Feeding equipment for enteral delivery systems (FEEDS) in the intensive care unit: a prospective observational cohort study.

BACKGROUND: Patients in the intensive care unit (ICU) require enteral nutrition (EN) to meet caloric requirements. Delivered via an enteral tube that can remain insitu for 30-90 days, manufacturers recommend EN giving sets (ENGS) are changed daily. Guidelines for EN are focused on nutritional support rather than clinical management. AIMS: Measure the frequency of ENGS replacement and describe practice patterns associated with EN, including time to commencement after enteral tube insertion; documentation and labelling of ENGS; type, duration and volume of EN administration; and incidence of EN-related complications. DESIGN: Exploratory descriptive study design, using a prospective non-participant observational audit. METHODS: A non-participant observational audit was conducted daily and compared to medical record data extraction for consecutive adult (>18 years) patients admitted to ICU requiring EN via an enteral tube. RESULTS: Over 6-weeks there were 110 observations for 30 patients receiving EN; 25 (83.3%) had an NGT and 5 had a naso-jejunal tube (16.7%) insitu. ENGS were changed 80 times on 73 (87.9%) observation days. The ENGS were used between 2 and 59 h (Med = 22.5, IQR = 10). Labelling and documentation occurred 58.5% and 60.6% of the time, respectively. Insertion duration was 1 day (IQR = 2, Range = 7) prior to EN commencement; EN was most often administered for 4 days (IQR = 5, Range = 28). Median 'target' rate was 40 (IQR = 20) millilitres per hour (mL/h), 12.5% more than the actual delivery rate of 35 mL/h (IQR = 25). Diarrhoea was the most common adverse outcome (n = 12, 40%). CONCLUSION: Observed practice is not consistent with manufacturers' recommendations. Weak evidence leaves a critical gap in recommendations for best practice at the bedside, where nurses are responsible for ongoing management. Without evidence-based protocols that incorporate nursing management, care may be inconsistent, reliant on individual experience, and ultimately sub-optimal.