Inadvertent intracranial insertion of nasogastric tubes : An overview and nursing implications

Nasogastric tubes are a commonly used medical device. There are numerous complications associated with their use, one of the most significant is when they are inadvertently inserted into the cranium. Clinicians need to be aware of this complication and the type of patient who is most susceptible.

Nursing administration of medication via enteral tubes in adults : a systematic review

Background Enteral tubes are frequently inserted as part of medical treatment in a wide range of patient situations. Patients with an enteral tube are cared for by nurses in a variety of settings, including general and specialised acute care areas, aged care facilities and at home. Regardless of the setting, nurses have the primary responsibility for administering medication through enteral tubes. Medication administration via an enteral tube is a reasonably common nursing intervention that entails a number of skills, including preparing the medication, verifying the tube position, flushing the tube and assessing for potential complications. If medications are not given effectively through an enteral tube, harmful consequences may result leading to increased morbidity, for example, tube occlusion, diarrhoea and aspiration pneumonia. There are resultant costs for the health-care system related to possible increased length of stay and increased use of equipment. Presently what is considered to be best practice to give medications through enteral tubes is unknown.

Objectives The objective of this systematic review was to determine the best available evidence on which nursing interventions are effective in minimising the complications associated with the administration of medications via enteral tubes in adults. Nursing interventions and considerations related to medication administration included form of medication, verifying tube placement before administration, methods used to give medication, methods used to flush tubes, maintenance of tube patency and specific practices to prevent possible complications related to the administration of enteral medications.

Search strategy The following databases were searched for literature reported in English only: CINAHL, MEDLINE, The Cochrane Library, Current Contents/All Editions, EMBASE, Australasian Medical Index and PsychINFO. There was no date restriction applied. In addition, the reference lists of all included studies were scrutinised for other potentially relevant studies.

Selection criteria Systematic reviews of randomised controlled trials (RCTs) and RCTs that compared the effectiveness of nursing interventions and considerations used in the administration of medications via enteral tubes. Other research methods, such as non-randomised controlled trials, longitudinal studies, cohort and case control studies, were also included. Exclusion criteria included studies investigating drug–nutrient interactions or the bioavailability of specific medications.

Data collection and analysis Initial consideration of potential relevance to the review was carried out by the primary author (NP). Two reviewers independently assessed study eligibility for inclusion. A meta-analysis could not be undertaken, as there were no comparable RCTs identified. All data were presented in a narrative summary.

Results There is very limited evidence regarding the effectiveness of nursing interventions in minimising the complications associated with enteral tube medication administration in adults. The review highlights a lack of high quality research on many important nursing issues relating to enteral medication administration. There is huge scope for further research. Some of the evidence that was identified included that nurses should consider the use of liquid form medications as there may be fewer tube occlusions than with solid forms in nasoenteral tubes and silicone percutaneous endoscopic gastronomy tubes. Nurses may need to consider the sorbitol content of some liquid medications, for example, elixirs, as diarrhoea has been attributed to the sorbitol content of the elixir, not the drug itself. In addition, the use of 30 mL of water for irrigation when administering medications or flushing small-diameter nasoenteral tubes may reduce the number of tube occlusions.

Nasogastric tubes : an historical context

Nurses commonly care for patients with nasogastric tubes. Many authors have addressed the management of nasogastric tubes; however, discussion rarely considers the historical perspective. The purpose of this article is to provide an historical context on nasogastric tubes

A systematic review of nursing administration of medication via enteral tubes in adults

Aim. This systematic review aimed to determine the best available evidence regarding the effectiveness of nursing interventions in minimising the complications associated with administering medication via enteral tubes in adults.
Background. Giving enteral medication is a fairly common nursing intervention entailing several skills: verifying tube position, preparing medication, flushing the tube and assessing for potential complications. If not carried out effectively harmful consequences may result leading to increased morbidity and even mortality. Until now, what was considered to be best practice in this area was unknown.
Design. Systematic review.
Methods. CINAHL, MEDLINE, The Cochrane Library, Current Contents/All Editions, EMBASE, Australasian Medical Index and PsychINFO databases were searched up to September 2005. Reference lists of included studies were appraised. Two reviewers independently assessed study eligibility for inclusion. There were no comparable randomised-controlled trials; data
were presented in a narrative summary.
Results. Identified evidence included using 30 ml of water for irrigation when giving medication or flushing small-diameter nasoenteral tubes may reduce tube occlusion. Using liquid medication should be considered as there may be less tube occlusions than with solid forms in nasoenteral tubes and silicone percutaneous endoscopic gastrostomy tubes. In addition, nurses may need to consider the sorbitol content of some liquid medications, for example elixirs, as diarrhoea has been attributed to the sorbitol content of the elixir, not the drug itself.
Conclusion. The evidence was limited. There was a lack of high-quality research on many important issues relating to giving enteral medication.
Relevance to clinical practice. Nurses have the primary responsibility for giving medication through enteral tubes and need knowledge of the best available evidence. Some of the nursing considerations and interventions relating to this skill have been researched in the clinical area and have implications for practice. There is a need for further studies to strengthen these findings.

Best practice in a resource vacuum : responding to the accommodation needs of people with high, complex or changing support needs

This paper aims to identify current practice responses to the housing and support needs of people with high, complex or changing support needs. Case studies of current housing dilemmas and responses were provided by Annecto and Scope (Vic), and included data about the responses of other providers known to these agencies. The paper will first present case study data in three categories of accommodation: living independently (ie. living alone in self-rented or self-owned housing with or without formal support); living without a home (ie. living in non permanent or non secure housing); and living in the parental home and planning for change. The case studies are followed by a discussion of the key response strategies evident in each, and an analysis of significant ‘lessons’ for policy.

