PICO Question: In critically ill mechanically ventilated adults receiving temporary enteral feedings, does the implementation of a nurse driven enteral nutritional therapy assessment protocol reduce the risk of hypocaloric intake compared with current practice?
Survey questions regarding mechanically ventilated critically ill adults receiving temporary enteral nutritional therapy (applies to intensive care registered nurses, nurse practitioners, or physician assistants): Select all that apply
RN________ NP_________ PA_________ OTHER (Please specify)_____________________________
1.) Does your intensive care unit have a specific guideline or protocol regarding enteral nutritional therapy in critically ill mechanically ventilated adults?
a. Yes and it is clear, concise, and easy to understand
b. Yes, but I don't quite understand it c. No
d. Not sure
2.) In your practice, do you routinely insert a nasal or oral gastric tube in the critically ill mechanically ventilated patient?
a. Always nasal
b. Always oral gastric
c. Whichever is easier d. The purpose of the tube drives my decision (for the purposes of draining or feeding)
3.) In your facility, for the purpose of temporary enteral nutritional therapy, what type of feeding tube is most often initiated?
a. Salem Sump (gastric)
b. Other Gastric__General NG tube
c. Post pyloric (Nasojejunal : NJ tube)
d. Not sure
4.) After enteral nutritional therapy has been ordered, what assessment criteria drives your decision that the critically ill mechanically ventilated patient is ready for enteral nutritional therapy to be initiated?
a) Bowel sounds auscultated in all four quadrants
b) Lack of abdominal distention
c) Patient has been intubated for more than 72 hours
d) The therapy has been ordered so there is no other criteria necessary
[B]e) Other__All of the above are issues that would be considered- however, "D" is the most often reason._______________________________________
5.) What rate do you currently initiate your enteral nutritional therapy in the critically ill mechanically ventilated patient?
a. 10 milliliters an hour and advance to goal as tolerated
b. 20 milliliters an hour and advance to goal as tolerated
c. Bolus feedings
d. I start my feedings at the goal rate
e. Other (please describe)__As ordered by the MD_
6.) What monitoring criteria do you employ when caring for a patient receiving enteral nutrition therapy?
a. Gastric residual volumes
b. Promotility agents
c. Patient positioning d. All of the above
e. Other_____________________________________________ __
7.) What assessment criterion currently drives your decision that the patient will tolerate an increased rate of enteral nutrition therapy a. Bowel sounds auscultated in all four quadrants
b. Lack of nausea and or vomiting
c. Lack of diarrhea d. Gastric residual volumes
8.) After initiation of enteral nutritional therapy, how often do you assess gastric residual volumes?
a. Every hour if residuals remain high b. Every four hours
c. Every eight hours
d. Once a shift
9.) What amount of gastric residual volumes would you consider acceptable to advance your feeding rate?
a. There should be no gastric residual volume
b. 10% of amount of feeding instilled
c. 20% of amount of feeding instilled
d. I do not use gastric residual volumes as an assessment criteria to determine patient tolerance to enteral nutritional therapy e. Other_______each of our MD's has their own acceptable residual- highest amount is 200 ml_
10.) When assessing gastric residual volumes, what amount would you consider "High volumes" which would cause you to "hold" the patient's feedings.
a. Greater than 50% of the amount of feeding instilled b. Greater than 250 cc in a four hour period regardless of the rate
c. Greater than 500 cc in a four hour period regardless of the rate
d. Greater than 100 cc in an hour regardless of the rate
e. Other _______________________________
11.) When assessing gastric residual volumes, how much do you consider an acceptable amount to return to the patient?
a. I discard all gastric contents
b. I return all gastric contents
c. I return only 250 cc of gastric contents
d. I return only 500 cc of gastric contents e. Other__________200 is the most I would return if the pt is getting continuous feedings
12.) How often do you flush your feeding tubes?
a. 60 cc every 2 hours
b. 60 cc every 4 hours
c. 60 cc every 6 hours
d. After administering medications e. Other___________at least every 4 hours and after meds___
Please feel free to add additional comments:
I personally don't feel that enteral feedings are a good soource of nutrition. Many critically ill patients need higher levels of calories and protein- these just do not provide it. I think food services should make a puree of REAL food and make it into a thin enough liquid that we can give it through an NG tube- IMHO- just my