Jpen Parenter Enter
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Jpen Parenter Enter · May 2004
Education and evidence are needed to improve neonatal parenteral nutrition practice.
Parenteral nutrition (PN) is an essential component of neonatal care for those infants who are unable to tolerate adequate enteral feeding. Its use is not without complications such as biochemical derangements, sepsis, thrombosis, extravasation of fluid, and death. Such complications can be reduced by meticulous management of PN in response to biochemical abnormalities, nutrition teams, policies to reduce sepsis, and staff training to be more aware of pericardial and pleural effusions. We ascertained the current practices in PN administration and management of complications in all neonatal units with 6 or more intensive care cots in England, Scotland, and Wales. ⋯ There is a diverse practice and knowledge with a concerning lack of education in nutrition among the middle grade doctors in England, Scotland, and Wales. The management of common complications such as sepsis and hyperglycemia are highly variable. Improved staff training and production of unified evidence-based guidelines need urgent consideration.
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Jpen Parenter Enter · Mar 2004
Placement of nasoenteral feeding tubes using external magnetic guidance.
Enteral feeding is preferred over parenteral methods, and feeding into the duodenum is preferred over gastric feeding in certain groups of critically ill patients. However, with current techniques, feeding tubes often coil in the stomach, exposing patients to the risk of aspiration. This study investigated whether a nasoenteral feeding tube can be guided beyond the pyloric sphincter, using external magnetic guidance. ⋯ This case series demonstrates that external magnetic guidance achieves transpyloric placement of an enteral feeding tube in 89.1% of cases. This reliable bedside technique is superior to other methods described in the literature.
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Jpen Parenter Enter · Mar 2004
Monitoring bolus nasogastric tube feeding by the Brix value determination and residual volume measurement of gastric contents.
Critically ill patients do not always tolerate nasogastric tube feeding. Gastric residual volumes (GRVs), obtained by aspiration from a nasogastric tube, are widely used to evaluate feeding tolerance and gastric emptying, but controversy exists about what constitutes the true GRV (diet formula or digestive juice) and how it should affect management. In this pilot study, we used the Brix value (BV) measurement of gastric contents to monitor both GRV and food content in patients receiving nasogastric feeding. ⋯ This pilot study raises the feasibility that refractometry and the BV measurement of gastric juice may be a promising tool for bedside monitoring of tolerance and gastric emptying in patients receiving nasogastric feeding, providing valuable complementary information to traditional use of GRV.
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Jpen Parenter Enter · Mar 2004
Detection of pepsin in tracheal secretions after forced small-volume aspirations of gastric juice.
Detecting small-volume aspirations of gastric contents is an important but difficult task. A potentially useful method for this purpose is assaying tracheal secretions for pepsin, an expected constituent of gastric juice. ⋯ The immunoassay used in this animal model study was able to detect pepsin in >90% of the experimental animals' tracheal secretions after multiple or single forced aspirations of gastric juice. The extent to which pepsin can be detected in the tracheal secretions of acutely ill tube-fed humans requires investigation, as does the extent to which clinical outcomes are affected by pepsin-positive tracheal secretions.