Beslenme desteğine yeni başlanan hastaları nazogastrik sondayla taburcu etmek uygun bir yaklaşım mı?
Abstract
Giriş
ve Amaç: Başta geriatri, nöroloji ve onkoloji hasta
gruplarında olmak üzere çeşitli nedenlerle oral yoldan beslenemeyen hastalar,
nazogastrik sonda, perkütan endoskopik gastrostomi ve perkütan endoskopik
jejunostomi gibi yapay yollarla enteral yoldan beslenmektedirler. Genel
uygulama, hastaların nazogastrik sondayla beslenmeye başlanıp, daha sonra kalıcı
beslenme yolları olan perkütan endoskopik gastrostomi veya jejunostomiye
değiştirilmesi şeklindedir. Kalıcı beslenme yollarına geçilmesi zamanlaması
konusunda kılavuzlar olmasına rağmen, bu konuda kafa karışıklığı vardır. Biz bu
çalışmamızda 6 aylık zaman dilimi içerisinde nazogastrik sonda ile beslenmeye
başlanarak taburcu edilen 61 hastayı beslenme yolu değişiklikleri açısından
değerlendirmeyi amaçladık. Gereç ve Yöntem:
Antalya Eğitim ve Araştırma Hastanesinde Haziran 2015-Aralık 2015 zaman
dilimi içerisinde iç hastalıkları kliniği, tıbbi onkoloji kliniği, nöroloji
kliniklerinde yatan, altta yatan hastalıkları nedeniyle oral yoldan
beslenemeyen ve nütrisyon ekibi tarafından nazogastrik sonda ile beslenmeye
başlanıp, nazogastrik tüp ile taburcu edilen 61 hasta ardışık sırayla çalışmaya
dahil edildi. Bulgular: Çalışmaya
aldığımız hastaların 35’i (%57.4) erkek, 25’i (%42.6) kadındı. Çalışma zaman
dilimi sonunda 20 (%41.6) hasta exitus
oldu. 12 (19.7) hastaya perkütan endoskopik gastrostomi açıldı. 16 (%26.2)
hasta nazogastrik sondadan ayrılarak oral yoldan beslenmeye başladı. 13 (%21.3)
hasta nazogastrik sondayla beslenmeye devam ediyordu. Hastalarda nazogastrik sonda
kalış süresi ortalama 34.93±40.98 gün, medyan 30.0 gün (min: 2 gün, max: 180 gün,
aralık: 178 gün) olarak saptandı. Sonuç:
Takip edilen 61 hastanın sadece 12 (19.7%) tanesine perkütan endoskopik
gastrostomi açılmış olması, bunun yanında hastaların 16’sının (26.2%) oral
yoldan beslenmeye geçmiş olması hastaların nazogastrik sondayla taburcu edilip
beslenme yolu değişikliklerine takipte karar verilmesinin doğru bir yaklaşım
olduğu kanatine varmamıza neden oldu.
References
- 1. Mensforth A, Nightingake J. Insertion and care of enteral feding tubes. In: Nightingale JMD, (ed). Intestinal Failure. London: Greenwich Medical Media Ltd, 2001;281-303. 2. H Lochs, L Valentini, T Schütz, et al.Clinical Nutrition 2006;25:177-360. 3. NICE Clinical Guidelines, No.32. Nutrition support for adults; Oral nutrition support, enteral tube feding and parenteral nutrition. National Collaborating Centre for Acute Care (UK); 2006 Feb, ISBN-10:0-9549760-2-9. 4. Koçak E, Filik L. Perkütan endoskopik gastrostomi. Endoskopi 2009;17:124-7. 5. Johnston SD, Tham TC, Mason M. Death after PEG: results of the National Confidential Enquiry into Patient Outcome and Death. Gastrointest Endosc 2008;68:223-7. 6. Norton B, Homer-Ward M, Donelly MT, et al. A randomised prospective comparison of percutaneous endoscpic gastrostomy and nasogastric tube feding afer acute dyspahgic stroke. BMJ 1996;312:13-6. 7. Dwolatzky T, Berezovski S, Friedmann R, et al. A prospective comparison of use of nasogastric and percutaneous endoscpic gastrostomy tubes for long-term enteral feedin in older people. Clin Nutr 2001;20:535-40. 8. Baeten C, Hoefnagels J. Feeding via nasogastric tube or percutaneous endoscpic gastrostomy. A comparison. Scand J Gastroenterol Suppl 1992;194:95-8. 9. Dennis M, Lewis S, Cranswick G, Forbes J; FOOD Trial Collaboration. FOOD a multicentre randomised trial evaluating feding policies in patients admitted to hospital with a recent stroke. Health Technol Assess 2006;10:iii-iv, ix-x, 1-120. 10. Geenage C, Beavan J, Ellender S, Bath PM. Interventions for dysphagia and nutritional support in acute and subacute stroke. Cochrane Database Syst rev 2012;10:CD000323.
