Confirming Nasogastric Feeding Tube, Essay Example

The title of the article being critiqued is “Confirming nasogastric feeding tube position versus the need to feed” by Stephen J. Taylor. The article has been published in the Intensive and Critical Care Nursing journal.

Abstract

The abstract provides a general overview of the research question or problem, the methodology employed, the findings and the conclusion and recommendations arrived at.

Introduction to Study

Quantitative research is normally used to define meanings to life situations and experiences. It involves subjective and systematic approach to the study question, with the goal to determine the relationship between an independent and the dependent variables. Similarly, the purpose of this research was to provide evidence-based recommendations that would help intensive care unit personnel, registered nurses, and institutions provide safe and effective care to severely injured patients who require nasogastric tubes to receive nutrition while under medical care.

Impact on Nursing

The use of nasogastric tubes for feeding is an important element of sustaining short or medium term nutrition of patients in critical conditions. There are a number of complications that can arise as a result of the use of these feeding tubes in patients. The research topic for the article is essential in highlighting the opportunity cost of confirming the position of feeding tubes in patients against the inherent need to feed. This research is important in highlighting the complications and challenges associated with the position of nasogastric feeding tubes. A misplaced nasogastric feeding tube can be move out of the stomach at a later stage of the patient’s treatment, or logged into the lungs at the time of insertion.

The research by the article is integral in helping to identify the potential risks of executing feeding for a patient with a nasogastric feeding tube without checking the position of the tube. While checking the tube’s position is an important and the best practice, it is commonly forgotten. This can lead to fatal results on the patient’s health. The problem that most nurses attempt to avoid is delayed feeding. Delayed feeding usually comes about because the nurses cannot confirm the position of the feeding tube. This delayed feeding has the potential of depriving patients of the nutrients that they require to fully recover.

Impact on Evidence Based Practice

Evidence based nursing employs the most current research available on a given topic together with existing personal expertise to generate quality decisions to provide optimal nursing care. Quantitative analysis in evidence based research is aimed at applying knowledge gained from a small sample to a much larger sample or population (Houser, 2012). As such the use of quantitative analysis is crucial in helping generate data, which can be aggregated and analyzed so as to map relationships and even potentially predict these relationships. This article achieves this by using a number of references that help generate data that maps the relationship between the need to feed versus checking the nasogastric feeding tube’s position.

However, quantitative data cannot be completely relied on in evidence based owing to two major factors; validity and reliability. While statistical data may be crucial in mapping and predicting relationships, this data may become generally unreliable and invalid over time. This is because with time, numerous parameters and variables change relative to change in the environment. As such, the article uses a number of articles from 1993 to 2011, recognizing the need for conducting regular data collection and statistical analyses so as to obtain up-to-date, valid and reliable data.

Reliability and validity of data is essential to successful and optimal application of change in the practice and outcomes based on my analysis of research (Polit & Beck, 2010). Out-of-date or invalid data would lead to the application of improper changes within the practice, altering outcomes towards unknown and generally unsafe conditions as outcomes would be founded on wrong premises. Because these criteria have been met in the evaluation of statistical evidence, optimal and relevant changes will be applied to the nursing practice. More accurate and efficient methodology can be devised to help in quality decision making. This increases confidence in working hypotheses while mitigating error margins within the practice.

Methodology

The research employed both quantitative and qualitative methodology. The research entailed identifying potential new sources of information on the methods of confirmation of the positioning of nasogastric tubes. This mainly employed the use of exisiting nursing research databases, namely; CINAHL, EMBASE and MEDLINE.

Sample

The research employed a wide variety of articles from a number fo sources. The research employed the use of 11 articles. The research conducted in these articles employed a number of strategies that were limited to the sample size use. The sample size in this case is the number of observations made by an attending nurse or doctor. The number of observations ranged from 48 to 9,931.

The samples employed in each research was specific to the research and depicted patients being treated for different illnesses and conditions. Furthermore, the samples depicted patients of different ages. Some of the special populations included in the different articles include; critically ill adults; acutely ill children; acutely ill adults; mechanically ventilated patients and Hospital patients requiring ?12FG feeding tube placement.

Ethics

This research involved a computerized search of Medline and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). This considered the names of specific nursing interventions with and without confirm, feed, nasogastric tube, pH, and X-ray. This implies that there was no direct human participation during the collection of samples. However, the samples collected included researches which had considered the participation of a wide variety of patients, treated for a number of conditions and illnesses. To include the nursing interventions by various studies, the search was expanded to include the works done between the years 1993-2011.

Data Collection

The study clearly identified and defined the dependent and independent variables. The research analyzed the nursing interventions by various researches to provide evidence-based recommendations on the opportunity cost of the need to feed over the risks associated with feeding using a misplace nasogastric tube.  The Data collection involved the computerized search of previous studies conducted on tube misplacement, effects of delayed feeding. pH and bilirubin, capnography and capnometry and EM-guidance. This method was used because it was considered economical in terms of time, and that the recommendations by various studies would be of importance; allowed for making comparisons based on effectiveness and timeline. This study used a one-time collection of data, through a computerized system. But the samples were drawn from studies conducted between the years 1993 and 2011.

