Filetype PDF | Posted on 05 Jan 2023 | 3 years ago
Authentication
digital resources
303x Filetype PDF File size 0.15 MB Source: connect.springerpub.com
Nurses Responsibilities on Providing Enteral Nutrition to
the Critically Ill PatientiAn European Federation of Critical
Care Nursing Associations Position Paper
b
a
,
,
Andreas SCHAEFER, BSc, APN Julie BENBENISHTY, RN, PhD Aleksandra
c
d
,
GUTYSZ-WOJNICKA, RN, CCRN, PhD Jelena SLIJEPCEVIC, RN, BSN, MSN , Silvia SCELSI, RN,
e
g
f
,
BSN, MNS Arnaud BRUYNEEL, RN, CCRN, MSc, and Mag Karin KLAS, RN
InICU,oneofthenurse’srolesistoensurepropernutritionsupporttofacilitatetheir
recovery. However,fewnutritionprotocolsfornursesarefound.TheEuropeanfederationof
Critical Care Nursing associations (EfCCNa)positionstatementprovidesICUnurseswith
evidencedguidelinesregardingcaringforcriticallyillpatientswithenteralnutritionsupport.
Keywords:criticalcareunit;enteralnutrition;nurses;EuropeanFederationofCriticalCare
Nursingassociation
of enteral nutrition (Dhaliwal,Cahill,Lemieux,&
BACKGROUND
Heyland,2014;McClaveetal.,2016).
Nutritional status impacts wound healing, venti-
latorweaning,organfunction,mobility,andmor-
NURSESRESPONSIBILITIES ON PROVIDING
tality (Cederholm et al., 2017). Tian, Heighes,
ENTERALNUTRITIONiANEFCCNAPOSITION
Allingstrup, and Doig (2018) preformed a meta-
STATEMENT
analysis of randomized controlled trials and
ThisEuropeanfederationofCriticalCareNursing
demonstrated that better outcomes occurred
associations (EfCCNa) position paper provides
when patients who were unable to eat received
a protocol for nurse to care critically ill patients
nutrition support within 24 to 48 hours of ICU
with enteral nutrition. In this position state-
admission. Therefore, it is essential that nurses
ment,criticallyill patient is defined as those with
understand nutrition assessment and applica-
complex health situations, at high risk for insuf-
tion, monitor and manage severely ill patient’s
ficient nutrition, and in the need of an individual
nutrition. In ICU, one of the nurse’s roles is to
approach;enteralnutritionisdefinedastheappli-
provide proper nutrition to ensure support of
cation of nutritional supplements via oro/naso
severelyillpatients’organsystems.Innourishing
gastraltubesordevicesplacedintogastrointesti-
critically ill patients, nurses have an important
nal area. Nurses must assure that patient’s nutri-
roleinidentifyingthoseatriskofinadequatefeed-
tion administration starts within 24 hr⚶48 hr
ing, malnutrition, and preventing complications
a
Critical Care Asklepios Klinik Schwalmstadt, Germany
b
TraumaCoordinatorHadassahHebrewUniversityMedicalCenterJerusalem,Israel.E-mail:julie@hadassah.org.il
c
Critical Care Nurse Specialist, Adiunct Faculty of Health Sciences Collegium Medicum University of Warmia and Mazury,
Olsztyn,Poland
d
DepartmentofAnesthesiology,ReanimatologyandIntensiveCareUniversityHospitalCentreZagreb,Croatia
e
DirectorNursingandHealthProfessionsDepartmentG.GasliniChildren’sHospitalGenova,Italy
f
Critical Care Department,CliniquesUniversitairesStLuc,UCL,Brussels,Belgium
g
ProgrammeDirectorGeneralNursing&CriticalCareNursingIMCUniversityofAppliedSciencesKrems,Austria
Pdf_Folio:86
86 Connect: The World of Critical Care Nursing, Volume 12, Number 3, 2018, 86-89
©2018WorldFederation of Critical Care Nursing
http://dx.doi.org/10.1891/1748-6254.12.3.86
Figure 1. Protocol of caring for critically ill patients with enteral nutrition.
