SPECIAL SESSION: Preventing Complications Associated with Tube Feedings

Description/Overview: The session will include a discussion of evidence to support or refute a variety of commonly used methods to determine feeding tube placement. Among the methods to be evaluated are: pH testing of feeding aspirates, observing the appearance of feeding tube aspirates, auscultation for a bubbling sound over the epigastric region as air is injected through the tube, electromagnetic monitoring, and carbon dioxide detection devices. Because the pH method is the most widely recommended bedside placement method, factors that may affect its accuracy will be reviewed; among these are the use of gastric acid inhibitors and recent feedings. Variations in methods used to detect feeding tube placement will be discussed in relation to a patient’s age and severity of illness. The pros and cons of the various methods will be reviewed and recommendations will be offered, based on the most current research findings. A comparison of the efficacy of a variety of methods to assess for aspiration will be presented. Methods to reduce risk for aspiration will be explored; among these are positioning of the head of the bed, positioning of the feeding tube within the gastrointestinal tract, and monitoring for signs of gastrointestinal intolerance to feedings. Controversy regarding the usefulness of gastric residual volumes as a predictor for aspiration risk will be discussed. Other possible indicators of gastrointestinal intolerance to feedings (such as hypoactive bowel sounds and vomiting) will be reviewed. Current guidelines issued by major practice organizations (including the American Society for Parenteral and Enteral Nutrition, the American Association of Critical Care Nurses Practice Alerts, and the National Patient Safety Agency) will be compared and discussed.