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Nurses Responsibilities on Providing Enteral Nutrition to
the Critically Ill PatientiAn European Federation of Critical
Care Nursing Associations Position Paper
b
a
,
,
Andreas SCHAEFER, BSc, APN Julie BENBENISHTY, RN, PhD Aleksandra
c
d
,
GUTYSZ-WOJNICKA, RN, CCRN, PhD Jelena SLIJEPCEVIC, RN, BSN, MSN , Silvia SCELSI, RN,
e
g
f
,
BSN, MNS Arnaud BRUYNEEL, RN, CCRN, MSc, and Mag Karin KLAS, RN
InICU,oneofthenurse’srolesistoensurepropernutritionsupporttofacilitatetheir
recovery. However,fewnutritionprotocolsfornursesarefound.TheEuropeanfederationof
Critical Care Nursing associations (EfCCNa)positionstatementprovidesICUnurseswith
evidencedguidelinesregardingcaringforcriticallyillpatientswithenteralnutritionsupport.
Keywords:criticalcareunit;enteralnutrition;nurses;EuropeanFederationofCriticalCare
Nursingassociation
of enteral nutrition (Dhaliwal,Cahill,Lemieux,&
BACKGROUND
Heyland,2014;McClaveetal.,2016).
Nutritional status impacts wound healing, venti-
latorweaning,organfunction,mobility,andmor-
NURSESRESPONSIBILITIES ON PROVIDING
tality (Cederholm et al., 2017). Tian, Heighes,
ENTERALNUTRITIONiANEFCCNAPOSITION
Allingstrup, and Doig (2018) preformed a meta-
STATEMENT
analysis of randomized controlled trials and
ThisEuropeanfederationofCriticalCareNursing
demonstrated that better outcomes occurred
associations (EfCCNa) position paper provides
when patients who were unable to eat received
a protocol for nurse to care critically ill patients
nutrition support within 24 to 48 hours of ICU
with enteral nutrition. In this position state-
admission. Therefore, it is essential that nurses
ment,criticallyill patient is defined as those with
understand nutrition assessment and applica-
complex health situations, at high risk for insuf-
tion, monitor and manage severely ill patient’s
ficient nutrition, and in the need of an individual
nutrition. In ICU, one of the nurse’s roles is to
approach;enteralnutritionisdefinedastheappli-
provide proper nutrition to ensure support of
cation of nutritional supplements via oro/naso
severelyillpatients’organsystems.Innourishing
gastraltubesordevicesplacedintogastrointesti-
critically ill patients, nurses have an important
nal area. Nurses must assure that patient’s nutri-
roleinidentifyingthoseatriskofinadequatefeed-
tion administration starts within 24 hr⚶48 hr
ing, malnutrition, and preventing complications
a
Critical Care Asklepios Klinik Schwalmstadt, Germany
b
TraumaCoordinatorHadassahHebrewUniversityMedicalCenterJerusalem,Israel.E-mail:julie@hadassah.org.il
c
Critical Care Nurse Specialist, Adiunct Faculty of Health Sciences Collegium Medicum University of Warmia and Mazury,
Olsztyn,Poland
d
DepartmentofAnesthesiology,ReanimatologyandIntensiveCareUniversityHospitalCentreZagreb,Croatia
e
DirectorNursingandHealthProfessionsDepartmentG.GasliniChildren’sHospitalGenova,Italy
f
Critical Care Department,CliniquesUniversitairesStLuc,UCL,Brussels,Belgium
g
ProgrammeDirectorGeneralNursing&CriticalCareNursingIMCUniversityofAppliedSciencesKrems,Austria
Pdf_Folio:86
86 Connect: The World of Critical Care Nursing, Volume 12, Number 3, 2018, 86-89
©2018WorldFederation of Critical Care Nursing
http://dx.doi.org/10.1891/1748-6254.12.3.86
Figure 1. Protocol of caring for critically ill patients with enteral nutrition.
