or RDNs can be trained to place
    • Allows operators to visually track feeding tube pathway throughout the insertion process; visualization can help avoid malposition (lung placement) and complications
    • Increased efficiency of SB placement, decreased time to tube placement and feeding.
    • Able to recognize inadvertent lung placements
    • Precise agreement between system and x-ray (96.5%)
Skip to content