Nazointestinal tüp yerleştirilmesi ve sonuçları

Yıl 2020, Cilt: 28 Sayı: 2, 56 - 59, 30.08.2020

Ferda Harmandar İsmail Gömceli Ayhan Çekin Orbay Harmandar Feyzi Bostan

Öz

Giriş ve Amaç: Enteral nütrisyon uygulamalarında gastrointestinal sistemi fonksiyonel olan olgularda, kusma, yüksek gastrik rezidüel volüm gibi nedenlerle aspirasyon riski artmıştır. Aynı zamanda gastrointestinal kanaldan fistülü olan veya pankreatit tanısı olan hastalarda nazointestinal tüp kullanımı klinik sonuçları açısından parenteral beslenmeye göre daha avantajlıdır. Nazointestinal tüple beslenme yöntemine, klinik sonuçları açısından avantajlı olmasına rağmen, yüksek maliyeti ve yerleştirme zorluğu nedeniyle dikkatli karar vermek gerekir. Gereç ve Yöntem: Bu çalışmada 01.01.2018-01.01.2019 tarihleri arasında nütrisyon polikliniği ve kliniklerde takip edilen hastalar retrospektif olarak değerlendirilmiş ve tüpün beslenme tedavisinde kullanımındaki sorunlar değerlendirilerek etkinlik açısından analiz edilmiştir. Bulgular: Çalışmada 1 yıl içinde nazointestinal tüp yerleştirilen 85 hasta retrospektif olarak tarandı. Bu hastaların %41.1’i (n=37) nörolojik hastalıklar tanılı, %43.53’ü (n=37) dahili hastalıklar tanılı, %15.3’ü (n=13) cerrahi hastalıklar tanılıydı. Hastaların %8.23’üne (n=7) fistül varlığı nedeniyle, %31.8’ine (n=27) kusma ve yüksek rezidüel volüm nedeniyle, %7.05’ine (n=6) pankreatit nedeniyle, %52.9’una (n=45) yüksek aspirasyon riski nedeniyle nazointestinal tüp yerleştirildi. Nazointestinal tüp; hastaların %69.41’inde (n=59) 1. gün, %11.76’sında (n=10) 2. gün, %9.41’inde (n=8) 3. gün jejunal bölgeye yerleştirildi. Hastaların %90.58’inde nazointestinal tüp istenilen bölgeye yerleştirilirken, %9.41’inde (n=8) istenilen bölgeye yerleştirilemedi. Hastaların %15.29’u (n=13) tüpü çektiği için, %15.29’u (n=13) tüp tıkandığı için yöntem tedavi planında etkin kullanılamadı. Hastaların %60’ında ise planlanan süre boyunca yöntem etkin kullanıldı. Sonuç: Nazointestinal tüple beslenme yöntemi, enteral beslenmenin sürekliliği açısından avantajlı bir yöntem olmasına rağmen yerleştirme işleminde başarı oranları tartışmalıdır. Ancak yerleştirme yöntemiyle ilgili deneyimin artması yöntemin başarısını yükseltmektedir. Nazointestinal tüp yerleştirme endikasyonunun doğru konulduğu durumlarda da istenilen etkin enteral beslenme sağlanmış olmaktadır.

Anahtar Kelimeler

Nazointestinal tüp, enteral beslenme, nazojejunal tüp

Nasointestinal tube placement and its consequences

Öz

Background and Aims: The risk of aspiration in enteral nutrition applications increases in patients with a functional gastrointestinal system due to reasons such as vomiting and high gastric residual volume. However, the use of nasointestinal tube is generally more advantageous than parenteral nutrition for better clinical outcomes in patients with fistula from the gastrointestinal tract or in those with pancreatitis. Despite the merits of nasointestinal tube feeding with respect to the clinical outcomes, it is necessary to make a careful decision owing to its high cost and difficulty in placement. Materials and Methods: Here, we retrospectively evaluated the patients who underwent follow-up examination at the nutrition outpatient clinic and other clinics between 01/01/2018 and 01/01/2019, we also evaluated and analyzed the overall effectiveness and problems associated with the use of the nasointestinal tube (NIT) for enteral nutrition. Results: In the study, 85 patients who underwent NIT insertion in the past 1 year were retrospectively examined. Among these, 41.1% (n = 37) patients were diagnosed with neurological diseases, 43.53% (n = 37) with internal diseases, and 15.3% (n = 13) with surgical diseases. NIT was placed in 8.23% (n = 7) of the patients due to the presence of fistula, in 31.8% (n = 27) for vomiting and high residual volume, in 7.05% (n = 6) for pancreatitis, and in 52.9% (n = 45) for high aspiration risk. The NIT was placed in the jejunal region on the 1st day in 69.41% (n = 59) of patients, on the 2nd day in 11.76% (n = 10), and on the 3rd day in 9.41% (n = 8). Although the NIT was placed in the desired region in 90.58% of the patients, it was not placed in the desired region in 9.41% (n = 8) of the patients. This method could not be used effectively in the treatment plan, because 15.29% (n = 13) of the patients pulled the tube and the tube in 15.29% (n = 13) patients was clogged. In 60% of the patients, the method was used effectively during the planned period. Conclusion: Although the nasointestinal tube feeding method is an advantageous method to continue enteral nutrition, the success rates with respect to the placement are controversial. However, the knowledge and understanding of the placement method increases with the success of this method. The desired effective enteral nutrition can be ensured in cases where the indication for nasointestinal tube placement is accurate.

Anahtar Kelimeler

Nasointestinal tube, enteral nutrition, nasojejunal tube

Kaynakça

• 1. Ellett ML. Important facts about intestinal feeding tube placement. Gastroenterol Nurs 2006;29:112-25.
• 2. Wan B, Fu H, Yin J. Early jejunal feeding by bedside placement of a nasointestinal tube significantly improves nutritional status and reduces complications in critically ill patients versus enteral nutrition by a nasogastric tube. Asia Pac J Clin Nutr 2015;24:51-7.
• 3. Petrov MS, Pylypchuk RD, Emelyanov NV. Systematic review: nutritional support in acute pancreatitis. Aliment Pharmacol Ther 2008;28:704-12.
• 4. Petrov MS, Zagainov VE. Influence of enteral versus parenteral nutrition on blood glucose control in acute pancreatitis: a systematic review. Clin Nutr 2007;26:514-23.
• 5. McClave SA, Lowen CC, Snider HL. Immunonutrition and enteral hyperalimentation of critically ill patients. Dig Dis Sci 1992;37:1153-61.
• 6. Peng YZ, Yuan ZQ, Xiao GX. Effects of early enteral feeding on the prevention of enterogenic infection in severely burned patients. Burns 2001;27:145-9.
• 7. Kelly DA. Liver complications of pediatric parenteral nutrition-Epidemiology. Nutrition 1998;14:153-7.
• 8. Hauenschild A, Schnell-Kretschmer H, Teichmann J, et al. Prospective evaluation of novel system for jejunal feeding. Surg Endosc 2003;17:452-6.
• 9. Cresci G, Martindale R. Bedside placement of small bowel feeding tubes in hospitalized patients: A new role for the dietitian. Nutrition 2003;19:843-6.
• 10. Stupak DP, Abdelsayed GG, Soloway GN. Motility disorders of the upper gastrointestinal tract in the intensive care unit: pathophysiology and contemporary management. J Clin Gastroenterol 2012;46:449-56.
• 11. Heyland DK, Drover JW, Dhaliwal R, Greenwood J. Optimizing the benefits and minimizing the risks of enteral nutrition in the critically ill: role of small bowel feeding. JPEN J Parenter Enteral Nutr 2002;26(6 Suppl):S51-57.
• 12. DiSario JA. Endoscopic approaches to enteral nutritional support. Best Pract Res Clin Gastroenterol 2006:20:605-30.
• 13. Pearce CB, Duncan HD. Enteral feeding. Nasogastric, nasojejunal, percutaneous endoscopic gastrostomy, or jejunostomy: its indications and limitations. Postgrad Med J 2002;78:198-204.
• 14. Kabaçam G, Özden A. Enteral tüple beslenme. Güncel Gastroenteroloji 2009;13:201-10.
• 15. Zaloga GP. Bedside method for placing small bowel feeding tubes in critically ill patients. Chest 1991;100:1643-6.
• 16. Horbal-Shuster M, Irwin M. Keeping enteral nutrition on track. Am J Nurs 1987;87:523-4.
• 17. Meyer, R., Harrison, S., & Mehta, C. How to guides: Bedside placement of nasojejunal tubes in children. Care of the Critically ill. 2001 17(1), 4.
• 18. Zhihui T, Wenkui Y, Weiqin L, et al. A randomised clinical trial of transnasal endoscopy versus fluoroscopy for the placement of nasojejunal feeding tubes in patients with severe acute pancreatitis. Postgrad Med J 2009;85:59-63.
• 19. O’Keefe SJ, Foody W, Gill S. Transnasal endoscopic placement of feding tubes in the intensive care unit. JPEN J Parenter Enteral Nutr 2003;27:349-54.
• 20. Fang JC, Hilden K, Holubkov R, DiSario JA. Transnasal endoscopy vs. fluoroscopy for the placement of nasoenteric feeding tubes in critically ill patients. Gastrointest Endosc 2005;62:661-6.
• 21. Foote JA, Kemmeter PR, Richard PA, et al. A randomised controlled trial of endoscopic and fluoroscopic placements of postpyloric feding tubes in critically ill patients. JPEN J Parenter Enteral Nutr 2004;28:154- 7.
• 22. Berger MM, Bollmann MD, Revelly JP, et al. Progression rate of self-propelled feeding tubes in critically ill patients. Intensive Care Med 2002;28:1768-74.
• 23. Ellett ML, Beckstrand J. Predicting the distance for nasojejunal tube insertion in children. J Soc Pediatr Nurs 2001;6:123-32.
• 24. Heyland DK, Drover JW, MacDonald S, Novak F, Lam M. Effect of postpyloric feeding on gastroesophageal regurgitation and pulmonary microaspiration: results of a randomized controlled trial. Crit Care Med 2001;29:1495-501.