Assessment
Nutritional Status
NRS-nutrition risk screening FeedingTube
the NUTRIC score determine both nutritional status and disease severity. daily assessment of correct placement of the feeding tube
MALNUTITION RISK SCORE (geriatric patients) (according to the hospital standards)
SUBJECTIVE GLOBAL ASSESSMENT(surgical or trauma patients) and the BMI
(primary assessment, especially useful in low BMI individuals, BMI < 18 means asure oral/nasal hygene and care
severe malnutrition and a high risk of refeeding syndrom while nutrition support
Implementation Monitoring
the Nurse assures the accurate and adequate the daily nutritional intake based on metabolic status
Nutrition protocols should be used
the Nurse should prevent aspiration, constipation/obstipation, diarrhea
if the patient is not absorbing, (high residual, diminshed gastric motility) prokinetic therapy should be the Nurse should monitor the tolerance of Nutrition
considered if the patient is not absorbing, (highr esidual,
handling of nutritional supplement should be in accordance with the manufacturers instructions and diminshed gastric motility) prokinetic therapy
under hygienic standards should be considered
the Nurse should minimize interruptions in Nutrition intake due to(e.g.) surgical procedures, imaging,
medical interventions, scopes
the Nurse should explain and comunicate to patients and significant others regarding nutrition
Evaluation
if within7-10 days the patient is not receiving daily required dose/
calories perienteral Nutrition should be considered
if the patient is suffering from intolerance of enteral Nutrition consider
exchanging the type of enteral supplement product (e.g. hypo-osmolare
formular, nephro diet,…)
evaluate tube functionability
after admission to ICU (McClave et al., 2016). • TheNutritionRiskintheCritically
Then, they should assess the nutritional status Ill (NUTRIC)scoreassessingboth
and feeding tube efficacy of patients, implement nutritional status and disease
and monitor enteral nutrition, and then evalu- severity (Heyland, Dhaliwal, Jiang,
ate the outcomes of enteral nutrition. Figure 1 &Day,2011;Kondrup,Allison,Elia,
illustrates the protocol of caring for critically ill Vellas, & Plauth, 2002)
patients with enteral nutrition. • MalnutritionRiskScore(Ferguson,
Capra,Bauer,&Banks,1999)
• SubjectiveGlobalAssessment(for
1. Assessment
surgical or traumapatients)andthe
i. Nutritional Status
BodyMassIndex(BMI,witha
Thereareanumberoftoolsthatcanbe
BMI<18indicatingsevere
usedfordailyassessingthenutritional
malnutritionandahighriskof
status, such as:
refeedingsyndromewhilenutrition
• Nutritionriskscreening(NRS)
support)(Cederholmetal.,
(Kondrup,Rasmussen,Hamberg,&
2017)
Stanga,2003)
Pdf_Folio:87
Connect: The World of Critical Care Nursing, Volume 12, Number 3, 2018 87
ii. Feeding Tube
exchangingthetypeofenteralsup-
• Dailyassessmentoftheplacement
plementproduct(e.g.,hypo-osmolare
of the feeding tube (according to the
formular,nephrodiet,etc.)(McClave
hospital standards) to ensure its
et al., 2016; Singer et al., 2011)
correct placement
• Evaluatingtubefunctionability
• Assuringoral/nasalhygieneandcare
(MinistryofHealthSingapore,
2. Implementation and monitoring (enteral
2010)
nutrition)
• Asurringtheaccurateandadequate
CONCLUSION
daily nutritional intake based on
The EfCCNa position stated above provides an
metabolicstatus
overview concerning the key role of nurses
• Nutritionprotocolsshouldbeused
in enteral nutrition for critically ill patient.
(Kreymann,2010;Makic,VonRueden,
The position statement is underpinned with
Rauen,&Chadwick,2011)
evidence-basedguidelinesandsourcesfromlead-
• Monitoringthetoleranceofnutrition
ing experts in behalf of nourishing critically ill
(Nguyen,2014)
patients such as ESPEN (European Society of
• Preventingaspiration,constipation,
ParenteralandEnteralNutrition),ASPEN(Amer-
anddiarrhoea(Blaseretal.,2017)
ican Society of Parenteral and Enteral Nutri-
• If the patient is not absorbing leading
tion), and ESICM (EuropeanSocietyofIntensive
to food residue and diminshedgastric
Medicine).
motility, then prokinetic therapy
shouldbeconsidered(Knowles,
References
McInnes,Elliot,Hardy,&Middleton,
Blaser, A. R., Starkopf, J., Alhazzani, W., Berger,
2014;Montejoetal.,2010)
M.M.,Casaer,M.P.,Deane,A.M.,&Loudet,C.
• Nutritionalsupplementshouldbe
I. (2017). Early enteral nutrition in critically
takeninaccordancewiththe
ill patients: ESICM clinical practice guide-
manufacturersinstructionsandunder
lines. Intensive Care Medicine, 43(3), 380⚶
hygienicstandards(NationalClinical
398.doi:10.1007/s00134-016-4665-0
GuidelineCentre,2012)
Cederholm, T., Barazzoni, R., Austin, P., Ballmer,
• Minimizinginterruptionsinnutrition
P., Biolo, G., Bischoff, S. C., & Jensen, G.
intakeduetosurgicalprocedures,
L. (2017). ESPEN guidelines on defini-
imaging,medicalinterventions,scopes
tions and terminology of clinical nutri-
andsoon
tion. Clinical Nutrition, 36(1), 49⚶64.
• Explainingandcommunicatingto
doi:10.1016/j.clnu.2016.09.004
patients andsignificantothers
Dhaliwal, R., Cahill, N., Lemieux, M., & Heyland,
regardingnutritionalsupport
D.K.(2014).TheCanadiancriticalcarenutri-
(Doenges,Moorhouse,&Murr,2013)
tionguidelinesin2013:Anupdateoncurrent
3. Evaluation
recommendationsandimplementationstrate-
• If the patient is not receiving daily
gies. Nutrition in Clinical Practice, 29(1), 29⚶
requireddose/calorieswithin7⚶10
43.doi:10.1177/0884533613510948
daysafterICUadmission,parenteral
Doenges, M. E., Moorhouse, M. F., & Murr, A. C.
nutrition shouldbeconsidered
(2013). Nursing diagnosis manual: Planing,
(McClaveetal.,2016)
individualizing,anddocumentingclientcare.
