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Objective The aim of this study was to describe clinical outcomes of bridled nasogastric tube (NGT) program implementation for infants requiring assisted home feeding (AHF) to discharge from the neonatal intensive care unit (NICU). Study Design This was a descriptive prospective analysis of a pilot cohort of infants after implementation of a bridled NGT AHF program to facilitate discharge from level III and IV NICUs from March 2019 to October 2020. Results Of 29 attempts in infants, 22 infants were discharged with bridled NGTs over 18 months. Bridle placement was unsuccessful in three patients, and four bridles were removed before discharge. Bridle use ranged from 7 to 125 days, with a median duration of 37 days. Dislodgement rate was 0.69 per 100 days. Seventeen infants (77%) achieved full oral feeds, while five (23%) discharged with bridled NGTs later converted to gastrostomy tubes. Conclusion Implementation of a bridled NGT program is feasible for level III and IV NICUs to facilitate discharging infants who require feeding support to transition home. Key Points Bridled NGT use after NICU is typically 1 month. Infants have low bridle NGT dislodgement. Most bridled NGT NICU grads attain full oral feeds. [ABSTRACT FROM AUTHOR]

Aim. To explore individual quality of life in patients with head and neck cancer from diagnosis up to 3 months after termination of radiotherapy. Research questions: 1) Which areas in life are important to quality of life, and which are influenced by the disease and by having oral or enteral nutrition; and 2) Which areas in life are influenced by having a nasogastric feeding tube (NGT) or a percutaneous endoscopic gastrostomy (PEG) tube? Material and methods. Data were collected in 36 patients. Semi-structured interviews were conducted using an extended version of the Schedule for the Evaluation of Individual Quality of Life (SEIQoL) and analysed with content analysis. Results. Negative and positive experiences of quality of life in general were about relation to family, own health, and leisure activities. Negative impacts on physical, psychological, existential and social problems, but also positive experiences are described by the patients related to the disease. More than half expressed eating-related problems. Enteral nutrition entailed negative and positive experiences, and no greater variations were described by the patients with NGT or PEG tube. Overall, there were interindividual variations. Conclusions. The patients’ perception of general or disease-related quality of life was not affected by whether they had enteral nutrition or not. From the patients’ perspective neither of the two feeding tubes (NGT or PEG) was clearly in favour. We suggest that more studies are needed on how the choice of enteral feeding tube can be evidence-based, and incorporating the patients’ perspective. [ABSTRACT FROM AUTHOR]

Abdominal X-rays, the diagnostic method for enteral feeding tube (EFT) positioning, are a source of irradiation for the patients and carry a potential risk of adverse effects. Data related to ultrasound (US)-guided EFT placement are scarce. We evaluated 41 patients with 41 EFT insertions with guidewire in place that was maintained until US examination. US detected 38 patients with proper positioning and 3 with inadequate positioning, with a sensitivity of 97% (95% CI 84.9-99.8%) and specificity of 100% (95% CI 19.7-100%). The assessment of EFT position through abdominal US is practical and safe, associated with satisfactory diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Key Clinical Message Nasogastric tubes (NGT) are extensively used and generally harmless, yet loop formation and malpositioning are often reported especially when using thin NGT for enteral feeding which placed blindly; therefore, diligent follow-up of NGT is required with confirmation of right placement, changing it to PEG if long use of NGT needed. [ABSTRACT FROM AUTHOR]

The use of enteral feeding tubes, such as nasogastric and gastrostomy tubes, to support a patient's nutritional intake is generally considered to be safe and effective. However, recent alerts and recommendations from the National Patient Safety Agency (NPSA) regarding enteral feeding have led health professionals to review their practice and guidelines. This article explores safe practice in enteral tube feeding in the light of three NPSA alerts: Promoting safer measurement and administration of liquid medicines via oral and other enteral routes (2007), Early detection of complications after gastrostomy (2010) and Reducing the harm caused by misplaced nasogastric tubes in adults and children (2011). [ABSTRACT FROM AUTHOR]

