Extending the Functional Life of Feeding Tubes

Purpose:
Purpose: To examine factors contributing to high number of feeding tube insertions, and to identify potential interventions to prolong the functional life of feeding tubes.

Background/Significance:
9.4 % of Miami VA Medical Center CLC Residents were found to have feeding tubes. Compared with National Average of 6.3% This prompted a multi-disciplinary review of factors associated with feeding tubes. Nurses identified perceived high rates of costly, uncomfortable re-insertions.

Methods:
Retrospective record reviews conducted. Factors associated with need for frequent feeding tube replacements were identified. Using Appreciative Inquiry, records of the longest functioning tubes were reviewed for factors contributing to successful tub-life. Use of pancrelipase solution was found to have been successfully used to unclog and maintain function of the longest lasting tube. Literature review and review of current Miami VA Hospital Nursing Practice Guidelines supported this practice.

Results:
Average life of PEJ tubes was found to be 80 days. Due to: Occlusion (22), Leaking (14) secondary to occlusion, and forceful attempts to irrigate, Displacement (21) and Other (2). Prior to PRN orders for pancreatic enzyme one tube was found to have been changed every 61 days. After development & teaching of an an algorythm to prevent occlusion this feeding tube was successfully unclogged seven times, at an estimated total cost savings of $14,560. Duration of this feeding tube was extended to 190 days. The use of the pancreatic enzyme has the potential for significant cost savings. Monitoring of functional tube life by use of the Plan Do Check Act model is in progress.

Conclusions and Implications for Practice:
Appreciative Inquiry is a useful model for Quality Improvement. Use of pancrelipase to restore patency of feeding tubes has the potential to result in significant extension of functional tube life, saving patients from unnecessary procdures and reducing costs.