Reducing Postpyloric Feeding Start Times in Patients With Large Hemispheric Infarction Receiving Therapeutic Hypothermia.

Background: Early postpyloric feeding provides effective and safe enteral nutrition for patients with large hemispheric infarction receiving therapeutic hypothermia.

Local problem: Patients with large hemispheric infarction undergoing therapeutic hypothermia often have gastrointestinal dysfunction and undergo repeated bedside attempts at blind postpyloric feeding tube placement. Confirming tube position via radiography can delay nutrient intake, increase costs, and expose patients to unnecessary radiation.

Methods: In this quality improvement study, specialist nurses were trained to use ultrasonography instead of radiography to confirm postpyloric feeding tube position, reducing reliance on ancillary services. Preimplementation and postimplementation data included time from tube placement to first feeding and the frequency of radiography use. Surveys were conducted to assess the health care team's satisfaction with the new process.

Results: Sixty-seven placements (30 before implementation, 37 after implementation) were evaluated. Feeding start times significantly decreased by 34.85% (mean [SD], 741.20 [192.73] minutes before implementation vs 482.86 [166.15] minutes after implementation; P < .001). The addition of ultrasound guidance for postpyloric feeding tube placement significantly decreased the number of abdominal radiographs per patient by 56.0% (mean [SD], 2.5 [0.9] before implementation vs 1.1 [0.4] after implementation; P < .001). Most health care team members indicated that this practice change reduced the time to initiation of enteral nutrition for patients with large hemispheric infarction receiving therapeutic hypothermia.

Conclusions: By improving processes, we reduced feeding start times, minimized radiography use, and enhanced the health care team's satisfaction with postpyloric feeding tube placement for patients receiving therapeutic hypothermia.