Assessing Nursing Enteral Nutrition Practices and Perspectives in An Intensive Care Unit of A Level Six Hospital in Kenya
DOI:
https://doi.org/10.24203/ajpnms.v8i6.6432Keywords:
Keywords: Enteral nutrition, intensive care, nursing, tube feedingAbstract
Background: Adequate nutritional support is important for the comprehensive management of patients in intensive care units (ICUs).
Aim: The study was aimed to survey prevalent enteral nutrition practices in the general intensive care unit, nurses' perception, and their knowledge of enteral feeding.
Study Design: The study was conducted in the ICU of a level 6 hospital in Kenya. The study design used was crosses sectional descript study.
Materials and Methods: thirty four questionnaires were distributed and the results analyzed. A database was prepared and analyzed.
Results: all (100%) questionnaires were filled and returned. A majority (32) of staff nurses expressed awareness of nutrition guidelines. A large number (27) of staff nurses knew about existence of nutrition protocols in the ICU. Almost all nurses (82.4%) chose enteral nutrition as their preferred route of nutrition unless contraindicated. All staff nurses were of the opinion that enteral nutrition is to be started at the earliest (within 24-48 h of the ICU stay). Half (50%) were of the thought that the absence of bowel sounds is an absolute contraindication to initiate enteral feeding. Passage of a nasogastric tube (Ryle’s tube) was considered mandatory before starting enteral nutrition by 86% of the respondents. Everyone knew that the method of Ryle's tube feeding in their ICU is intermittent boluses. Only 4 staff nurses were unaware of any method to confirm Ryle's tube position. The backrest elevation rate was 70%. Gastric residual volumes were always checked, but the amount of the gastric residual volume for the next feed to be withheld varied. The majority said that the unused Ryle's tube feed is to be discarded after 24 h. The most preferred (48%) to upgrade their knowledge of enteral nutrition as a personal initiative and CME.
Conclusion: Information generated from this study can be helpful in identifying nutrition practices gaps and may be used to review and revise enteral feeding practices where necessary.
Keywords: Enteral nutrition, intensive care, nursing, tube feeding
References
• Anderson T. K, (2000) Nutrition and Dietetics; Technical Regulation for setting minimum requirements fo
• Barr, J., Hecht, M., Flavin, K. E., Khorana, A., & Gould, M. K. (2004). Outcomes in critically ill patients before and after the implementation of an evidence-based nutritional management protocol. Chest, 125, (4) 1446-1457. doi: 10.1378/chest.125.4.1446
• Beghetto, M.G.(2007) Nutritional status as a predictor of death, infection and hospital stay (Thesis). London: Faculty of Medicine, Federal University of Rio Grande do Sul; Available in 2007
• Binnekade, J.M, Tepaske, R, Bruynzeel, P. Mathus-Vliegen, E.M.H, de Haan, R.J.(2005) Daily enteral feeding practice on the ICU: attainment of goals and interfering factors. Crit Care. 2005, 9 (3): R218-25.
• Bongers, A. T, (2006); Enteral nutrition in the critically ill: a. Prospective survey in an Australian intensive care unit
• Charney, P., & Malone, A. (2013). Pocket guide to enteral nutrition. Chicago: Academy of Nutrition and Dietetics
• Correia M.I. and Waitzberg, D.L.(2003) The impact of malnutrition on morbidity, mortality, length of stay and hospital costs Evaluated through a multivariate model analysis. Clin Nutr. 2003, 22 (3) :235-9.
• De Jonghe B, Appere-De-Vechi C, Fournier M, Tran B, Merrer J, Melchior J.C, Outin H. A(2001) prospective survey of nutritional support practices in intensive care unit patients: what is prescribed? What is delivered? Crit Care Med 2001, 29 (1) :8-12.
• Ferreira I.K.C (2007). Nutritional Therapy in the Intensive Care Unit. Rev Bras Ter Intensive. 2007, 19 (1) :90-7.
• Fulbrook B, Merrer J, Melchior J.C, Outin H(2007) Critical care nutrition support research: lessons learned from recent trials Crit Care. 2012;16:R209.
• Griffiths . B. G, (1997) A prospective survey of nutritional support practices , Clin Nutr. 2006, 25 (1) :37-44.