Abstract
Background and Aims:
Patients who cannot be fed orally due to various reasons, especially those
comprising the geriatric, neurological, and oncological patient groups, are fed
enterally via artificial routes such as nasogastric tube, percutaneous
endoscopic gastrostomy, and percutaneous endoscopic jejunostomy. The general
practice is to begin feeding via the nasogastric tube and then replace with
permanent feeding routes such as percutaneous endoscopic gastrostomy or
jejunostomy. Although guidelines regarding the timing of placing permanent
feeding routes are available, confusion still exists in this regard. We [A1] conducted
this study to evaluate feeding route changes among patients who were discharged
by feeding via the nasogastric tube during a 6-month time period. Materials and Method: A [A2] total
of 61 patients who were hospitalized in the internal medicine clinic, the
medical oncology clinic, and the neurology clinic in Antalya Training and
Research Hospital from June 2015 to December 2015 were enrolled consecutively
in this study. These patients could not be fed via the oral route due to their
underlying diseases and were fed via the nasogastric tube by the nutritional
team and then discharged with the nasogastric tube feeding route. Results: Of[A3]
the 61 patients, 35 (57.4%) were males and 25 (42.6%) were females. At the end
of the study period, 20 patients (41.6%) died. A total of 12 (19.7) patients
were fed with the percutaneous endoscopic gastrostomy route, and 16 (26.2%)
patients restarted feeding via the oral route. Nasogastric tube feeding was
continued for 13 (21.3%) patients. The duration of nasogastric tube feeding was
34.93±40.98 days [median 30.0 days (min: 2 days, max: 180 days, range: 178
days)]. Conclusion: Of the 61
patients who were evaluated in this study, 12 (19.7%) were fed via the
percutaneous endoscopic gastrostomy route, whereas 16 (26.2%) patients
restarted feeding via the oral route. This result suggests that the decision to
discharge patients with feeding via the nasogastric tube is an appropriate
approach.
References
- 1. Mensforth A, Nightingake J. Insertion and care of enteral feding tubes. In: Nightingale JMD, (ed). Intestinal Failure. London: Greenwich Medical Media Ltd, 2001;281-303. 2. H Lochs, L Valentini, T Schütz, et al.Clinical Nutrition 2006;25:177-360. 3. NICE Clinical Guidelines, No.32. Nutrition support for adults; Oral nutrition support, enteral tube feding and parenteral nutrition. National Collaborating Centre for Acute Care (UK); 2006 Feb, ISBN-10:0-9549760-2-9. 4. Koçak E, Filik L. Perkütan endoskopik gastrostomi. Endoskopi 2009;17:124-7. 5. Johnston SD, Tham TC, Mason M. Death after PEG: results of the National Confidential Enquiry into Patient Outcome and Death. Gastrointest Endosc 2008;68:223-7. 6. Norton B, Homer-Ward M, Donelly MT, et al. A randomised prospective comparison of percutaneous endoscpic gastrostomy and nasogastric tube feding afer acute dyspahgic stroke. BMJ 1996;312:13-6. 7. Dwolatzky T, Berezovski S, Friedmann R, et al. A prospective comparison of use of nasogastric and percutaneous endoscpic gastrostomy tubes for long-term enteral feedin in older people. Clin Nutr 2001;20:535-40. 8. Baeten C, Hoefnagels J. Feeding via nasogastric tube or percutaneous endoscpic gastrostomy. A comparison. Scand J Gastroenterol Suppl 1992;194:95-8. 9. Dennis M, Lewis S, Cranswick G, Forbes J; FOOD Trial Collaboration. FOOD a multicentre randomised trial evaluating feding policies in patients admitted to hospital with a recent stroke. Health Technol Assess 2006;10:iii-iv, ix-x, 1-120. 10. Geenage C, Beavan J, Ellender S, Bath PM. Interventions for dysphagia and nutritional support in acute and subacute stroke. Cochrane Database Syst rev 2012;10:CD000323.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Articles |
| Authors | |
| Publication Date | September 15, 2019 |
| Published in Issue | Year 2019 Volume: 18 Issue: 2 |
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