Development of material models to predict the crashworthiness of tubes

Metallic tubes have been extensively studied for their crashworthiness as they closely resemble automotive crash rails. Recently, the demand to produce light weight yet safer vehicles has led to the need to understand the behaviour of novel materials such as composites, metallic foams and sandwich structures durign a crash. This paper presents a method to predict the crashworthiness of structural components using material modes. The material factors that most affect the crushing response are determined and quantified by developing and validating the crushing of a square tube model in Abaqus. The inputs from the model are used to construct a simple, physically realistic constitutive model and new test methods for predicting the material behaviour at high strain rates using low test speeds. These material models enable a designer to predict the crash behaviour of a structure without the need to perform extensive physical tests, thus reducing the time and cost of development.

Strain rate effects on the energy absorption of rapidly manufactured composite tubes

Quasi-static and intermediate rate axial crush tests were conducted on tubular specimens of Carbon/Epoxy (Toray T700/G83C) and Glass/Polypropylene (Twintex). The quasi-static tests were conducted at 10 mm/min (1.67 x 10¯⁴ m/s); five different crush initiators were used. Tests at intermediate rates were performed at speeds of 0.25, 0.5, 0.75, 1, 2, and 4m/s. Modes of failure and specific energy absorption (SEA) values were studied. The highest SEA measured was 86 kJ/kg. This value was observed using Carbon/Epoxy samples at quasi static rates with a 45° chamfer initiator. The highest energy absorption for Twintex tubes was observed to be 57.56 kJ/kg during 45° chamfer initiated tests at 0.25 m/s. Compared with steel and aluminium, SEA values of 15 and 30 kJ/kg, respectively, the benefits of using composite materials in crash structures become apparent.

Performance of wrought aluminium and magnesium alloy tubes in three-point bending

This present work examines the load carrying capacity, energy absorption and fracture characteristics of wrought magnesium and aluminium alloy tubes in three-point bending. Magnesium alloy AZ31, and aluminium alloys 6063 and 7075, were extruded into cylindrical tubes of both equivalent thickness and mass. A strong thickness effect was present meaning that the AZ31 tube had significantly higher load and energy absorption performance than an equivalent mass 6063 tube, albeit not as high as the 7075 tube. Hinge formation and maximum load was delayed for the magnesium alloy, meaning that a high energy absorption rate persisted to higher deformation displacements than the aluminium alloys. It was also found that fracture during deformation was dependent on the indenter diameter, tube thickness and lower support separation.

Effect of grain size on the performance of extruded magnesium alloy tubes in three-point bending

The performance of extruded AZ31, AZ61 and AM-EX1 tubes was examined in three-point bending. Different extrusion temperatures were used to investigate the effect of grain size on the load-carrying capacity, energy absorption and fracture propensity of the tubes. Results showed that while the peak load increased with a smaller average recrystallised grain size, the retention of large elongated un-recrystallised grains in the microstructure reduced the load. The presence of the large elongated grains also appeared detrimental to the ability of the tube to deform before fracture.

Modelling the side impact of carbon fiber tubes

Metallic tubes have been extensively studied for their crashworthiness as they closely resemble automotive crash rails. Recently, the demand to improve fuel economy and reduce vehicle emissions has led automobile manufacturers to explore the crash properties of light weight materials such as fibre reinforced polymer composites, metallic foams and sandwich structures in order to use them as crash barriers. This paper discusses the response of carbon fibre reinforced polymer (CFRP) tubes and their failure mechanisms during side impact. The energy absorption of CFRP tubes is compared to similar Aluminium tubes. The response of the CFRP tubes during impact was modelled using Abaqus finite element software with a composite fabric material model. The material inputs were given based on standard tension and compression test results and the in-plane damage was defined based on cyclic shear tests. The failure modes and energy absorption observed during the tests were well represented by the finite element model.

The indentation behaviour of carbon fibre composite tubes-experiments & modelling

Metallic tubes have been extensively studied for their crashworthiness as they closely resemble automotive crash rails. Recently, the demand to produce lighter weight, yet safer vehicles has led to the need to understand the crash behaviour of novel materials, such as fibre reinforced polymer composites, metallic foams and sandwich structures. This paper discusses the static indentation response of Carbon Fibre Reinforced Polymer (CFRP) tubes. The side impact on a CFRP tube involves various failure mechanisms. This paper highlights these mechanisms and compares the energy absorption of CFRP tubes with similar Aluminium tubes. The response of the CFRP tubes during bending was modelled using ABAQUS finite element software with a composite fabric material model. The material inputs were given based on standard tension and compression test results and the in-plane damage was defined based on cyclic shear tests. The failure modes and energy absorption observed during the tests were well represented by the finite element model.

Sperm cells of the pollen tubes of Brassica : ultrastructure and isolation

Sperm cells of pollen tubes grown both in vivo and in vitro form a male germ unit. Extensions from both sperm cells of each pollen tube are closely associated with the tube nucleus. A high yield (2.7 × 104. 20 mg−1 pollen grains germinated) of intact sperm cells was obtained following release by osmotic shock from pollen tubes grown in vitro. Structural integrity of isolated sperm was maintained by isolation at low temperature in an osmotically balanced medium. At 4° C many isolated sperm pairs were still enclosed within the pollentube inner plasma membrane. Sperm cells not enclosed within this membrane no longer remained connected as a pair. During isolation vesicles formed on the sperm cell surface from disruption of the fibrillar components bridging the periplasmic space. Both in the pollen tube and after isolation the sperm nucleus is in close association with at least one region of the sperm plasma membrane. Sperm isolated at room temperature showed the presence of nucleopores, and nuclei were euchromatic, instead of heterochromatic as in intact sperm in the pollen tube.