ABSTRACT
Parenteral nutrition (PN) is a highly complex medication and its provision can be prone to a variety of errors. Safe administration of this therapy requires that the competency of clinicians, particularly nurses, be demonstrated using a standardized process. In this document, a standardized model for PN administration competency is proposed based on a competency framework, the ASPEN-published interdisciplinary core competencies, discipline-specific standards of practice, safe practice recommendations, and clinical guidelines. ASPEN recognizes that all healthcare institutions may not currently meet the aspirational goals of this document. This framework will guide institutions and agencies in developing tools and procedures and maintaining competency of staff members around safe PN administration. The ASPEN Board of Directors has approved this document.
Subject(s)
Clinical Competence , Intubation, Gastrointestinal/adverse effects , Parenteral Nutrition/adverse effects , Patient Safety , Practice Guidelines as Topic , Checklist , Clinical Competence/standards , Filtration , Humans , Intubation, Gastrointestinal/instrumentation , Intubation, Gastrointestinal/nursing , Intubation, Gastrointestinal/standards , Nutritional Sciences/education , Nutritional Sciences/methods , Parenteral Nutrition/instrumentation , Parenteral Nutrition/nursing , Parenteral Nutrition/standards , Patient Safety/standards , Quality Improvement , Quality of Health Care , Societies, Scientific , United StatesABSTRACT
PURPOSE: We sought to determine whether a regimen of 70% ethanol locks could reduce the rate of central venous catheter (CVC) infections in parenteral nutrition-dependent children with intestinal failure. METHODS: We performed a retrospective review of 23 parenteral nutrition-dependent children in our multidisciplinary intestinal rehabilitation clinic who started ethanol lock therapy between September 2007 and June 2009. The treatment regimen consisted of a 70% ethanol lock instilled 3 times per week in each catheter lumen. The rate of CVC infections before and after initiation of ethanol lock therapy was compared using the Wilcoxon signed ranks test with significance set at P < .05. RESULTS: The most common diagnoses leading to intestinal failure were necrotizing enterocolitis (26.1%), gastroschisis (21.7%), and intestinal atresia (14.3%). Ethanol locks were well tolerated with no reported adverse side effects. The infection rate decreased from 9.9 per 1000 catheter days prior to initiation of ethanol locks to 2.1 per 1000 catheter days during therapy (P = .03). CONCLUSIONS: A regimen of ethanol lock therapy administered three days per week appears to be a safe and effective means of reducing the rate of CVC infections in parenteral nutrition-dependent children with intestinal failure.
Subject(s)
Anti-Infective Agents, Local/administration & dosage , Catheter-Related Infections/prevention & control , Catheterization, Central Venous/adverse effects , Ethanol/administration & dosage , Intestinal Diseases/therapy , Parenteral Nutrition/methods , Adolescent , Adult , Catheter-Related Infections/epidemiology , Child , Female , Humans , Incidence , Instillation, Drug , Male , Retrospective Studies , Treatment Outcome , United States/epidemiology , Young AdultABSTRACT
Although there have been helpful literature reviews on pediatric nasogastric (NG) tube management, there is a lack of evidence with regards to special circumstances, such as at-risk patients with altered neurological status or developmental disabilities. At our hospital, an interdisciplinary Enteral Feeding Task Force was created to address the special needs and concerns of complex pediatric patients. We carefully weighed the evidence from the literature, incidents at our hospital and other children's hospitals, and a synthesis of expert opinion. This article describes our evidence-based process of policy revision, and it includes excerpts from our revised NG tube management policy.
