Dispelling Myths and Unfounded Practices About Enteral Nutrition
Correction(s) for this article
-
Erratum: Stephanie Zoeller, Matthew L. Bechtold, Berri Burns, et al. Dispelling Myths and Unfounded Practices About Enteral Nutrition. Nutr Clin Pract. 2020; 35(2):196-204
- Volume 35Issue 5Nutrition in Clinical Practice
- pages: 973-973
- First Published online: June 2, 2020
Stephanie Zoeller RD, CNSC, LD/N
Orlando VAMC, Orlando, Florida, USA
Search for more papers by this authorMatthew L. Bechtold MD, FACP, FASGE, FACG, AGAF
Division of Gastroenterology & Hepatology Department of Medicine University Hospital & Clinics, Columbia, Missouri, USA
Search for more papers by this authorBerri Burns RD, LD, CNSC
Infusion Pharmacy at Home, Center for Connected Care, Cleveland Clinic, BOC, Independence, Ohio, USA
Search for more papers by this authorTheresa Cattell RD, CNSC
Nutrition Support Riverside Methodist Hospital, Columbus, Ohio, USA
Search for more papers by this authorBrandee Grenda MBA, RD, LDN, CNSC, CLC, CPT
Community First Medical Center, Chicago, Illinois, USA
Search for more papers by this authorLindsey Haffke MS, RD, LMNT, LD, CNSC
CHI Health at Home – Home Infusion Pharmacy, Omaha, Nebraska, USA
Search for more papers by this authorCara Larimer RDN
Enteral Nutrition Moog Medical Devices Group, Salt Lake City, Utah, USA
Search for more papers by this authorJan Powers PhD, RN, CCNS, CCRN, NE-BC, FCCM
Nursing Research and Professional Practice, Parkview Health System, Fort Wayne, Indiana, USA
Search for more papers by this authorLauren Tweel MSc, RD, CNSC
Chinook Regional Hospital, Alberta Health Services, South Zone, Lethbridge, Alberta, Canada
Search for more papers by this authorCorresponding Author
Peggi Guenter PhD, RN, FAAN, FASPEN
American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
Corresponding Author:
Peggi Guenter, PhD, RN, FAAN, FASPEN, Senior Director, Clinical Practice, Quality and Advocacy American Society for Parenteral and Enteral Nutrition, Silver Spring, MD, USA.
Email: [email protected]
Search for more papers by this authorthe ASPEN Enteral Nutrition Task Force
Orlando VAMC, Orlando, Florida, USA
Search for more papers by this authorStephanie Zoeller RD, CNSC, LD/N
Orlando VAMC, Orlando, Florida, USA
Search for more papers by this authorMatthew L. Bechtold MD, FACP, FASGE, FACG, AGAF
Division of Gastroenterology & Hepatology Department of Medicine University Hospital & Clinics, Columbia, Missouri, USA
Search for more papers by this authorBerri Burns RD, LD, CNSC
Infusion Pharmacy at Home, Center for Connected Care, Cleveland Clinic, BOC, Independence, Ohio, USA
Search for more papers by this authorTheresa Cattell RD, CNSC
Nutrition Support Riverside Methodist Hospital, Columbus, Ohio, USA
Search for more papers by this authorBrandee Grenda MBA, RD, LDN, CNSC, CLC, CPT
Community First Medical Center, Chicago, Illinois, USA
Search for more papers by this authorLindsey Haffke MS, RD, LMNT, LD, CNSC
CHI Health at Home – Home Infusion Pharmacy, Omaha, Nebraska, USA
Search for more papers by this authorCara Larimer RDN
Enteral Nutrition Moog Medical Devices Group, Salt Lake City, Utah, USA
Search for more papers by this authorJan Powers PhD, RN, CCNS, CCRN, NE-BC, FCCM
Nursing Research and Professional Practice, Parkview Health System, Fort Wayne, Indiana, USA
Search for more papers by this authorLauren Tweel MSc, RD, CNSC
Chinook Regional Hospital, Alberta Health Services, South Zone, Lethbridge, Alberta, Canada
Search for more papers by this authorCorresponding Author
Peggi Guenter PhD, RN, FAAN, FASPEN
American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
Corresponding Author:
Peggi Guenter, PhD, RN, FAAN, FASPEN, Senior Director, Clinical Practice, Quality and Advocacy American Society for Parenteral and Enteral Nutrition, Silver Spring, MD, USA.
