Survey regarding tube feedings

bellehill, RN · Oct 27, 2010

1)c

2)e...if the patient is mechanically ventilated we do oral, non-vented we do nasal

3)a

4)e...enteral feeding should be started as soon as possible, it is best practice for the patient

5)a

6)a

7)d

8)b

9)e...we hold tube feeding one hour for residual >150cc

10)b

11)c

12)d

angle85 · Oct 27, 2010

dear dnpstudent,

i worked in icu 1.5 year and in ccu 1.5 year

i hope my reply is helpful for you

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__yes______ 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)

e. other_________________________________________

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__(ryle's tube - stomach tube)___

c. post pyloric (nasojejunal : nj tube)

d. not sure

e. other___________________________________________

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

e) other_________________________________________

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)___________________________

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

e. other______________________________

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

e. other_____________________________________

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____________________________________________

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____________________________________________

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_____________________________________________ ___

TigerGalLE, BSN, RN · Oct 27, 2010

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 We have a registered dietitian that is consulted and orders the appropriate nutritional therapy
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)
e. Other Depends on the physician that intubates. Some MDs will insert oral FT following intubation. Nurses usually insert nasally if inserted before or after intubation.
3.) In your facility, for the purpose of temporary enteral nutritional therapy, what type of feeding tube is most often initiated?
b. Other Gastric______________________________________
c. Post pyloric (Nasojejunal : NJ tube)
d. Not sure
e. Other___________________________________________
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
e) Other_________________________________________
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)___________________________
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
e. Other______All of the above________________________
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
e. Other_____________________________________
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__100ml or less__________________________________________
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 > 100ml after 4hrs .. hold for 1 hour and recheck
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____________________________________________
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_______Most patients have orders for at least 10ml H20 flush per hour___
Please feel free to add additional comments:

I hope this helps

fiveofpeep · Oct 27, 2010

1.) Does your intensive care unit have a specific guideline or protocol regarding enteral nutritional therapy in critically ill mechanically ventilated adults?

c. No

2.) In your practice, do you routinely insert a nasal or oral gastric tube in the critically ill mechanically ventilated patient?

a. Always nasal

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)

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?

c) Patient has been intubated for more than 72 hours

5.) What rate do you currently initiate your enteral nutritional therapy in the critically ill mechanically ventilated patient?

b. 20 milliliters an hour and advance to goal as tolerated

6.) What monitoring criteria do you employ when caring for a patient receiving enteral nutrition therapy?

d. All of the above

7.) What assessment criterion currently drives your decision that the patient will tolerate an increased rate of enteral nutrition therapy

d. Gastric residual volumes

8.) After initiation of enteral nutritional therapy, how often do you assess gastric residual volumes?

b. Every four hours

9.) What amount of gastric residual volumes would you consider acceptable to advance your feeding rate?

e. Other: less than 100ml and not steadily increasing throughout the day

10.) When assessing gastric residual volumes, what amount would you consider "High volumes" which would cause you to "hold" the patient's feedings.

e. Other: greater than 100cc in 4hrs

11.) When assessing gastric residual volumes, how much do you consider an acceptable amount to return to the patient?

e. Other: anything less than 100ml

12.) How often do you flush your feeding tubes?

d. After administering medications which usually ends up being q2-4h

meandragonbrett · Oct 29, 2010

You would probably get more responses if you used Survey Monkey so that we didn't have to type our responses out.

KNMRN83 · Oct 31, 2010

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____X____ 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?

c. No

2.) In your practice, do you routinely insert a nasal or oral gastric tube in the critically ill mechanically ventilated patient?

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)

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?

d) The therapy has been ordered so there is no other criteria necessary

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

6.) What monitoring criteria do you employ when caring for a patient receiving enteral nutrition therapy

d. All of the above

7.) What assessment criterion currently drives your decision that the patient will tolerate an increased rate of enteral nutrition therapy

e. Other: lack of tube feeds or tube feed-like material coming back out of an NGT or OGT

8.) After initiation of enteral nutritional therapy, how often do you assess gastric residual volumes?

e. Other: it depends on the pt, and usually our pts have OGT or NGT hooked up to wall suction and that is how we assess if the pt is tolerating rather than checking residuals

9.) What amount of gastric residual volumes would you consider acceptable to advance your feeding rate?

d. I do not use gastric residual volumes as an assessment criteria to determine patient tolerance to enteral nutritional therapy

10.) When assessing gastric residual volumes, what amount would you consider "High volumes" which would cause you to "hold" the patient's feedings.

b. Greater than 250 cc in a four hour period regardless of the rate

11.) When assessing gastric residual volumes, how much do you consider an acceptable amount to return to the patient?

b. I return all gastric contents

12.) How often do you flush your feeding tubes?

d. After administering medications

mpccrn, BSN, RN · May 19, 2011

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)

e. Other_________________________________________

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______________________________________

c. Post pyloric (Nasojejunal : NJ tube)

d. Not sure

e. Other_feeds are usually started with the already placed NGT. If there is a prolonged intubation, a dubhoff or fredric-miller tube is placed.

