Interpretation of nursing Group Standard 19: Can nursing enteral nutrition solution supported by adult enteral nutrition be hung on the ordinary infusion rack for infusion?
It has been nearly two months since the publication of the Nursing Group standard T/ CNAS10-2020 “Nursing for Adult Enteral Nutrition Support”, and there is still more than a month to go before it is officially implemented.Now, let us rob before it is implemented, to a preview, it as the next month department nursing business learning focus!What range of adult enteral nutrition support are prescribed by T/ CNAS10-2020?This document provides the basic requirements, operation points, complication care and health education of enteral nutrition support for adults.What terms and definitions are involved in T/ CNAS10-2020?Nutrition support is provided through enteral channels to supplement or provide essential nutrients for the maintenance of the human body when the patient’s diet is not available or intake is insufficient.The volume of unemptied gastric content, including saliva, gastric juice, duodenal reflux fluid, and intestinal nutrient solution, which can be measured by draining it through a gastric tube with a syringe.3. Abnormal state of gastric retention: accumulation of gastric contents that are not emptied in time. Food from 4 to 6 hours ago is vomited or food left in the stomach is still in the stomach for more than 8 hours.200ml indicated gastric retention.Percutaneous gastrostomy tube is inserted to connect the stomach/intestine to the outside of the body through puncture through the abdominal surface and the anterior wall of the stomach/jejunum through surgery or endoscopic/imaging techniques.What are the basic requirements of T/CNAS10-2020?1 Enteral nutrition support should be implemented according to the doctor’s advice, and the approach and method of enteral nutrition support should be understood.2. The tolerance of enteral nutrition should be evaluated during enteral nutrition support, and complications should be identified and handled in time.3 Enteral nutrition label should be pasted on the exposed end of feeding tube and enteral nutrition infusion set, and infusion using a special infusion stand.What operational points does adult enteral nutrition support have?Type on the blackboard and underline!This section covers the evaluation before operation of adult enteral nutrition support, preparation of enteral nutrition preparation, implementation, maintenance of feeding tube, and flushing tube. You have mastered the five major operating points, and the essence of T/CNAS10-2020.1. The degree of cooperation of the patient should be evaluated, including abdominal discomfort, diarrhea and gastric retention.2. The patient’s current access to enteral nutrition support, feeding tube location, and patency of feeding tube should be evaluated.Preparation of enteral nutrition preparations 1 should be prepared and used now, and pollution should be avoided in the process of configuration.2. The enteral nutrition preparation should not be stored for more than 4h at room temperature, and should be refrigerated for more than 4h, and should be discarded if it is not used up within 24h;Finished enteral nutrition preparations should be stored according to product instructions.Enteral nutrition preparations should be kept separate from other medicines.3. Implementation 1. When there is no special position contraindication, the head of the bed should be raised 30° ~ 45° during feeding, and the semi-decubial position should be maintained for 30 ~ 60min after feeding.2. Heat the nutrient solution to 37℃ ~ 40℃.For continuous infusion of nutrient solution, a special heating device for enteral nutrition infusion can be used.3 for one-time infusion, the feeding tube can be slowly injected with a syringe, and the amount of each infusion should not exceed 400ml according to the total amount of nutrient solution.For intermittent gravity infusion, enteral nutrition preparation can be placed in a flask or a special nutrition liquid infusion bag, connected with enteral nutrition feeding tube through enteral nutrition infusion device, and fed in batches by gravity infusion method.5 For continuous pump infusion, the enteral nutrition pump can be used for 12-24h infusion on the basis of intermittent gravity infusion. The infusion speed should be adjusted to 20-50mL /h from slow to fast, and gradually increase according to patient tolerance.6 minutes push infusion and intermittent gravity infusion should be checked before each feeding.In severe patients with continuous pump infusion, gastric residuals should be checked every 4 to 6 hours.Enteral nutritional tolerance should be assessed every 4 to 6 hours.Note: 0 ~ 2 points: continue enteral nutrition, maintain the original rate, symptomatic treatment.3 ~ 4 points: continue enteral nutrition, slow down the speed, 2 hours after re-evaluation.