Email: [email protected]
Search for more papers by this authorthe ASPEN Enteral Nutrition Task Force
Orlando VAMC, Orlando, Florida, USA
Search for more papers by this authorFinancial disclosure: C. Larimer is employed by Moog Medical Devices; J. Powers is on the Speakers Bureau at Abbott Nutrition and is an owner at EMPowers Consulting; F. Reuning is a co-founder of U Deliver Medical.
Conflict of interest: None declared.
Podcast available: Listen to a discussion of this manuscript with NCP Associate Editor Mary S. McCarthy, PhD, RN, CNSC, FAAN, and authors Stephanie Zoeller, RD, LD/N, CNSC, and Peggi Gurtner, PhD, RN, FAAN, FASPEN. This and other NCP podcasts are available at: https://onlinelibrary.wiley.com/page/journal/19412452/homepage/podcasts
Abstract
Many protocols and steps in the process of enteral nutrition (EN) use are not overly supported with strong research and have been done the same way over many years without questioning the use of best-practices evidence. This article reports many of the myths and unfounded practices surrounding EN and attempts to refute those myths with current evidence. These practices include those about enteral access devices, formulas, enteral administration, and complications.
References
- 1Robinson D, Walker R, Adams SC, et al. https://www.nutritioncare.org/uploadedFiles/Documents/Guidelines_and_Clinical_Resources/ASPEN%20Definition%20of%20Terms,%20Style,%20and%20Conventions%20Used%20in%20ASPEN%20Board%20of%20Directors%E2%80%93Approved%20Documents.pdf Published 2018. Accessed January 20, 2019.
- 2 Agency for Healthcare Research and Quality (AHRQ). Healthcare Cost and Utilization Program (HCUP). Data on enteral nutrition from National Inpatient Survey. https://hcupnet.ahrq.gov Published 2014. Accessed January 20, 2019.
- 3Read J, Guenter P. ASPEN Enteral Nutrition by the Numbers: EN Data Across the Healthcare Continuum. Silver Spring, MD: ASPEN; 2017.
- 4Mundi MS, Pattisson A, McMahon MT, Davidson J, Hurt RT. Prevalence of home parenteral and enteral nutrition in the United States. Nutr Clin Pract. 2017; 32(6): 799-805.
- 5Boullata JI, Long Carrera A, Harvey L, et al. ASPEN safe practices for enteral nutrition therapy. JPEN J Parenter Enteral Nutr. 2017; 41(1): 15-103.
- 6Pronovost PJ, Berenholtz SM, Needham DM. Translating evidence into practice: a model for large scale knowledge translation. BMJ 2008 October 6; 337:a1714.
- 7Wallace SC. Data snapshot: complications linked to iatrogenic enteral feeding tube misplacements. PA Patient Saf Advis. 2017; 14: 1-60.
- 8 Children's Hospital Association. Blind Pediatric NG Tube Placements Continue to Cause Harm [patient safety action alert]. Child Health Patient Safety Organization, Inc; 2012. https://www.childrenshospitals.org/-/media/Files/CHA/Main/Quality_and_Performance/Patient_Safety/Alerts/2012/ChildHealthPSO_BlindPediatricNGTubePlacements_PatientSafetyAlert_wattachment_08012012.pdf. Accessed December 2, 2019.
- 9Metheny N. AACN Practice Alert. Initial and ongoing verification of feeding tube placement in adults (applies to blind insertions and placements with an electromagnetic device). Critl Care Nurse. 2016; 36(2): e8-e13.
- 10Lyman B, Kemper C, Northington L, et al. Use of temporary enteral access devices in hospitalized neonatal and pediatric patients in the United States. JPEN J Parenter Enteral Nutr. 2016; 40(4): 574-580.
- 11Metheny NA, Stewart BJ, Mills AC. Blind insertion of feeding tubes in intensive care units: a national survey. Am J Crit Care. 2012; 21(5): 352-360.
- 12Irving SY, Rempel G, Lyman B, Sevilla WMA, Northington L, Guenter P; American Society for Parenteral and Enteral Nutrition. Pediatric nasogastric tube placement and verification: best practice recommendations from the NOVEL project. Nutr Clin Pract. 2018; 33(6): 921-927.
- 13 Patient Safety Movement Foundation. Actionable Patient Safety Solution Challenge #15 Nasogastric Tube (NGT) Placement and Verification. https://patientsafetymovement.org/actionable-solutions/challenge-solutions/nasogastric-tube-ngt-placement-and-verification/ Published 2018. Accessed February 1, 2019.
