Lentz, Mikayla K, BSN, RN

Moyer, Molly, BSN, RN

Pasquale, Caitlin N, BSN, RN

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksPatient Care Services / NursingIn Adult Critical Care Patients Receiving EnteralFeedings, Would Volume Based Nutritional IntakeCompared to Current Enteral Feeding Policy HelpPatients Meet their Nutirional Goals?.Mikayla K. Lentz BSN, RNLehigh Valley Health Network, Mikayla_K.Lentz@lvhn.orgCaitlin N. Pasquale BSN, RNLehigh Valley Health Network, Caitlin_N.Pasquale@lvhn.orgMolly Moyer BSN, RNLehigh Valley Health Network, Molly.Moyer@lvhn.orgFollow this and additional works at: http://scholarlyworks.lvhn.org/patient-care-services-nursingPart of the Nursing CommonsThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtLentz, M. Pasquale, C. Moyer, M. (2017, July 28). In Critical Care Patients Receiving Enteral Feedings, Would Volume Based NutritionalIntake Compared to Current Enteral Feeding Policy Help Patients Meet Their Nutritional Goals?. Poster presented at: LVHN Vizient/AACN Nurse Residency Program Graduation, Lehigh Valley Health Network, Allentown, PA.© 2014 Lehigh Valley Health Network Lehigh Valley Health Network, Allentown, Pennsylvania In adult critical care patients receiving enteral feedings, would volume based nutritional intake compared to current enteral feeding policy help patients meet their nutirional goals?  • Nutrition is essential for patients on the Trauma/ Neuro ICU (TNICU) and the Burn Unit  • Paused tube feedings during nursing care for short periods of time. –“There is no benefit from stopping feedings during short periods of HOB lowering (Bankhead R., et al, 2009) –“Precautionary withholding of enteral feedings during repositioning does not reduce the incidence of aspiration in critically ill patients” (DiLibero, J. et al, 2015) • Inadequate nutrition due to tube feeding pauses: –current manner in which enteral tube feeding is delivered in the ICU results in grossly inadequate nutritional support (McClave et. al, 1999)  • Volume based feeding vs Rate based feeding  • Chart audits on 10 patients: –Less than prescribed nutrition – 6 patients with a deficit of 7-31% of their prescribed nutrition –More than prescribed nutrition – 4 patients with a surplus up to 14% of their prescribed nutrition • Survey: –18% of nurses knew that tube feedings were calculated for 22 hours a day From the conversations had with staff, nurses voiced their concerns about forgetting to resume feedings after turns and not being able to hear the alarms on the tube feeding pumps –56.8% of nurses believe their patients are receiving prescribed nutrition –66% staff would be interested in learning about a nursing based protocol for titrating enteral feedings  • Volume based feeding (VBF) allows RN to adjust infusion rate to make up for interruptions in delivery (McClave, et. Al, 2015) – Research conducted by McClave et. al (2015): VBF group: 92.9% caloric requirements met; rate based feeding group: 80.9% caloric requirements met – Recent guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient suggests use of the VBF protocol (McClave, et. al, 2016) • Chart audits were conducted on TNICU and the Burn Unit to calculate how much of their prescribed nutrition patients were receiving • A survey was sent out to nursing staff on the TNICU, the Burn Unit, and the Trauma/Neuro/ Burn Float Pool to test their knowledge of tube feedings  • Conversations were had with both dietary and nursing staff about their general thoughts/ concerns regarding enteral feedings • Research was conducted regarding volume based feeding and its effectiveness  • Pausing tube feedings is causing patients to not meet their caloric intake requirements  –Research shows that not all short term nursing care requires tube feed to be held when HOB is <30 degrees (Bankhead, et. al, 2009, DiLibero, J. et al, 2015)Other barriers included difficulty calculating true daily feed totals because of the times at which nursing  –There is very little data to support that it is  necessary to pause tube feedings during short, routine periods where HOB < 30; more research needs to be conducted to examine whether or not healthcare providers can eliminate unnecessary holds on feedings • Data collected on the TNICU and Burn Unit at LVH-CC showed that 60% of the patients surveyed were not meeting caloric requirements • Survey reflected a need for further RN education • Literature search highlighted the benefits from a volume based feeding protocol and how it fulfills a larger amount of patient caloric needs rather than the rate based protocol (McClave et al, 2015, McClave et al, 2016) • Further research would need to be conducted to prove the effectiveness of VBF on the TNICU and Burn Units  Mikayla Lentz BSN RN (TNICU), Cailtin Pasquale BSN RN (TNICU), Molly Moyer BSN RN (Burn) Background/ Introduction: Methods: Chart Audits and Survey: Volume Based Feeding: Conclusions: References:   • Bankhead, R. et al. (2009). A.S.P.E.N enteral nutrition practice recommendations. Journal of Parenteral and Enteral Nutirtion, 33(122). • DiLibero, J. et al. (2015). “Witholding or continuing enteral feedings during repositioning and the incidence of aspiration.” American Journal of Critical Care. • McClave, S. A., et al. (1999). “Enteral tube feeding in the intensive care unit: Factors impeding adequate delivery.” Critical Care Medicine 27(7). • McClave, S. A., et al. (2015). “Volume-based feeding in the critically ill patient.” Journal of Parenteral and Enteral Nutrition 39(6). • McClave, S. A., et al. (2016). “Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of critical care medicine and American society for parenteral and enteral nutrition.” Journal of Parenteral and Enteral Nutirtion 40(2). 

In Adult Critical Care Patients Receiving Enteral Feedings, Would Volume Based Nutritional Intake Compared to Current Enteral Feeding Policy Help Patients Meet their Nutirional Goals?.

https://scholarlyworks.lvhn.org/cgi/viewcontent.cgi?article=1841&context=patient-care-services-nursing

In Adult Critical Care Patients Receiving Enteral Feedings, Would Volume Based Nutritional Intake Compared to Current Enteral Feeding Policy Help Patients Meet their Nutirional Goals?.

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