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Get it in Keep it in Keep it running

Get it in Keep it in Keep it running. Adventures in bedside feeding tube placement and other hands-on feeding tube related activities by registered dietitians. Utah Academy of Nutrition and Dietetics Annual Meeting, March 20, 2014. Objectives.

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Get it in Keep it in Keep it running

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  1. Get it in Keep it in Keep it running Adventures in bedside feeding tube placement and other hands-on feeding tube related activities by registered dietitians. Utah Academy of Nutrition and Dietetics Annual Meeting, March 20, 2014

  2. Objectives • Describe the experience of one clinical nutrition team developing a program for hands-on feeding tube placement and care. • Discuss benefits in terms of patient care of dietitian involvement in feeding tube placement and care, including cost savings. • Discuss pros and cons for dietitians of taking on the role of feeding tube placement and care.

  3. Participation Activity

  4. What Get it in Bedside feeding tube placement Keep it in FT bridle placement Keep it running FT clog clearing By Dietitians

  5. Why?

  6. Why • Altruistim (patient care) • Self interest (job satisfaction) • Practical reasons (cost containment)

  7. Patient Care

  8. Job Satisfaction • Avoid burn out • New marketable skill • Increased recognition

  9. Cost Containment

  10. Getting It Done Data collection Training Equipment Support Idea

  11. Desire Idea Inspiration

  12. Support • Direct manager • Fellow staff • Nursing • Physicians • Administration • Approving committees • Outside sources

  13. Equipment

  14. Feeding tube bridle

  15. Dobhoff feeding tube OUCH!

  16. Frederick-Miller feeding tube

  17. Cortrak

  18. Other tubes

  19. Other tubes

  20. Personal Protective Equipment: a fashion must

  21. Personal Protective Equipment: a fashion must

  22. Stethescope

  23. TubeClear

  24. Training: bridle placement • MD champion • Watch one – Do one • Competency check list provided by manufacturer

  25. Bridle placement method • Insert probes • Feel & listen for click • Remove stylet • Pull tape through • Clip onto feeding tube • Knot and clip ends

  26. Training: bedside feeding tube placement • Outside advice • Create training competency • One on one training with multiple RNs • Trained RDs pass off other RDs

  27. FT placement method • Position patient • Measure • Advance to stomach • Assess • Pull back with syringe • Watch for “pop” • Observe contents for amount, texture, color • Listen over abdomen middle and side • Advance using “puff and twist” • Assess again, look for changes • Secure • Confirm placement (abdominal film) • Document

  28. Training: TubeClear • In-house training by manufacturer • Artificial feeding tube clogs provided • Competency checklist provided

  29. Dietitian Pros & Cons • Better understanding of patient experience • Increased empathy • Ability to trouble shoot feeding tube problems • Recognition from RNs and other staff • Improved relationship with caregiver team

  30. Dietitian Pros & Cons • Exposure to mucous and vomit • Inflict pain or discomfort • Difficult or agitated patients • Increased responsibility/liability • Greater commitment

  31. Data collection • Checklist items • Adverse events • RD time spent • Time from order to insertion • Gastric vs SB placement • Who placed the tube

  32. Reduced total fluoro placement • Bedside placement by RNs and RDs • Avoid unnecessary replacement • Bridles • Clearing clogs • Avoiding clogs • Feed stomach when appropriate • Educating MDs on appropriate uses for fluoro • Intraoperative placement

  33. Reduced total fluoro placement • Feeding tubes placed in fluoro • 2012: 124 • 2013: 88 • Cost reduced by 29%

  34. References McClave et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adjult Critically Ill Patient. JPEN, 2009, 33 (3),:277-316. Faisy et al. Impact of energy deficit calculated by a predictive method on outcome in medical patients requiring prolonged acute mechanical ventilation. Fr J Nutr. 2009;101:1079-1087. Bartlett et al. Measurement of metabolism in multiple organ failure. Surgery. 1982;92:771-779. Villet et al. Negative impact of hypocaloric feeding an denergy balance on clinical outcome in ICU patients. ClinNutr. 2005;24:502-509.

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