Table 2.
Practices of NGT intubation and feeding (N = 464).
| Practices | n | % |
|---|---|---|
| Placement of NGT | ||
| Methods used to determine internal length of the NGT | ||
| FX | 369 | 79.5 |
| NEX | 168 | 36.2 |
| Hanson method (([NEX–50 cm]/2)+50 cm) | 7 | 1.5 |
| GWNUF | 0 | 0 |
| Methods considered the gold standard to confirm placement of blindly inserted NGT | ||
| Auscultation of injected air | 233 | 50.2 |
| Bubble test | 161 | 34.7 |
| Observing feeding tube aspirate | 159 | 34.3 |
| Radiography | 125 | 26.9 |
| Observing a change in the external tube length | 83 | 17.9 |
| pH testing of aspirate | 80 | 17.2 |
| Observing signs of respiratory distress | 65 | 14.0 |
| Capnography | 12 | 2.6 |
| Methods to confirm placement of blindly inserted NGT during tube insertion procedure | ||
| Observing feeding tube aspirate | 384 | 82.8 |
| Observing a change in the external tube length | 348 | 75.0 |
| Observing signs of respiratory distress | 326 | 70.3 |
| Auscultation of injected air | 305 | 65.7 |
| Bubble test | 238 | 51.3 |
| pH testing of aspirate | 33 | 7.1 |
| Radiography | 24 | 5.2 |
| Capnography | 18 | 3.9 |
| Methods to confirm placement of blindly inserted NGT after feeding is started | ||
| Observing a change in the external tube length | 348 | 75.0 |
| Observing feeding tube aspirate | 357 | 76.9 |
| Observing signs of respiratory distress | 304 | 65.5 |
| Auscultation of injected air | 203 | 43.8 |
| Bubble test | 185 | 39.9 |
| pH testing of aspirate | 28 | 6.0 |
| Radiography | 24 | 5.2 |
| Capnography | 13 | 2.8 |
| Time point NGT location is checked | ||
| During insertion procedure | 368 | 79.3 |
| Before each bolus or intermittent feeding | 358 | 77.2 |
| Before medication administration | 357 | 76.9 |
| During bedside handover | 189 | 40.7 |
| At 4-hour intervals during continuous feeding | 172 | 37.1 |
| Exit site of NGT marked after location verification | ||
| Always | 431 | 92.9 |
| Sometimes | 20 | 4.3 |
| Never | 13 | 2.8 |
| EN administration | ||
| Time to initiate feeding adult critically ill patients with hemodynamic stability after admission | ||
| ≤48 hours after admission | 439 | 94.6 |
| >48 hours after admission | 25 | 5.4 |
| EN formulations discarded within 24 hours of preparation if not used | ||
| Yes | 458 | 98.7 |
| No | 6 | 1.3 |
| Longest time EN formulas are exposed to room temperature | ||
| 4 hours | 381 | 82.1 |
| 6 hours | 44 | 9.5 |
| 8 hours | 26 | 5.6 |
| 10 hours | 13 | 2.8 |
| Patient placed (without contraindications) in backrest elevation of 30°–45° before feeding | ||
| Always | 417 | 89.9 |
| Sometimes | 36 | 7.8 |
| Never | 11 | 2.4 |
| Patient placed in semi-recumbent position for at least 30 to 60 minutes | ||
| Always | 397 | 85.6 |
| Sometimes | 54 | 11.6 |
| Never | 13 | 2.8 |
| Method used to administer EN | ||
| Bolus feeding | 203 | 43.8 |
| Continuous feeding | 166 | 35.8 |
| Intermittent feeding | 84 | 18.1 |
| Feeding method selected according to physicians orders | 11 | 2.3 |
| Volume that should not be exceeded during each bolus feeding | ||
| 400 mL | 461 | 99.4 |
| 500 mL | 2 | 0.4 |
| 600 mL | 1 | 0.2 |
| Time points when tube is flushed | ||
| Before intermittent or bolus feeding | 417 | 89.9 |
| After intermittent or bolus feeding | 372 | 80.2 |
| At 4-hour intervals with continuous EN | 324 | 69.8 |
| After GRV measurement | 270 | 58.2 |
| Solution used to flush the tube | ||
| Warm boiled water | 442 | 95.3 |
| Cold boiled water | 10 | 2.2 |
| Normal saline | 9 | 1.9 |
| Sterile water | 3 | 0.6 |
| Solution used for oral care in adult critically ill patients | ||
| Sterile normal saline | 255 | 55.0 |
| Chlorhexidine mouth wash | 170 | 36.6 |
| Warm water | 20 | 4.3 |
| Furacilin solution | 11 | 2.4 |
| Kangfuxin Ye | 8 | 1.7 |
| Monitoring and managing FI | ||
| Frequency of GRV monitoring | ||
| Every 4–8 hours | 291 | 62.7 |
| Never | 96 | 20.7 |
| Every 6 hours | 40 | 8.6 |
| Every 8 hours | 37 | 8.0 |
| Method used to measure GRV | ||
| Syringes | 450 | 97.0 |
| Scintigraphy | 6 | 1.3 |
| Refractometry | 6 | 1.3 |
| Breath tests | 2 | 0.4 |
| Threshold of high GRV | ||
| 200 mL | 207 | 44.6 |
| 150 mL | 117 | 25.2 |
| 250 mL | 77 | 16.6 |
| 100 mL | 63 | 13.6 |
| How to deal with high GRV | ||
| Stop feeding immediately | 391 | 84.3 |
| Use prokinetic agents | 251 | 54.1 |
| Slow infusion speed | 210 | 45.3 |
| Perform abdominal massage for the patient | 190 | 40.9 |
| Report to the doctor for further examination | 9 | 1.9 |
| How to determine when FI is present | ||
| Observe for abdominal distention and/or discomfort | 442 | 95.3 |
| Observe for nausea and/or vomiting | 370 | 79.7 |
| Measure GRV | 364 | 78.4 |
| Listen for bowel sounds | 211 | 45.5 |
| What to do when the patient has diarrhea | ||
| Feeding continued while evaluating the etiology of diarrhea to determine appropriate treatment | 255 | 55.0 |
| Cease EN immediately | 209 | 45.0 |
Abbreviations: NGT, nasogastric tube; NEX, nose–ear–xiphoid; FX, forehead–xiphoid; GWNUF, gender, weight, and nose to umbilicus with adult’s head flat on the bed; EN, enteral nutrition; GRV, gastric residual volume; FI, feeding intolerance.