Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
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Enteral feedings are an integral part of care for many hospitalized patients. Accessing the gastrointestinal (GI) tract safely and in a timely manner can be challenging. Various techniques and devices to enhance the safety of bedside feeding tube placement are available for clinicians. ⋯ The MGFT uses a magnetic device to manipulate the feeding tube through the GI tract into the small intestine. The ETPD provides real-time visualization of the feeding tube as it progresses into the small intestine. Training and repetition are essential for safe and successful feeding tube placement, and the highlighted devices can contribute to both of these goals.
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This review provides clinicians with a comprehensive overview of indirect calorimetry including the principles, methodology, technologic advancements, benefits, and challenges. Clinical applications for indirect calorimetry and the potential limitations are specifically addressed for both the inpatient and outpatient setting. Measurement of energy expenditure is the most accurate method to assess energy needs. ⋯ Indirect calorimetry offers a scientifically-based approach to customize a patient's energy needs and nutrient delivery to maximize the benefits of nutrition therapy. With recent advances in technology, indirect calorimeters are easier to operate, more portable, and affordable. Increased utilization of indirect calorimetry would facilitate individualized patient care and should lead to improved treatment outcomes.
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Over the past few years, one of the major advancements in bedside peripherally inserted central catheter (PICC) placement has been the addition of portable ultrasound for vascular access. Traditional bedside PICC insertion success rates varied from 65% to 75% due to the limited visualized area of access available for PICC placement (1.5 inches above to 1.5 inches below the antecubital fossa). With the implementation of ultrasound, success rates have climbed to 91%-94% for bed-side-placed PICC. This article reviews the dynamics of ultrasound, provides practical tips to use image visualization, and illustrates the important key functions of this technology.