Assessment
Nutritional Status
NRS-nutrition risk screening FeedingTube
the NUTRIC score determine both nutritional status and disease severity. daily assessment of correct placement of the feeding tube
MALNUTITION RISK SCORE (geriatric patients) (according to the hospital standards)
SUBJECTIVE GLOBAL ASSESSMENT(surgical or trauma patients) and the BMI
(primary assessment, especially useful in low BMI individuals, BMI < 18 means asure oral/nasal hygene and care
severe malnutrition and a high risk of refeeding syndrom while nutrition support
Implementation Monitoring
the Nurse assures the accurate and adequate the daily nutritional intake based on metabolic status
Nutrition protocols should be used
the Nurse should prevent aspiration, constipation/obstipation, diarrhea
if the patient is not absorbing, (high residual, diminshed gastric motility) prokinetic therapy should be the Nurse should monitor the tolerance of Nutrition
considered if the patient is not absorbing, (highr esidual,
handling of nutritional supplement should be in accordance with the manufacturers instructions and diminshed gastric motility) prokinetic therapy
under hygienic standards should be considered
the Nurse should minimize interruptions in Nutrition intake due to(e.g.) surgical procedures, imaging,
medical interventions, scopes
the Nurse should explain and comunicate to patients and significant others regarding nutrition
Evaluation
if within7-10 days the patient is not receiving daily required dose/
calories perienteral Nutrition should be considered
if the patient is suffering from intolerance of enteral Nutrition consider
exchanging the type of enteral supplement product (e.g. hypo-osmolare
formular, nephro diet,…)
evaluate tube functionability
after admission to ICU (McClave et al., 2016). • TheNutritionRiskintheCritically
Then, they should assess the nutritional status Ill (NUTRIC)scoreassessingboth
and feeding tube efficacy of patients, implement nutritional status and disease
and monitor enteral nutrition, and then evalu- severity (Heyland, Dhaliwal, Jiang,
ate the outcomes of enteral nutrition. Figure 1 &Day,2011;Kondrup,Allison,Elia,
illustrates the protocol of caring for critically ill Vellas, & Plauth, 2002)
patients with enteral nutrition. • MalnutritionRiskScore(Ferguson,
Capra,Bauer,&Banks,1999)
• SubjectiveGlobalAssessment(for
1. Assessment
surgical or traumapatients)andthe
i. Nutritional Status
BodyMassIndex(BMI,witha
Thereareanumberoftoolsthatcanbe
BMI<18indicatingsevere
usedfordailyassessingthenutritional
malnutritionandahighriskof
status, such as:
refeedingsyndromewhilenutrition
• Nutritionriskscreening(NRS)
support)(Cederholmetal.,
(Kondrup,Rasmussen,Hamberg,&
2017)
Stanga,2003)
Pdf_Folio:87
Connect: The World of Critical Care Nursing, Volume 12, Number 3, 2018 87
ii. Feeding Tube
exchangingthetypeofenteralsup-
• Dailyassessmentoftheplacement
plementproduct(e.g.,hypo-osmolare
of the feeding tube (according to the
formular,nephrodiet,etc.)(McClave
hospital standards) to ensure its
et al., 2016; Singer et al., 2011)
correct placement
• Evaluatingtubefunctionability
• Assuringoral/nasalhygieneandcare
(MinistryofHealthSingapore,
2. Implementation and monitoring (enteral
2010)
nutrition)
• Asurringtheaccurateandadequate
CONCLUSION
daily nutritional intake based on
The EfCCNa position stated above provides an
metabolicstatus
overview concerning the key role of nurses
• Nutritionprotocolsshouldbeused
in enteral nutrition for critically ill patient.
(Kreymann,2010;Makic,VonRueden,
The position statement is underpinned with
Rauen,&Chadwick,2011)
evidence-basedguidelinesandsourcesfromlead-
• Monitoringthetoleranceofnutrition
ing experts in behalf of nourishing critically ill
(Nguyen,2014)
patients such as ESPEN (European Society of
• Preventingaspiration,constipation,
ParenteralandEnteralNutrition),ASPEN(Amer-
anddiarrhoea(Blaseretal.,2017)
ican Society of Parenteral and Enteral Nutri-
• If the patient is not absorbing leading
tion), and ESICM (EuropeanSocietyofIntensive
to food residue and diminshedgastric
Medicine).
motility, then prokinetic therapy
shouldbeconsidered(Knowles,
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Guidelines for the provision and assess-
cial interest or affiliations with any commercial
ment of nutrition support therapy in the
interests related to the subjects discussed within
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Pdf_Folio:89
Connect: The World of Critical Care Nursing, Volume 12, Number 3, 2018 89
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