• If the patient is suffering
Philadelphia, PA: F.A. Davis Company.
fromintoleranceofenteralnutrition,
Ferguson, M., Capra, S., Bauer, J., & Banks,
nursecanrecommendconsidering
M. (1999). Development of a valid and
Pdf_Folio:88
88 Connect: The World of Critical Care Nursing, Volume 12, Number 3, 2018
reliable malnutrition screening tool for adult
Ministry of Health Singapore. (2010). Nurs-
acute hospital patients. Nutrition, 15, 458⚶
ing clinical practice guidelines 1/2010 nurs-
464.doi:10.1016/S0899-9007(99)00084-2
ing management of nasogastric tube feeding
Heyland,D.K.,Dhaliwal,R.,Jiang,X.,&Day,A.G.
in adult patients. Singapore. Retrieved from
(2011). Identifying critically ill patients who
https://www.moh.gov.sg/home
benefit the most from nutrition therapy: The
Montejo, J. C., Minambres, E., Bordeje, L.,
development and initial validation of a novel
Mesejo, A., Acosta, J., Heras, A., & Man-
riskassessmenttool.CriticalCare,15(6),268.
zanedo, R. (2010). Gastric residual volume
doi:10.1186/cc10546
during enteral nutrition in ICU patients: The
Knowles, S., McInnes, E., Elliot, D., Hardy,
REGANE study. Intensive Care Medicine,
J., & Middleton, S. (2014). Evaluation of
36(8), 1386⚶1393. doi:10.1007/s00134-010-
the implementation of a bowel manage-
1856-y
ment protocol in intensive care: Effect on
National Clinical Guideline Centre. (2012).
clinician practices and patient outcomes.
Infection: Prevention and control of
Journal of Clinical Nursing, 23, 716⚶730.
healthcare-associated infections in pri-
doi:10.1111/jocn.12448
mary and community care: Partial update
Kondrup, J., Allison, S. P., Elia, M., Vellas, B.,
of NICE clinical guideline 2. Royal Col-
& Plauth, M. (2002). ESPEN guidelines for
lege of Physicians (UK). Retrieved from
nutrition screening 2002. Clinical Nutri-
https://www.ncbi.nlm.nih.gov/pubmed/23285
tion, 22(4), 415⚶421. doi:10.1016/S0261-
500
5614(03)00098-0
Nguyen, N. Q. (2014). Pharmacological ther-
Kondrup, J., Rasmussen, H. H., Hamberg,
apy of feed intolerance in the critically ills.
O., & Stanga, Z. (2003). Nutritional risk
World Journal of Gastrointestinal Phar-
screening (NRS 2002): A new method-
macology and Therapeutics, 5(3), 148.
based on an analysis of controlled clinical
doi:10.4292/wjgpt.v5.i3.148
trials. Clinical Nutrition, 22(3), 321⚶336.
Singer, P., Anbar, R., Cohen, J., Shalita-Chesner,
doi:10.1016/S0261-5614(02)00214-5
M., Lev, S., Grozovski, E., & Madar, Z. (2011).
Kreymann, G. (2010). New developments in clin-
The tight calorie control study (TICACOS)
ical practice guidelines. South African Jour-
a prospective, randomized, controlled pilot
nal of Clinical Nutrition, 23(Suppl. 1), 29⚶32.
study of nutritional support in critically ill
doi:10.1080/16070658.2010.11734266
patients.IntensiveCareMedicine,37(4),601⚶
Makic, M. B. F., VonRueden, K. T., Rauen, C. A.,
609.doi:10.1007/s00134-011-2146-z
&Chadwick, J. (2011). Evidence-based prac-
Tian, F., Heighes, P. T., Allingstrup, M. J., &
tice habits: Putting more sacred cows out to
Doig, G. S. (2018). Early enteral nutrition
pasture. Critical Care Nurse, 31(2), 38⚶62.
provided within 24 hours of ICU admission:
doi:10.4037/ccn2011908
Ameta-analysis of randomized controlled tri-
McClave, S. A., Taylor, B. E., Martindale, R.
als. Critical Care Medicine,46(7),1049⚶1056.
G., Warren, M. M., Johnson, D. R., Braun-
doi:10.1097/CCM.0000000000003152
schweig, C., & Gervasio, J. M. (2016).
Disclosure. The authors have no relevant finan-
Guidelines for the provision and assess-
cial interest or affiliations with any commercial
ment of nutrition support therapy in the
interests related to the subjects discussed within
adult critically ill patient. Journal of Par-
this article.
enteral and Enteral Nutrition, 40(2), 159⚶
211.doi:10.1177/0148607115621863
Pdf_Folio:89
Connect: The World of Critical Care Nursing, Volume 12, Number 3, 2018 89
no reviews yet
Please Login to review.
