JPEN. Journal of parenteral and enteral nutrition
-
JPEN J Parenter Enteral Nutr · Jul 2016
Impact of Process Optimization and Quality Improvement Measures on Neonatal Feeding Outcomes at an All-Referral Neonatal Intensive Care Unit.
We hypothesized that the implementation of a feeding quality improvement (QI) program among premature neonates accelerates feeding milestones, safely lowering hospital length of stay (LOS) compared with the baseline period. ⋯ Process optimization and the implementation of a standardized feeding strategy minimize practice variability, accelerating the attainment of enteral and oral feeding milestones and decreasing LOS without increasing adverse morbidities.
-
JPEN J Parenter Enteral Nutr · May 2016
Comparative StudyUse of an Electromagnetic Device Compared With Chest X-ray to Confirm Nasogastric Feeding Tube Position in Critical Care.
Insertion of nasogastric feeding tubes (NGTs) is common in critical care. However, misplacement is frequent and can carry a significant morbidity. Current methods to confirm position of NGTs are not reliable in this setting. We retrospectively compared the position of NGTs using an electromagnetically guided nasogastric tube (e-NGT) with that demonstrated by chest x-ray (CXR), the proportion of lung placements avoided, and the time taken to establish enteral feeding. ⋯ When placed by a dedicated team, e-NGT allowed immediate detection of tube misplacement. As such, if used as the sole method for determining NGT position, e-NGTs minimize feeding delay and the need for multiple CXRs with subsequent cost savings.
-
JPEN J Parenter Enteral Nutr · May 2016
Challenging the 48-Hour Rule-Out for Central Line-Associated Bloodstream Infections in the Pediatric Intestinal Failure Population: A Retrospective Pilot Study.
While parenteral nutrition (PN) has revolutionized the management of patients with intestinal failure (IF), central line-associated bloodstream infections (CLABSIs) remain a leading cause of mortality and morbidity in this population. The objective of this study is to characterize the presentation of CLABSIs in pediatric IF and to determine the time to positivity of blood cultures. ⋯ Our data suggest that most pediatric patients with IF who have CLABSI develop positive cultures within 24 hours, and the absence of fever and leukocytosis does not necessarily indicate the absence of infection. These findings may support clinical practice guidelines in favor of shorter hospital stay when CLABSI is suspected; however, a prospective analysis of CLABSI in this population is recommended to determine the safety and appropriate setting prior to any practice change.
-
JPEN J Parenter Enteral Nutr · Mar 2016
One-Step Insertion of Low-Profile Gastrostomy in Pediatric Patients vs Pull Percutaneous Endoscopic Gastrostomy: Retrospective Analysis of Outcomes.
Standard care for initiation of enteral feeding in children has been pull percutaneous endoscopic gastrostomy (pull-PEG). As an alternative to pull-PEG, a 1-step endoscopic procedure for inserting a low-profile gastrostomy tube "button" has been developed that allows initial placement of a balloon-retained device. This report presents outcomes of metrics used to compare button placement with pull-PEG in a pediatric population. ⋯ Similar study outcomes between the 1-step procedure and pull-PEG groups suggest that the former is a feasible alternative to pull-PEG for initial tube placement in children. The 1-step method involves a single procedure and reduces patient exposure to anesthesia, operating room time, and the potential for complications compared with a pull-PEG requirement for multiple procedures.