Administration of nasogastric tubes and gastrostomy in HSCT patients
Natalia G. Saltykova, Nina N. Gurgenidze, Alexander N. Shvetsov, Maksim A. Kucher, Boris V. Afanasyev
Raisa Gorbacheva Memorial Research Institute of Pediatric Oncology, Hematology and Transplantation, Pavlov First Saint Petersburg State Medical University, St. Petersburg, Russia
Contact: Natalia G. Saltykova, Clinical Nurse
Nutritional status (NS) is an important factor that can influence overall effectiveness of hematopoietic stem cell transplantation (HSCT) in patients with malignancy. Nowadays NS evaluation and its correction are an integral part of supportive care, which is due to complications in the early post-transplantation period that negatively affect NS, among which are gastrointestinal toxicity: nausea, vomiting, mucositis, enteropathy, and infectious complications, for which enteral nutrition (EN) and/or parenteral nutrition (PN) are frequently administrated. Nutrition therapy effectiveness and safety may vary widely from the level of nursing staff competence and experience.
Materials and methods
On the basis of current state of art in clinical nutrition, worldwide recommendations and our own experience in nutrition support in patients with HSCT, the principles and features of EN implementation are presented.
EN is a process of specialized mixtures of macro- and micronutrients administration by oral way, via feeding tube, or gastrostoma. EN has advantages in comparison with PN: it is more physiological, contributes tp the maintenance of intestinal microenvironment, faster recovery of mucus barrier of gastrointestinal tract and has significantly lower risk of infectious and metabolic complications. The most common method of EN is nasogastric tube, which may be of various length and size, made of polyvinyl chloride, silicone or polyurethane, and which is injected through the nasal lumen into the stomach. In addition, nasogastric tube can be used for gastroparesis treatment (abdominal decompression), poisoning, drugs administrating (unconscious and pediatric patients) and for gastrointestinal bleeding control. In case of decreased nasogastric tube tolerance, long-lasting EN necessity and unless contraindicated, it is possible to install an inert gastrostomy tube. Modern endoscopic and percutaneous methods of gastrostomy installation are minimally invasive surgery and can be used in children with a body mass below 3 kg.
The leading role in patient’s care belongs to the nursing staff, which should regularly takes care of nasogastric or gastrostomy tube, takes preventive measures for bedsore, granulations tissue, dislocation and obstruction prophylaxis, as well as conducting training with the patient and it’s relatives. It is important to keep in mind the patient characteristics, i.e., immunodeficiency (risk of infections), thrombocytopenia (risk of bleeding), mucositis (pain, bleeding), vomiting, diarrhea, which requires additional skills and compliance with nutrition therapy technology. In case of lacking competence, the nurses may incorrectly perform EN, which could lead to increased risk of complications in patients and change of further treatment approaches.
Standard operating procedures (SOPs), which contain documented sets of instructions or algorithms for step-by-step actions, according to which medical staff must strictly follow during implementation of nutrition therapy, should be developed and implemented into clinical practice in every transplant center. Senior nurses and doctors who are responsible for conducting EN should periodically give training lectures and hold workshops for medical staff, patients, and their representatives to increase the level of knowledge and skills, which will improve the efficiency, compliance, and safety of nutrition support.
Nutritional support, enteral nutrition, HSCT.