Tube Feeding Question

[CoastMedRN]

I know we have been taught to STOP/HOLD a tube feeding whenever we place the patient flat for short term procedures like baths, turning, etc. But I want opinions if this ritual makes sense and why. For example, to place a patient flat for pulling up in bed, say 5 minutes for a fresh pad etc. why stop the tube feeding since the patient will be getting maybe 5 cc of feeding more or less. I understand it is policy normally to DO this but what is your opinion of the science behind it? One GI doctor told me it really does not matter or make sense for a few minutes if the feeding is 75cc/hr or less. Another GI doctor said absolutely hold it but could only say "that is the policy" but could not explain how a few cc's for short term would lead to emesis or aspiration. Your thoughts pro/con/whatever. And if you have any case studies/science behind it not just "it's policy where I work". Thanks my colleagues for any thoughts.

[meandragonbrett]

There was an article in Critical Care Nurse either in 2007, 08, or 09 that discussed this very topic. I will see if I can find it.

[mykrosphere]

i agree. awesome question......that i never really questioned!

[Creamsoda, ASN, RN]

Just wanted to bring this topic back up as it came up at work. I still for the life of me don't get the rational. I never have and never will unless someone can give me a good solid rational, this has plagued me for a few years. Where I work in ICU, I don't see how stopping the tube feed for 2 minutes while you are turning the patient or boosting them up will reduce their chances of aspirating. Its their stomach full of tube feed that has already infused that will increase their risk of aspirating. The 1 cc is going to put them over the top? Yes I will hold it if they will be flat for more than a few minutes during a bath or whatever, but routine turns I don't see the point. But I still bath my patients with HOB at 30, unless I'm turning or washing their hair in bed. The only logic was the one poster who said if you got called away and for that one time you had to leave them flat at least its already off...which we would almost never do, but hey it could happen. Basically when I rolled my eyes when the nurse said, hey what about the tube feed? I said I don't believe in that, and he replied, "you don't believe in aspiration?". I corrected him, saying of course I do, I just can't logically believe one cc is going to do it. Its going to be their ileus, poor toleration and a stomach full of food ect ect.

Any one with other thoughts? Try to convince me otherwise?

[xtxrn, ASN, RN]

Anybody with GERD lie down and within 2 minutes have to sit back up????

BTDT. :) And that's without the hose making the sphincter "violated".

[nurseprnRN, BSN, RN]

i think that this would make a terrific study and it would not be hard to do, though it might take awhile to get a decent sample size. you could probably use one of those little bedside uss or see if the gadget that they use for bladder scans for residual would work. you could also see if you could use a little gastrografin (a clear but radiopaque substance) to see if it was getting washed back to the esophagus under various conditions-- since this would involve x-ray, you might have to limit it to cases when the pt was in radiology anyway.

it doesn't make sense to turn off a tf for the minutes it takes to turn, lift, or whatnot, if there is already some sort of accumulated volume in the stomach. but tf rate is dependent on how fast it does move out of the stomach. i mean, if it didn't move out at the same rate it came in, or faster, things would get messy in a hurry, right? what is that baseline residual, anyway? it would be easy to check for residual before any such maneuver-- perhaps there's a max residual that is too much, but less is low-risk.

(btw: if your tf is at 30cc/hr and you turn it off for three minutes, that's not 6cc, it's 1.5 cc....-- it's running at 1/2 cc/minute)

[nagano21]

First time post here,

Anyway to answer your question it is no longer required. When I go to work I will look for the article which proved this, but since I started nursing I thought it was was probably one of the most un-needed things I saw us doing frequently, especially for those of us who would do it only seconds prior to laying flat, whatever was in their stomach was in there, the small amt of cc's that would be given during the time they were down and sat back up was tiny.

Anyway a nurse I work with recently brought in an article (I work in ICU/CCU) from a nursing magazine that was based off of a study that was performed, as well as that for better glucose control the starting then stopping of TF's was shown to actually cause fluctuations in blood sugars... not sure how long the test subjects had their feeds stopped for. It was a very interesting article and hope I can find it to share.