- 14 International Organization for Standardization. ISO 80369-3:2016, Small-bore connectors for liquids and gases in healthcare applications – Part 3: connectors for enteral application. https://www.iso.org/obp/ui/#iso:std:iso:80369:-3:ed-1:v1:en. Accessed May 7, 2019.
- 15 US Food and Drug Administration. Medical Device Connectors. https://www.fda.gov/medical-devices/general-hospital-devices-and-supplies/medical-device-connectors Published September 14, 2018. Accessed May 7, 2019.
- 16 Feeding Tube Awareness Foundation. Tube Feeding Basics: Jejunal tubes. https://www.feedingtubeawareness.org/tube-feeding-basics/tubetypes/j-tubes. Accessed May 9, 2019.
- 17 The Royal Children's Hospital Melbourne. Jejunal feeding guidelines. https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Jejunal_Feeding_Guideline/. Accessed May 10, 2019.
- 18Henderson JM, Strodel WE, Gilinsky NH. Limitations of percutaneous endoscopic jejunostomy. JPEN J Parenter Enteral Nutr. 1993; 17(6): 546-50.
- 19Pash E. Enteral nutrition: options for short-term access. Nutr Clin Pract. 2018; 33(2): 170-176.
- 20Malone A, Nieman Carney L, Long Carrera A, Mays A. Enteral Nutrition Handbook. 2nd ed. Silver Spring, MD: ASPEN; 2019.
- 21Wang TG, Wu MC, Chang YC. The effect of nasogastric tube on swallow function in persons with dysphagia following stroke. Arch Phys Med Rehabil. 2006; 87(9): 1270-73.
- 22Pryor LN, Ward EC, Cornwell PL, et al. Impact of nasogastric tubes on swallowing physiology in older, healthy subjects: a randomized controlled crossover trial. Clin Nutr. 2015; 34(4) 572-578.
- 23Wang ZY, Chen JM, Ni GN. Effect of an indwelling nasogastric tube on swallowing function in elderly post-stroke dysphagia patients with long-term nasal feeding. BMC Neurology. 2019; 19(1): 83. https://doi.org/10.1186/s12883-019-1314-6. Accessed May 9, 2019.
- 24 Real Food Blends. Administration of our meals. https://www.realfoodblends.com/. Accessed May 9, 2019.
- 25 Liquid Hope Information. https://www.functionalformularies.com/liquid-hope-information.html. Accessed May 9, 2019.
- 26Bobo E. Reemergence of blenderized tube feedings: Exploring the evidence. Nutr Clin Pract. 2016; 31(6): 730-735.
- 27Guha S, Bouhrira N, Antonino MJ, Silverstein JS, Cooper J, Myers MR. Impact of design changes in gastrostomy tube (G-tube) devices for patients who rely on home-based blenderized diets for enteral nutrition. J Am Coll Nutr. 2019; 38(4): 311-317.
- 28 Feeding Tube Awareness Foundation. Blended Diets. https://www.feedingtubeawareness.org/tube-feeding-basics/diet-nutrition/blended-diets/. Accessed May 10, 2019.
- 29Niv E, Fireman Z, Vaisman N. Post-pyloric feeding. World Journal of Gastroenterol. 2009; 15(11): 1281-1288
- 30Bechtold ML, Matteson ML, Choudhary A, Puli SR, Jiang PP, Roy PK. Early versus delayed feeding after placement of a percutaneous endoscopic gastrostomy: a meta-analysis. Am J Gastroenterol. 2008; 103(11): 2919-24.
- 31Szary NM, Arif M, Matteson ML, Choudhary A, Puli SR, Bechtold ML. Enteral feeding within 3 hours after percutaneous endoscopic gastrostomy placement: a meta-analysis. J Clin Gastroenterol. 2011; 45(4): e34-8.
- 32Cobell WJ, Hinds AM, Nayani R, et al. Feeding after percutaneous endoscopic gastrostomy: experience of early versus delayed feeding. South Med J. 2014; 107(5): 308-11.
- 33Mundi MS, Duellman W, Epp L, Davidson J, Hurt RT. Comparison of gravity flow rates between ENFit and legacy feeding tubes. JPEN J Parenter Enteral Nutr. 2018; 42(3), 522-528.
- 34Guenter P, Boullata J. Nursing 2013 survey results: drug administration by enteral feeding tube. Nursing. 2013; 43(12): 26-33.
- 35Boullata JI. Drug administration through an enteral feeding tube. Am J Nurs. 2009; 109(10): 39-42.
