Administration of medications through enteral feeding catheters.

BACKGROUND: Enteral feeding catheters are commonly used to administer both nutritional feedings and oral forms of medications. Obstruction of the catheters is a major concern. OBJECTIVES: To study characteristics of obstruction of enteral feeding catheters in ICU patients and current knowledge and practices of ICU nurses of administering medications through such catheters. METHODS: A postcard invitation to participate in this descriptive survey was mailed to a random sample of 12,069 members of the American Association of Critical-Care Nurses. The 52-item investigator-designed questionnaire was mailed to the 1700 critical care nurses who agreed to participate; 1167 (68.6%) returned completed survey questionnaires. RESULTS: Nurses estimated that 33.8% of their patients received 8.9 doses of medication per day through the enteral feeding catheter. The rate of obstruction of the tube by medications was 15.6%. Crushed medications contributed to obstruction, although liquid forms of the medications often were available. Nurses' primary source of knowledge about administering medications through enteral feeding catheters was clinical practice (56.9%) and consultation with peers (21.7%); only 19% had had inservice training on the topic. Written agency guidelines varied considerably, and 74% of nurses used two or more techniques that were contrary to recommendations. Factors significantly associated with lower rates of obstruction of enteral feeding catheters included (1) assistance from the pharmacy service to ensure liquid forms of medications, (2) nurses' attendance at a relevant seminar or inservice training program, and (3) not routinely crushing and administering enteric-coated or sustained-release medications through the enteral feeding catheter. CONCLUSIONS: Collaboration between nursing and pharmacy services to ensure delivery of liquid medications and avoid use of crushed medications may reduce the high rate of catheter obstruction due to medications. Research-based guidelines and a more formal dissemination of information to nurses are needed.

A nursing survey to determine the characteristics of medication administration through enteral feeding catheters.

A statewide survey was designed to develop a better understanding of the current practices and problems encountered with medication administration through enteral feeding catheters (EFCs). The sample of 223 registered nurses and licensed practical nurses estimated that a median of 10% of patients received medications through an EFC. EFC obstruction was estimated to have occurred a median of 1.5 times per week, with 50% of obstructions estimated to be due to medication administration. Nine of 14 specific medications reported as "most frequently contributing to" feeding catheter obstruction available in liquid form, yet tablets were crushed and given. When nurses perceived the pharmacy department as helping them insure that liquid dosage form was used, there was greater use of liquid forms, less use of crushed forms, and less medication-associated catheter obstruction. In this sample, the majority of nurses did not follow consistently the few recommendations available.

The relationship of septicemia-related diagnoses and positive blood cultures.

In order to determine the relationship of blood culture results and septicemia-related diagnoses, laboratory and patient chart records were evaluated on 25 intensive care unit patients who were hospitalized in 1989. Overall, there were 14 in whom the DRG and blood culture results were both positive, 4 with positive DRGs and negative blood cultures, and 7 with negative DRGs and positive blood cultures. These findings suggest that neither positive blood culture results nor diagnosis codes are entirely accurate indicators of the overall incidence of septicemia, and that the two indicators were not closely associated in our hospital.

Flow characteristics of enteral feeding with psyllium hydrophilic mucilloid added.

One therapy for managing diarrhea in patients in intensive care units who are receiving enteral nutrition is administration of psyllium hydrophilic mucilloid (PHM). This laboratory study was conducted to determine whether the addition of PHM (Metamucil) to enteral feeding formula (Entrition) adversely affected the flow characteristics of the feeding formula through a small-bore feeding tube. Descriptive data were obtained from 72 trials of feeding formula with varied infusion rates, formula osmolality and temperature, and PHM concentrations. Two thirds (n = 48) of the trials were successful (PHM did not clog the tubing and obstruct flow). The remaining one third of the trials (n = 24) were unsuccessful. Successful formula infusion was influenced by formula temperature and osmolality but not by infusion rate, PHM concentration, or flow interruption. If formula with PHM was followed by formula without PHM, the infusion was successful regardless of infusion rate or formula osmolality. Thus, the data from this laboratory study indicate that when therapeutic doses of PHM are prescribed, it is feasible for PHM to be mixed in room-temperature feeding formula and infused without clogging the feeding tube.

Predictors of physical functioning after a cardiac event.

An increased understanding of the factors that promote or hinder patients' return to optimal activity levels after a cardiac event is necessary to help them achieve this goal. Accordingly, the purpose of this study was to examine psychologic resources, depression, physical recovery, and illness severity for their relationships with subjective and objective physical functioning (exercise data). A correlational survey design was used to assess patients' (n = 46) illness responses 9 weeks after the cardiac event. Patients also participated in a symptom-limited exercise test. The findings suggested that the individual's return to greater activity levels after a cardiac illness was associated with less depression and illness severity, and higher levels of objective physical functioning, physical recovery, and self-esteem. Further, patients' objective physical functioning was associated not only with greater subjective physical functioning but also with greater levels of physical recovery and mastery.

Descriptive analysis of diagnosis-related groups in patients from a Veterans Administration Medical Center.

Discharge diagnoses from October 1, 1987 to September 30, 1988 were analyzed to quantitate infection. Four hundred forty-nine (4.8%) of 9,290 discharges (excluding 1-day stays) were infections. Pneumonia, caused by all etiological agents, was responsible for 2.4% of the principal diagnoses. These data help define the role of infection in hospitalized veterans and further supports earlier findings that respiratory tract infections are the most common of all infections in our veterans.

Microorganisms and diarrhea in enterally fed intensive care unit patients.

Thirty-six intensive care unit patients, receiving aseptic or manually (routine) reconstituted enteral feeding formulas, were evaluated prospectively for the relationship of microbial involvement, gastric pH, and antimicrobial therapy to diarrhea. The routine protocol group had a significantly higher incidence of bacterial contamination than the aseptic protocol group (Fisher's exact test, p less than 0.05). There were no significant direct associations between isolate category (Gram-negative bacilli, Gram-positive cocci, Gram-negative cocci, yeast), gastric pH, or antimicrobials and diarrhea. However, two organisms (Group D Enterococci and yeast) were indirectly implicated in some cases of diarrhea.