• Heyland DK. (2013)Critical care nutrition support research: lessons learned from recent trials. Curr Opin Clin Nutr Metab Care. 2013;16(2):176–181
• Heyland, D.K., Konopad, E., Alberda, C., Keefe, L., Cooper, C. and Cantwell, B. (1999) How well the critically ill Patients tolerate early, intragastric enteral feeding? Results of a prospective, multicenter trial. Nutr Clin Pract. 1999, 14 (1) :23-8.
• Ireton-Jones. S, (2006) alteration in nutritional status and diaphragm muscle function. Reprod Nutr Dev. 1998.38(2):175-80.
• Joyce & Deborah, (1996). Enteral nutrition therapy in the intensive care unit: infusion versus needs. Rev Bras Ter Intensive. 2006, 18 (4) :331-7.
• Kondrup J. Johansen N, Plum LM, L Bak, I.H Larsen.(2002) Incidence of nutritional risk and causes of Inadequate nutritional care in hospitals. Clin Nutr. 2002, 21 (6) :461-8.
• Kvale , F., Marshall, (2011) ventilation with continuous positive airway pressure: assessment in normal diet effect with acute respiratory failure. Can ad Anaesth Soc J 27(2):89-95
• Kyle UG, Genton L, Heidegger CP, Maisonneuve N, Karsegard VL, Huber O(2006)Hospitalized mechanically ventilated patients are at higher risk of enteral underfeeding than non-ventilated patients. Clin Nutr. 2006;25(5):727-35.
• Lichtenberg, S. Chiolero, R.L, Bollmann M.D, Revelly J.P, Cayeux M.C. RN.(2005) Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clin Nutr. 2005, 24 (4) :502-9.
• Llano-Diez M, Renaud G, Andersson M, Marrero HG, Cacciani N, Engquist H, (2012). Mechanisms underlying ICU muscle wasting and effects of passive mechanical loading. Crit Care.;16:R209.
• Lopez, N, Goldstein R S.(2009) Nutritional support for individuals with COPD: a meta-analysis. Chest. ;117(3):672-8
• Marik, P.E, Zaloga, G.P. Early enteral nutrition in acutely ill patients: a systematic review. Crit Care Med 2001, 29 (12) :2264-70. Erratum in: Crit Care Med 2002, 30 (3): 725.
• McClave, S.A, Heyland, D.K . The physiologic response and associated clinical benefits from provision of early enteral nutrition. Nutr Clin Pract. 2009; 24 (3) :305-15.
• McClave, S.A, Martindale, R.G, Vanek, V.W, McCarthy, M. Roberts, P. Taylor B, Ochoa, J.B, Napolitano, L. G. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). JPEN J Parenter Enteral Nutr. 2009; 33 (3) :277-316.
• Meara N Duarte AC, Lameu EB,, 2008 Malnutrition, renutrition and respiratory function. Pediatr Pulmonol. 1997;(Suppl 16):167-8.
• Merck Sharp & Dohma Corp., (2013) nutrition therapy in the intensive care unit Clinical Nutrition of the adult. 2nd ed , 24 (4) :502-9.
• Metheny (2006)
• Norman et al., (2008) Clinical Nutrition of the adult. 2nd ed. Sao Paulo: Manole; 2005. P. 369-90.
• O´Leary-Kelley CM, Puntilho KA, Barr J, Stotts N, Douglas MK. Nutritional adequacy in patients receiving mechanical ventilation who are fed enterally. Am J Crit Care. 2005;14(3):222-31.
• O'Keefe G. H, (2009) inter-alteration in nutritional status and diaphragm muscle function. Reprod Nutr Dev. 1998.38(2):175-80.
• O'Meara D, Mireles-Cabodevila E, Frame F, Hummell AC, Hammel J, Dweik RA, Arroliga AC. Evaluation of delivery of enteral nutrition in critically ill patients receiving mechanical ventilation. Am J Crit Care. 2008;17(1):53-61.
• Rubinson, Diette, Song,Brower, and Krishnan (2004) Outcomes in critically ill patients before and after the implementation of an evidence-based nutritional management protocol Federal University of Rio Grande do Sul
• Seres F. K, (2010) Incidence of nutritional risk and causes of Inadequate nutritional care in hospitals. Clin Nutr. 2002, 21 (6) :461-8.
• Shefold, & Weber, (2010) Predictors of prologed mechanical ventilation in a cohort of 3,269 cabg patientes. Minerva Anestesiol. 2007;78(12):615-21.
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