PC-03. Some features of nasogastric tube installation and care in cancer patients
Natalya G. Saltykova, Maxim A. Kucher, Alexander D. Kulagin
RM Gorbacheva Research Institute, Pavlov University, St. Petersburg, Russia
Contact: Natalya G. Saltykova, phone: +7 (964) 395-33-67, e-mail: email@example.com
Nasogastric tube (NT) is a necessary tool for evaluation of the gastrointestinal tract and delivery of enteral nutrition (EN) in pediatric and adult patients. In the patients receiving treatment with chemotherapy and hematopoietic stem cell transplantation (HSCT), the indications for NT installation occur quite common, especially for implementation of EN and administration of medical drugs. At the same time, clinical characteristics of the HSCT patients, e.g., mucositis, severe thrombocytopenia, vomiting and diarrhea, require skilled nursing care and her competence in clinical nutrition and NT application. The aim of this work was to increase knowledge among the nursing staff concerning the nasogastric tube installation and providing enteral nutrition.
Materials and methods
We present our own experience of the NT usage and EN implementation, which was performed in accordance with general clinical nutrition recommendations for patients treated with chemotherapy and HSCT. From January 2020 to August 2022, 157 patients who required NT installation were included in the prospective study at the R. M. Gorbacheva Research Institute. This cohort included children 1 month to 17 years old (n=92, median age of 3.6 y.o.), and 65 adult patients (18 to 71 years old, median age of 33 y.o.). Most patients (n=108) underwent allogeneic HSCT (68.8%), 8.9% of patients were subjected to autologous HSCT (n=14), and chemotherapy was performed in 15.3% of the cases (n=20).
NT was installed at the HSCT departments in 48.4% of the cases, as compared with 51.5% of the patients treated at the intensive care unit. The main indications for NT installation were as follows: EN, in 84.7%; drug delivery, in 3.8%; gastrointestinal paresis, in 6.3% of cases. In 32.4% of the patients, NT was installed upon initiation of mechanical lung ventilation. At the time of NT installation, such clinical manifestations as anorexia 83.4%, nausea 39.4%, vomiting 30.5%, diarrhea 33.7%, mucositis 20.3% (12.1%, of severe degree), intestinal and combined graft-versus-host disease were observed, respectively, in 5.7% and 8.2% of cases. In 42.6% of cases, NT was installed in presence of thrombocytopenia IV (<20×109/l), which, however, did not lead to nasal bleedings. The duration of the NT usage ranged from 1 to 118 days (a median of 11 days). The most common reasons for NT removal were, e.g., restoration of self-feeding in 50 patients (31.8%); no further need for NT (n=59, 37.6%) and self-removal of NT by the patient (n=22, 14% of cases). Acute complications during NT installation were registered in 3.2% of cases manifesting as nasal bleeding (n=4) and NT dislocation (n=1).
NT installation and assisted EN are fairly frequent clinical procedures in the patients undergoing chemotherapy and HSCT, which can lead to complications in cases of wrong implementation of this technique, thus requiring theoretical knowledge and practical skills from the nurses.
Nasogastric tubes, enteral nutrition, nursing care, cancer therapy.