[nurseprnRN, BSN, RN]

was this it?

critical care nursing quarterly:

february 2002 - volume 24 - issue 4 - p 67-74

critical care research: part 1

special feature: exploring the benefits and myths of enteral feeding in the critically ill

swanson, ross w. rn, ba, ccrn; winkelman, chris rn, phd, ccrn

abstract

patients in the intensive care unit setting have been nutritionally deprived for various reasons. many patients who are critically ill cannot absorb nourishment by traditional routes. enteral feeding should be considered for all patients who cannot meet caloric needs. there are many benefits to enteral feeding such as decreased infection, rapid wound healing, and decreased length of stay and mortality. many critical care nurses subscribe to myths for not feeding their patients. the myths for not feeding critically ill patients involve gut motility, feeding residuals, and patient positioning. there is significant evidence both to support nutrition as integral to recovery from a critical illness and to suggest that enteral feeding is efficient and effective at providing nutrition.

[nagano21]

Possibly, I would need to take another look at the article he brought in... I am guessing it probably is though.

[KelRN215, BSN, RN]

I work in neuro and we sometimes have patients that have to lay flat for DAYS following spinal surgery. Occasionally these are patients with very complicated histories who are exclusively tube fed. We don't hold their feeds for the entire length of time that they have to be flat. That would mean not even thinking about initiating feeds for 3-5 days for some of them.

[Creamsoda, ASN, RN]

First time post here,

Anyway to answer your question it is no longer required. When I go to work I will look for the article which proved this, but since I started nursing I thought it was was probably one of the most un-needed things I saw us doing frequently, especially for those of us who would do it only seconds prior to laying flat, whatever was in their stomach was in there, the small amt of cc's that would be given during the time they were down and sat back up was tiny.

Anyway a nurse I work with recently brought in an article (I work in ICU/CCU) from a nursing magazine that was based off of a study that was performed, as well as that for better glucose control the starting then stopping of TF's was shown to actually cause fluctuations in blood sugars... not sure how long the test subjects had their feeds stopped for. It was a very interesting article and hope I can find it to share.

Yes if you could find it that would be great!. I know where I used to work a few years ago they finally told us we could stop this habit as there was some research done, but that was a while ago and not sure where the research was done. I would just love to have it handy incase someone gives me the stink eye next time I roll my eyes. haha

[smartnurse1982]

This is old but i just had a clinical supervisor mark points off of my "observation skills" because i paused the feeding for 8 minutes while changing the patient's diaper. The pt is also trach-vent.

She said there is research that shows laying the HOB flat for a few minutes and leaving the feeding running does not make a difference.

[regina.moss]

I'm glad I found this thread and definitely agree that it makes no sense to hold tube feedings for turning patients, etc. I was not able to find any policy regarding this practice at my hospital so I would like to get one started. However, like you, I am having a hard time finding actual evidence. Several years ago, there was an article of Critical Care Nurse journal that recommends NOT turning off feedings when laying a patient flat because of the reasons that you mentioned. The article also mentioned complications, such as clogged feeding tubes and sub therapeutic nutrition levels, that occur due to the outdated practice of holding tube feeds when laying a patient flat. I will continue to look for additional evidence. I was told by a nurse who also works at Kaiser that doctors in that unit specifically wrote "do not turn off feeding" for turning, etc. It is hard to change everyone's practice when there is no policy to support it. Wish me luck in trying to change this practice. It drives me absolutely crazy when I have nurse's aids and lift team staff lecturing me that I did not turn off the feeding when we turned (it literally takes 2 minutes to turn). Even worse is when they turn off the feeding without telling me and I go back after an hour or 2 (or more ) to find that the feeding has been off. I only have to hope that my patient did not become hypoglycemic or my Tube didn't get clogged . Please keep me up to date with what you find out. You may email me at [email protected].