The data collection was conducted with the help of three medical and nursing research databases; (1) CINAHL, (2) EMBASE, and (3) MEDLINE. Search on the three databases resulted in 31 reviewed papers in which the confirmation method was compared against known radiographic tube positioning and/or accurate laboratory measurements.

Data Analysis and Findings

The analysis process involved comparing the supporting evidences against recommendations in various studies. This sought to authenticate the recommendations, and thus allow for application of such evidences in the management and application of effective use nasogastric tubes in feeding. 11 articles were found to be helpful and contained information required for the researchers to conduct a complete quantitative and qualitative analysis. The level of evidence was determined under a number of recommendations. The different classes of evidence included;

The classes of evidence included four classes. Class I evidence included randomized control trials that had no substantial limitations or metaanalysis. Class II evidence included randomized control trials that had a number of limitations associated with case-control or cohort studies. Class III evidence included case studies and qualitative studies. Class IV evidence included expert opinion and reports as well as clinical protocols and standards of care. The researcher identified and three levels of recommendations. Level I recommendations resulted from the analysis of class I evidence.  Level II recommendations resulted from the analysis of class II evidence. Level 3 recommendations were supported by class III and class IV evidence.

There are a number of common recommendations that are highlighted throughout a number of the related research articles used. There is a common recommendation that the length of nasogastric tubes have to be measured from xiphisternum to ear to nose according to the manner in which it will be inserted. Patients are at risk of aspiration if and when the tube is slightly withdrawn. Raising a patients backrest ?30? leads to a significant reduction in aspiration risk.

Techniques such as capnometry and capnography considerably reduces the costs that are incurred when using X-ray while at the same time minimizing the risk of a patient developing lung trauma. capnometry and capnography have to be combined with other techniques for confirming gastrointestinal position.

The findings of the study are valid because they are based on evidence that are widely sourced and thoroughly inspected. The comparison of many levels of evidence and recommendations to realize universal recommendations on the confirmation of nasogastric feeding tube position against the need to feed would produce valid and founded conclusions.

The X-ray is the widely accepted standard to confirm the position of nasogastric tube positioning. This is because it gives a visual representation of the human anatomy while showing the position of the tube within its specific context.

Electromagnetic trace technique was effective in confirming the gastrointestinal placement in 100% of the cases in which it is used. However, the technique is not quite as effective when testing for the nasogastric tube positioning and lung misplacement.

Fluoroscopy and Endoscopy provide accurate gastrointestinal placement as it provides a visual representation of the tubes position in the context of anatomical positioning.

Offer direct visualization of tube position against anatomical position giving accurate GI placement

Discussion

The article discusses the implications of nasogastric tube misplacement and the complications that are associated with it. One of the main points that the article draws from the research is the fact that anatomical abnormalities can cause some gastrointestinal placement techniques difficult. Direct vision techniques, fluoroscopy and endoscopy are particularly vulnerable to being difficult in the event a patient has anatomical abnormalities. Critically ill patients, as well as unconscious patients and infants are most susceptible to misplacement. The most evident risk of the delays that are caused by intubation is the deficiency of nutrition due to delayed nutrition. Electromagnetic tracing is most useful in preventing trauma to the lungs and experiences little to no delay in confirming the gastric positioning.

The article’s discussion is considerably founded on the statistical and qualitative data that has been collected from the reviewed sources. The discussion employs a holistic approach in taking into consideration the practical issues that are linked with tube misplacement. One of the practical issues discussed is inadequate training or a lacking aptitude. The interoperation of the color of the pH stick is also a subject that is relative to an individual’s perception. The ability to effectively discern the difference in color of the pH stick is subject to the individual’s perception of color.

Conclusions and Recommendations

The article concludes by stating acknowledging that there is no cost0effective technique that can be used to confirm gastric positioning while eliminating trauma to the lungs. Recommendations are based on a rating of the techniques according to the level of line that is evident in each. First-line methods and second line methods are therefore recommended to be used. However, this should onlybe done once the level of risk of the patient has been determined. The author also identifies the need for further research into the possible and most effective combinations of first-line and second-line techniques that ensure accuracy and minimize the amount of trauma inflicted on internal, organs such as the lungs.

References

Houser, J. (2012). Nursing research : reading, using, and creating evidence. Sudbury: Jones & Bartlett Learning.

Namrata, S., Brij, S., Manik, S., Vikas, S., Payal, B., Kalaivani, M., . . . Anoop, S. (2012). Evaluation of Early Enteral Feeding Through Nasogastric and Nasojejunal Tube in Severe Acute Pancreatitis: A Noninferiority Randomized Controlled Trial. Pancreas, 41(1), 153-159. Retrieved April 22, 2015, from http://journals.lww.com/pancreasjournal/Abstract/2012/01000/Evaluation_of_Early_Enteral_Feeding_Through.21.aspx

Polit, D. F., & Beck, C. T. (2010). Essentials of nursing research : appraising evidence for nursing practice. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Stayner, J., Bhatnagar, A., McGinn, A. N., & Fang, J. C. (2012). Feeding Tube Placement Errors and Complications. Nutrition in Clinical Practices, 738-748.

Taylor, S. J. (2013). Confirming nasogastric feeding tube position versus. Intensive and Critical Care Nursing, 29, 59-69.