- 36Boullata JI. ASPEN Guidebook on Enteral Medication Administration. Silver Spring, MD:ASPEN; 2019. http://www.nutritioncare.org/ENMedicationGuidebook/
- 37McClave SA, Taylor BE, Martindale RG, et al. 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 (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2016; 40(2): 159-211.
- 38Heyland D, Stoppe C, Benstoem C, Lemieux M. Strategies to optimize the delivery of en: use of and threshold for gastric residual volumes. Critical Care Nutrition Systematic Reviews. 2018. https://criticalcarenutrition.com/docs/systematic_reviews_2018/5.5%20GRVs_2018.pdf Accessed May 10, 2019.
- 39Poulard F, Dimet J, Martin-Lefevre L, et al. Impact of not measuring residual gastric volume in mechanically ventilated patients receiving early enteral feeding: a prospective before-after study. JPEN J Parenter Enteral Nutr. 2010; 34(2): 125-30.
- 40DiLibero J, Lavieri M, O'Donoghue S, DeSanto-Madeya S. Withholding or continuing enteral feedings during repositioning and the incidence of aspiration. Am J Crit Care. 2015; 24(3): 258-61.
- 41Linn DD, Beckett RD, Foellinger K. Administration of enteral nutrition to adult patients in the prone position. Intensive Crit Care Nurs. 2015; 31(1): 38-43.
- 42Saez de la Fuente I, Saez de la Fuente J, Quintana Estelles MD, et al. Enteral nutrition in patients receiving mechanical ventilation in a prone position. JPEN J Parenter Enteral Nutr. 2016; 40(2): 250-5.
- 43van der Voort PH, Zandstra DF. Enteral feeding in the critically ill: comparison between the supine and prone positions: a prospective crossover study in mechanically ventilated patients. Crit Care. 2001; 5(4): 216-20.
- 44Reignier J, Thenoz-Jost N, Fiancette M, et al. Early enteral nutrition in mechanically ventilated patients in the prone position. Critical Care Medicine. 2004; 32(1): 94-99.
- 45Reignier J, Dimet J, Martin-Lefevre L, et al. Before–after study of a standardized ICU protocol for early enteral feeding in patients turned in the prone position. Clin Nutr. 2010; 29(2): 210-216.
- 46 Centers for Disease Control and Prevention. Wash Your Hands. https://www.cdc.gov/features/handwashing/. Accessed May 13, 2019.
- 47Bankhead RR, Boullata J, Brantley S, et al. A.S.P.E.N. enteral nutrition practice recommendations. JPEN J Parenter Enteral Nutr. 2009; 33(2): 122-167.
- 48Arriola TA, Hatashima A, Klang MG. Evaluation of extended-release pancreatic enzyme to dissolve a clog. Nutr Clin Pract. 2010; 25(5): 563-564.
- 49Marcuard SP, Stegall KS. Unclogging feeding tubes with pancreatic enzyme. JPEN J Parenter Enteral Nutr. 1990; 14(2): 198-200.
- 50Fisher CB, Blalock B. Clogged feeding tubes: a clinician's thorn. Pract Gastroenterol. 2014; 38(3): 16-22.
- 51Abdelhadi R, Rahe K, Lyman B. Pediatric enteral device management. Nutr Clin Pract. 2016; 31(6): 748-761.
- 52 Halyard Health. MIC-KEY* G Feeding Tube: Your Guide To Proper Care. https://www.mic-key.com/wp-content/uploads/2016/09/MIC-KEY-Care-and-Use-Guide-English.pdf. Published 2015. Accessed June 19, 2019.
- 53Malone A, Seres DS, Lord LM. Complications of Enteral Nutrition. In: Adult Nutrition Support Core Curriculum, 3rd ed. Silver Spring, MD: ASPEN; 2017, 265-284.
- 54de Brito-Ashurst I, Preiser JC. Diarrhea in critically ill patients: the role of enteral feeding. JPEN J Parenter Enteral Nutr. 2016; 40(7): 913-923.
- 55McCarthy MS, Fabling JC, Bell DE. Drug–nutrient interactions. In: Shikora SA , RG Martindale, SD Schwaitzberg, eds. Nutrition Considerations in the Intensive Care Unit: Science, Rationale and Practice. Dubuque, IA: Kendall-Hunt; 2002: 153–171. 4.
- 56Ratnaike R, Jones TE. Mechanisms of drug-induced diarrhoea in the elderly. Drugs & Aging. 1998; 13(3): 245-253.