Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
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Enteral tube feed (ETF) intolerance occurs frequently in hospitalized patients and more so in critically ill patients. Most critical care nurses continue to assess gastric residual volume (GRV), especially among those with a history of ETF intolerance. We hypothesized that ultrasound assessment of GRV correlates directly with aspirated tube feed volume. ⋯ Ultrasound assessment provides accurate assessment of gastric volume in real-life settings, and the CC diameter of the gastric antrum provides a simple surrogate of GRV.
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Enteral nutrition (EN) misconnections have been identified as a serious and potential deadly problem. An international effort led by EN industry leaders has developed a small-bore enteral connector (ENFit) that in theory will reduce the frequency of misconnections. Despite the potential benefit of preventing misconnections, the full impact of adoption of the ENFit connector is unknown. To assess the impact of transitioning to ENFit on our home EN (HEN) patients, the current study evaluated gravity feeding comparing 2 proposed small-bore connectors to the legacy (current connector) using various commercial formulas. ⋯ There is wide variability in the flow dynamics in ENFit connectors with significant potential impact on many facets of HEN, including medicine delivery, blenderized feeds, venting, and compliance with EN due to increased time to administer feeds. We highly recommend additional testing of flow dynamics, including gravity flow, as ENFit tubes are being developed and adopted.
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The literature indicates that pediatric malnutrition is more common than the number of times it is actually diagnosed. A new pediatric malnutrition definition is now available with criteria to make the diagnosis. ⋯ These reasons extend beyond the health of an individual patient to potential impacts on society as a whole. When all of these reasons are examined and added, making the diagnosis of pediatric malnutrition becomes an obligation of the pediatric caregiver.
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A nasogastric tube (NGT) insertion is a common procedure in intensive care units, with some serious complications that result from the malposition of the NGT tip. This pilot study was designed to investigate the efficiency of ultrasound in verifying correct NGT placement and to compare these results with radiographic findings. ⋯ Bedside sonography performed by a radiologist is an effective and sensitive diagnostic procedure for confirming the correct NGT position in patients in the pediatric critical care unit.
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Since the first intravenous nutrition support attempt with olive oil in the 17th century, intravenous fat emulsions (IVFEs) have evolved to become an integral component in the management of patients receiving home parenteral nutrition (HPN). IVFEs serve as a calorie source and provide essential fatty acids (linoleic acid and α-linolenic acid) in patients unable to achieve adequate intake of these fatty acids through alternative means. ⋯ The hope is that these IVFEs will prevent, or decrease the risk of, some of the HPN-associated complications. The goal of this article is to review how IVFEs came into use, their composition and metabolism, options for IVFE delivery in HPN, benefits and risks of IVFE use, and strategies to minimize the risks associated with IVFE use in HPN patients.