Ask the care expert ... about tube feeding practices
Sherrie Dornberger, RNC, CDONA, FACDONA, executive director, NADONA
No matter how often we train our nurses on tube feedings, we still are seeing increases of aspiration pneumonia. Is there something we may be missing during training?
I agree updated training of the staff is needed if you are having aspiration pneumonia. Consider making this a QAPI project.
To start, drill home raising the head of the bed. Lower the head for a nap, but if it is a continuous feed, it should be a continuous elevation.
Percutaneous gastrostomy tube feedings are the best choice for a resident with a feeding tube for a length of time. It is more comfortable for the resident needing a prolonged use of the tube. The incidence of pneumonia is no different between nasogastric tubes and percutaneous tubes, according to researchers (Gomes et al., 2010).
With the tube feedings, measure the gastric residual volume every four to six hours during continuous feedings and immediately before each intermittent feeding. This is especially important if the resident can't communicate signs of gastrointestinal intolerance.
There is evidence brushing a resident's teeth and mouth after each meal lowers the risk of aspiration pneumonia. Missing teeth or poorly fitted dentures hinder chewing and swallowing. Infected teeth and poor hygiene contaminate oral secretions and predispose the resident to aspiration pneumonia.
The closed system of feeding, using what resembles IV bags, also can help. Some of the bags for the “open” system, in which individual cans are added by a nurse to the feeding bags, can grow bacteria in less than 20 minutes. A nurse with unwashed hands or who opens a can with a pen is accidently adding bacteria to the bag, increasing the chances of aspiration pneumonia.