≥5 points: enteral nutrition was suspended, and the input route was reassessed or changed.4. Maintenance of feeding tube 1. Transnasal feeding tube 1) Elastic tape should be used to fix the feeding tube.2) Check whether the pipe and its fixing device are in place, whether the pipe is unobstructed, and the compression of the skin and mucous membrane at the fixing place of the feeding tube every day.3) for long-term catheterization, the catheter should be replaced to the other side of the nasal cavity every 4 to 6w.2 gastrostomy/jejunostomy 1) The skin around the fistula should be disinfected regularly and the dressing should be changed to keep the surrounding skin clean and dry.2) 48h after catheterization, the catheter can be gently rotated 90° for re-positioning, once per day, and gradually rotated 180° ~ 360° for re-positioning.3) The external fixation device should be kept at a distance of 0.5cm from the abdominal wall skin.For intermittent gravity infusion or fractional push infusion, 20 ~ 30ml warm boiled water should be used before and after each feeding.2 Continuous infusion through the pump, should be used every 4h with 20 ~ 30ml warm water pulse flushing pipe once.3. Before and after each administration and after the determination of stomach residue, 20 ~ 30ml warm boiled water pulse flushing tube was applied.For patients with impaired immune function or in critical condition, sterilized injection water should be used to flush the tube.Avoid mixing liquid medicine with nutrient solution with pH ≤5.What complications does enteral nutrition support have and how to nurse?There are five complications of enteral nutrition support in adults, and the following nursing interventions are described as follows: 1. Gastric retention 1. Gastric residual volume can be assessed by means of ≥50ml nutrient solution syringe and bedside ultrasound.2. Gastric residual amount >At 200ml, patients should be assessed for nausea and vomiting, abdominal distension, abnormal bowel sounds and other symptoms;If there is discomfort, feeding should be slowed down or suspended, and the feeding program should be adjusted or gastrointestinal motility drugs should be used as advised by the doctor.3. Gastric residual amount >500ml, feeding suspension should be considered in combination with the patient’s chief complaint and physical signs.2, diarrhea 1 patients should observe the frequency of diarrhea, the color, quality and quantity of defecation, timely communication with the doctor.2 For diarrhea caused by too fast infusion of nutrient solution, infusion speed should be slowed down, and infusion pump can be used to control infusion speed.3 For low-temperature diarrhea caused by too low temperature of nutrient solution, a heater can be used.Three, nausea and vomiting 1 should find the cause of nausea and vomiting.2 The infusion speed should be reduced to assist the patient in the right decubitus position.4. The feeding tube is blocked. 1. Rinse the feeding tube with 20 ~ 30 ml warm water by suction and impulse injection.2 If it does not work, 20 ~ 30ml of 5% sodium bicarbonate solution can be used to flush the feeding tube.3 If the above operations are ineffective, the doctor should be informed.5. Aspiration 1 Feeding should be suspended immediately to find out the cause of aspiration.2 Patients should be encouraged to cough, help to take half decubitus position, coma patients should turn their head to one side.If the patient has symptoms of airway obstruction or asphyxia, negative pressure suction should be given immediately.Patients’ vital signs should be observed and medication should be taken as instructed.How to provide health education for enteral nutrition support patients and their families?Patients and their families should be informed of the importance of enteral nutrition and the maintenance of feeding lines.Patients and their families should be informed of the main ingredients, effects and possible adverse reactions to enteral nutrition preparations.Patients and their families should be informed of the preservation and use of nutritional preparations.Patients and their family members should be informed of the precautions and coordination points during enteral nutrient infusion.Patients and their family members should be informed of the methods of feeding line fixation and skin protection at the stoma.6 Patients and their families should be instructed in the prevention and treatment of complications.Anyhow, nursing group standard T/CNAS10 ─ 2020 care of adult enteral nutrition support for clinical nurse specification the five related operations, and other related complications and nursing key points, provides clinical implementation of enteral nutrition support in adults with operating standards and guidelines, each clinical nurses should learn and master, improving the quality of patient care services.Reference  Chinese Nursing Association.Nursing group standard T/ CNAS10-2020 “Adult enteral nutrition support nursing” (source: China Health Care Research Institute) statement: the copyright of this article belongs to the original author, if there is a source error or infringement of your legitimate rights and interests, you can contact us through the mailbox, we will promptly deal with.Email address: email@example.com