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

e) Other_________________________________________

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)___________________________

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 HOB is always elevated 30 degrees at least. If the patient has to be placed flat for whatever reason, the feeds are stopped and restarted once the HOB is elevated again.

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

e. Other______________________________

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

e. Other_____________________________________

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_Less than 150cc ___________________________________________

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 __150cc_in 4 hours, protocol calls to stop the feeds for 1 hour and then restart feeds, check residual in an hour, if it is still high, contact the physician.

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. If the residual is 60cc or less, I return it to the patient, if over, I discard it all.

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__100cc q 4 hours if their NA levels are ok.

Please feel free to add additional comments:

ICUenthusiast · May 22, 2011

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 x 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)

e. Other_________________________________________

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______________________________________

c. Post pyloric (Nasojejunal : NJ tube)

d. Not sure

e. Other Salem Sump for decompression, change to Cortrak when starting feeding or when a Cortrak-certified RN can replace is preferred.. Cortrak placement determined by physician/RN decision. Gastric is fine unless physician wants gut rest, in which Cortrak-certified RN will go into jejunum or duodenum.

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

e) Other X-ray is performed before starting all feedings to confirm placement, and can also show if there is any obstruction or s/s of other issues like ileus. Otherwise, we are taught to start ASAP to keep the gut in a happy place.

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) Varies

6.) What monitoring criteria do you employ when caring for a patient receiving enteral nutrition therapy?

a. Gastric residual volumes

b. Promotility agents (in some cases)

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 (if pt able)

c. Lack of diarrhea

d. Gastric residual volumes

e. Other______________________________

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

e. Other_____________________________________

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 It's in the protocol in which I don't remember exactly

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____________________________________________

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 30 cc q4h

This is all protocol in my hospital, which we are supposed to print out the protocol sheet and place in the paper chart for all pts on tube feeding.

ciaobellaRN · May 23, 2011

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)...NJ for enteral nutrition, OG for drainage/decompression

e. Other_________________________________________

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______________________________________

c. Post pyloric (Nasojejunal : NJ tube)...If not NJ, as far into the duodenum as we can get it!

d. Not sure

e. Other___________________________________________

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

e) Other...The RN collaborates with the medical team caring for the patient daily. In addition, the critically ill mechanically ventilated patient is assessed by the attending physician and any consulted MD's daily, if not more frequent. Enteral nutrition IS NOT ordered until it is ready to be initiated.

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...A registered dietician assesses the patient and communicates her recommendations as to what type of feed the patient needs, what rate to start it at, how often to advance, and what the goal rate is. More often than not, the MD follows her recommendations.

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...Certain lab values, tube placement confirmation initially by xray and air bolus with bedside assessments, monitoring cm mark position labeled on the tube, noting the condition of the dressing holding the tube in place, frequency of BM's, how often tubing is changed, how often the feed itself is replaced with new feed, how often the tube is flushed, hourly mL's of intake into the tube (including feed, med's, flush, etc.)...

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...we also have some patient's on trophic feeds. Typically the goal rate is 10 mL/hr and the tube is preferred to be as far into the duodenum as possible.

e. Other______________________________

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...policy states q4h. If residual is over 200 mL TF are stopped, and there is a protocol on how and when to restart/advance.

c. Every eight hours

d. Once a shift

e. Other_____________________________________

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____________________________________________

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...greater than 200 mL's

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...no more than 200 mL's

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

RNforLongTime · May 24, 2011

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___X___ 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?

c. No

2.) In your practice, do you routinely insert a nasal or oral gastric tube in the critically ill mechanically ventilated patient?

b. Always oral gastric

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)

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?

d) The therapy has been ordered so there is no other criteria necessary

5.) What rate do you currently initiate your enteral nutritional therapy in the critically ill mechanically ventilated patient?

e. Other (please describe Dietician orders type of tube feeding and recommended starting rate and parameters for increasing tube feeding to goal

6.) What monitoring criteria do you employ when caring for a patient receiving enteral nutrition therapy?

a. Gastric residual volumes

__

7.) What assessment criterion currently drives your decision that the patient will tolerate an increased rate of enteral nutrition therapy

d. Gastric residual volumes

8.) After initiation of enteral nutritional therapy, how often do you assess gastric residual volumes?

b. Every four hours

9.) What amount of gastric residual volumes would you consider acceptable to advance your feeding rate?

e. Other-if the gastric residual is less than 120cc then I advance the feeding rate

10.) When assessing gastric residual volumes, what amount would you consider "High volumes" which would cause you to "hold" the patient's feedings.

d. Greater than 100 cc in an hour regardless of the rate

11.) When assessing gastric residual volumes, how much do you consider an acceptable amount to return to the patient?

b. I return all gastric contents--the first time I check residual. I'll recheck in an hour and if the residual is still high, then I discard gastric contents

12.) How often do you flush your feeding tubes?

d. After administering medications AND 30cc q4hrs with residual check

**LaurelRN, MSN · May 28, 2011

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)

e. Other_________________________________________

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

e. Other___________________________________________

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._______________________________________

[/b]

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

e. Other______________________________

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

e. Other_____________________________________

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 :twocents: