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National Survey of Feeding Tube Verification Practices: An Urgent Call for Auscultation Deimplementation
Annette M Bourgault1, Jan Powers, Lillian Aguirre
1Annette M. Bourgault, PhD, RN, CNL, FAAN, is an associate professor in the College of Nursing, University of Central Florida, and a nurse scientist at Orlando Health. Jan Powers, PhD, RN, CCNS, CCRN, NE-BC, FCCM, is the director of nursing research and professional practice at Parkview Health System, Fort Wayne, Indiana. Lillian Aguirre, DNP, APRN, CCNS, CCRN, is a clinical nurse specialist for the Trauma/Burn Critical Care Services, Orlando Regional Medical Center, a part of Orlando Health, Florida. Robert B. Hines, PhD, is an associate professor at the University of Central Florida College of Medicine, Orlando. Ansu T. Sebastian, MSN, RN, CCRN, PCCN, is a PhD student in the College of Nursing, University of Central Florida, and assistant nurse manager at AdventHealth, Orlando, Florida. Michele J. Upvall, PhD, RN, CNE, FAAN, is vice dean at VinUniversity, College of Health Sciences, Hanoi, Vietnam.
Insights
Despite evidence against it, most critical care nurses still use auscultation for feeding tube verification. Little progress has been made in adopting safer methods, highlighting the need for updated clinical guidelines and targeted interventions.
Area of Science:
- Medical Devices
- Patient Safety
- Clinical Practice
Background:
- Feeding tube insertion is linked to serious harm events like pneumothoraces and pneumonia.
- Current bedside verification methods often fail to accurately distinguish pulmonary from gastrointestinal placement.
- Despite guidelines advising against it, auscultation remains the most common feeding tube verification method.
Purpose of the Study:
- To assess national feeding tube verification practices among critical care nurses.
- To evaluate progress in deimplementing the auscultation method.
- To examine stylet reinsertion and cleansing practices.
Main Methods:
- A national survey was conducted with 408 critical care nurses.
- Data collected included verification methods, deimplementation progress, and stylet handling.
- Statistical analysis identified factors associated with auscultation use.
Main Results:
- 76% of nurses used auscultation for feeding tube verification.
- Nursing education, facility type, peer observation, and policy awareness correlated with auscultation use.
- Only 35% used enteral access devices for initial verification, and 38% of reinserted stylets were not cleansed.
Conclusions:
- There has been minimal progress in deimplementing auscultation over seven years.
- Evidence-based guidelines need updates to include newer enteral access systems.
- Tradition-based practices like auscultation require a multifaceted program for deimplementation.
Background:
Harm events such as pneumothoraces and pneumonia continue to be associated with feeding tube insertion. Most bedside verification methods are not accurate to discriminate pulmonary from gastrointestinal system. Evidence-based clinical practice guidelines do not support auscultation of feeding tubes in adults, yet auscultation is the most common method used.
Objectives:
Our survey assessed national feeding tube verification practices used by critical care nurses, including progress in auscultation method deimplementation, and stylet reinsertion and cleansing practices.
Methods:
A national survey of 408 critical care nurses was performed.
Results:
The majority performed auscultation (311 of 408 [76%]) to verify feeding tube placement. In the final multivariable model, nursing education, facility type, observation of colleagues performing auscultation, and awareness of an institutional policy were associated with auscultation of feeding tubes. Thirty-five percent used enteral access devices to verify initial feeding tube placement. Stylet cleansing methods were variable; 38% of reinserted stylets were not cleansed.
Discussion:
Minimal progress has been made in deimplementation of auscultation in the past 7 years despite passive knowledge dissemination in research articles, clinical practice guidelines, and procedure manuals. Although pH measure is used as a first-line feeding tube verification method in the United Kingdom, it is rarely used in the United States. Clinical practice guidelines should be updated to incorporate new research on enteral access systems.
Conclusions:
Tradition-based practices such as auscultation and certain stylet cleansing methods should be deimplemented. A focused interdisciplinary, multifaceted program is needed to deimplement auscultation practice for adult feeding tubes.
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