Purpose: The optimal method for providing enteral nutrition to patients with head-and-neck cancer is unclear. The purpose of the present study was to evaluate the safety and efficacy of our reactive policy, which consists of the installation of a nasogastric (NG) feeding tube only when required by the patient''s nutritional status. Methods and Materials: The records of all patients with Stage III and IV head-and-neck cancer treated with concomitant chemotherapy and radiotherapy between January 2003 and December 2006 were reviewed. The overall and disease-free survival rates were estimated using the Kaplan-Meier method and compared with the log–rank test. Results: The present study included 253 patients, and the median follow-up was 33 months. At 3 years, the estimated overall survival and disease-free survival rate was 82.8% and 77.8%, respectively, for the whole population. No survival difference was observed when the patients were compared according to the presence and absence of a NG tube or stratified by weight loss quartile. The mean weight loss during treatment for all patients was 10.4%. The proportion of patients requiring a NG tube was 49.8%, and the NG tube remained in place for a median duration of 40 days. No major complications were associated with NG tube installation. Only 3% of the patients were still dependent on enteral feeding at 6 months. Conclusion: These results suggest that the use of a reactive NG tube with an interdisciplinary team approach is a safe and effective method to manage malnutrition in patients treated with concomitant chemotherapy and radiotherapy for head-and-neck cancer. [Copyright &y& Elsevier]

Background: Surgical feeding ostomies (eg, gastrostomy) have become required by many nursing facilities for all patients receiving enteral nutrition, whether for short- or long-term use. These policies lack supportive evidence. Comparisons of adverse event rates between surgical and natural orifice tubes are few and lacking in the inpatient setting. Additionally, we hypothesize that adverse events related to feeding tubes are underreported. We sought to quantify adverse events to test the relative safety of surgical feeding ostomies and natural orifice (eg. nasogastric or orogastric) feeding tubes in hospitalized patients.Methods: This was a prospective observational cohort study of enterally fed inpatients using semiweekly focused physical examination, scripted survey, and chart review.Results: All tube-fed patients admitted to a large, urban, academic hospital received semiweekly bedside evaluation and chart review over a 9-week period (n = 226 unique patients, mean 6.25 visits each, total 1118 observations). Demographics were comparable between 148 subjects with natural orifice and 113 subjects with surgical feeding tubes. A higher incidence of adverse events was observed with surgical tubes (3.34 vs 1.25 events per 100 subject days, P < .001). Only 50% of all adverse events were documented in the medical record. More patients with surgical tubes were discharged to skilled nursing facilities (58% vs 24%).Conclusions: Surgical feeding tubes are associated with significantly higher in-hospital adverse event rates when compared with natural orifice (nasal or oral) feeding tubes. Policies requiring surgical feeding ostomies should be reevaluated. [ABSTRACT FROM AUTHOR]

Indeed, the nasogastric feeding (NGF) tube should be used only for the main intended purpose such as feeding, and the correct insertion of the NGF tube into the gastrointestinal tract is encouraged; however, an NGF tube aberrantly inserted into the lung might provide a valuable opportunity of obtaining samples from the lower respiratory tract. [ABSTRACT FROM AUTHOR]

A critical point of nasogastric feeding tube placement, potentially resulting in an unsafe and/or non-effective operation of the device, is the monitoring of its proper placement into the stomach. A properly obtained and interpreted radiograph is currently recommended to confirm placement. We reported the case of a 68-year-old demented woman referred for complicated dysphagia. A nasogastric tube was blindly inserted and its placement was confirmed by the radiologist. Enteral nutrition was initiated but the patient began to vomit immediately. After reviewing the radiograph it was understood that a gastric loop in the tube and its tip pointing upwards did not allow a safe infusion of the feeding formula. It is not enough having the radiologist reporting that a nasogastric feeding tube is placed in the stomach; the inclusion in the report of specific warnings on any potential cause of malfunctioning of the device should be considered. The presence of a gastric loop should be taken into account as a cause of potential malfunctioning. [ABSTRACT FROM AUTHOR]