Feeding equipment for enteral delivery systems (FEEDS) in the intensive care unit: a prospective observational cohort study

Background: Patients in the intensive care unit (ICU) require enteral nutrition (EN) to meet caloric requirements. Delivered via an enteral tube that can remain insitu for 30–90 days, manufacturers recommend EN giving sets (ENGS) are changed daily. Guidelines for EN are focused on nutritional support rather than clinical management.Aims: Measure the frequency of ENGS replacement and describe practice patterns associated with EN, including time to commencement after enteral tube insertion; documentation and labelling of ENGS; type, duration and volume of EN administration; and incidence of EN-related complications.Design: Exploratory descriptive study design, using a prospective non-participant observational audit.Methods: A non-participant observational audit was conducted daily and compared to medical record data extraction for consecutive adult (>18 years) patients admitted to ICU requiring EN via an enteral tube.Results: Over 6-weeks there were 110 observations for 30 patients receiving EN; 25 (83.3%) had an NGT and 5 had a naso-jejunal tube (16.7%) insitu. ENGS were changed 80 times on 73 (87.9%) observation days. The ENGS were used between 2 and 59 h (Med = 22.5, IQR = 10). Labelling and documentation occurred 58.5% and 60.6% of the time, respectively. Insertion duration was 1 day (IQR = 2, Range = 7) prior to EN commencement; EN was most often administered for 4 days (IQR = 5, Range = 28). Median ‘target’ rate was 40 (IQR = 20) millilitres per hour (mL/h), 12.5% more than the actual delivery rate of 35 mL/h (IQR = 25). Diarrhoea was the most common adverse outcome (n = 12, 40%).Conclusion: Observed practice is not consistent with manufacturers’ recommendations. Weak evidence leaves a critical gap in recommendations for best practice at the bedside, where nurses are responsible for ongoing management. Without evidence-based protocols that incorporate nursing management, care may be inconsistent, reliant on individual experience, and ultimately sub-optimal.