Registered Dietitian Nutritionist Day: Highlighting the Importance of Safe Post Pyloric Feeding Tube Placement

March 8, 2023, Registered Dietitian Nutritionist Day, honors dietitians who champion nutrition and, when necessary, provide it via a feeding tube. 

ENvizion Medical recognizes their importance to healing and is proud that its ENvue system assists them in safe post pyloric feeding tube placement.

What Is Registered Dietitian Nutritionist Day?

Registered Dietitian Nutritionist Day, officially March 8, generates awareness of the crucial roles registered dietitian nutritionists (RDNs) play. It was first celebrated in 2008 in observance of their being considered the nation's food and nutrition experts and educators. 

Nutrition is important enough to be delineated into seven separate medical specialties. Board certification is offered in diverse nutrition disciplines, from pediatrics to the elderly, and from cancer to sports. The Academy of Nutrition and Dietetics is an accredited agency, and its members are recognized as educators by the United States Department of Education.

Clinically, RDNs are indispensable, for without nutrition, healing can neither begin nor resume in the medical setting. Physicians, nurses, and other providers rely on RDNs, partnering with them in the bigger - holistic - picture of care. There is no therapy that can succeed without nutrition, underscoring the importance of RDNs. 

Their significance not only applies to wellness and healing or in providing on-site consultations. Their value as educators is in the pro-active information they instill. They impact the fields of lipid management, diabetes, obesity, and chronic medical illnesses. 

They also administer and place post pyloric feeding tubes: they can experience the added safety theENvue System offers.

RDNs Engage Clinically

In intensive care settings and other skilled facilities, proper, complete nutrition, considered an emergency, mandates intervention. 

The earliest feeding possible is considered a therapeutic strategy. It minimizes disease severity, bolsters the immune response, reduces complications, and improves patient outcomes. Yet, this strategy isn't possible when the patient ability to swallow is impaired. 

Post pyloric nutrition is indicated and necessary when a patient is comatose, has swallowing dysfunction, suffers anorexia, or is incapacitated (e.g., dementia or psychiatric illness). Such a scenario goes beyond education and requires hands-on intervention. 

RDNs are competent to intervene clinically. Accordingly, they are certified to treat medical conditions by delivering proper nutrition by feeding tube insertion when needed. As a specialty they have been placing small bowel feeding tubes for almost two decades now. Thus, it is within their skillset and scope of practice.  They are authorized to deliver nutrition to the appropriate part of the gastrointestinal tract for proper absorption. 

Their availability also further achieves the goal of beginning nutrition as soon as possible. This means post pyloric feeding tube placement so that nutrition can reach the small intestines. RDNs' readiness for insertion establishes the additional timely opportunity for feeding tube placement when attending physicians are not always available. 

It is now felt that post pyloric feeding in settings of intensive care should be considered routine. More use of post pyloric feeding, however, means routine safety is needed, and that challenge is answered by the ENvue system. 

Post Pyloric Feeding Tube Placement - Not a Benign Procedure

Inserting a post pyloric feeding tube is neither straightforward nor benign. The anatomy is such that there is no straight route of passage. First, of prime importance, is avoiding placing the feeding tube into the trachea and, worse, proceeding into the lung. The proximity of the entrance to both esophagus and trachea makes this a critical step (or a disastrous misstep). 

This can result in breaching air-tight lung membranes, allowing air to escape into the chest cavity, causing a tension pneumothorax (lung collapse). This is a major cause of death from a complication in what is considered a routine procedure. 

Second, curves in the anatomy as well as sphincters present obstacles. Inability to successfully cross the pyloric sphincter - stomach outlet - is the most common cause of post pyloric feeding tube failure. 

Therefore, the procedure requires the skills for which RDNs are trained and, when needed, demonstrate. 

RDNs Are Aware of Tips for Safe Post Pyloric Placement

RDNs know what's at stake with improper post pyloric feeding tube placement. They are familiar with the complications: 

• Pneumothorax

• Aspiration pneumonia

• Misplacement

• Inadequate or delay of nutrition delivery

They know the contraindications to attempting post pyloric feeding tube placement:

• Active GI bleeding

• Bowel obstruction

• Tumor mass or severe adhesive disease (anatomical obstruction)

• Paralytic ileus (functional obstruction)

• Necessity of bowel rest, e.g., in acute pancreatitis

They also know that when placement is unsuccessful, 

• nutrition fails and 

• healing is delayed. 

New Technology - Safety Begets Clinical Confidence and Decreases Complications

Clinical staff are called upon to provide and perform a varied array of services in their care of the ill. It is a truism that staff should not engage in something for which they do not feel confident. Post pyloric feeding tube placement, with its challenges, can cause staff to feel less confident. 

Not performing a procedure because a lack of confidence means something needed doesn't take place. Performing a procedure without confidence can result in complications. 

ENvizion Medical has developed the ENvue System, an electromagnetic feeding tube placement system specifically for safe insertion and accurate placement. When the safety of a procedure is appreciated, confidence rises and procedures get done more smoothly and with fewer complications.

An external electric field generator allows overlay of information from sensors in the tube and its tip, on a display in real-time, as applied to a body map of the specific patient. The unique ENvue System is the only verification method that predicts mistaken deviation of the tube even before it happens.

The ENvue System also eliminates the repeated radiation exposure from post-procedure X-ray verification and the delay in learning of complications.

The system assures safety that instills confidence in RDNs and other professional who insert post pyloric feeding tubes. This confidence translates directly to the speed with which post pyloric nutrition can be delivered and healing begun. That is a key benefit to the patient. 

Conclusion

RDNs are more than just nutrition experts. They are educators who can treat medical conditions. They are board-certified according to respective disciplines to both educate about nutrition and to engage in making it happen. This defines them as clinicians with hands-on skills to provide the most important aspect of care - nutrition, so healing can begin. 

Their role in healing includes their competence in hands-on procedures. The imperative to initiate needed nutrition for healing, such as with post pyloric feeding tube placement, is as soon as possible. These dovetail with the consummate safety of the ENvue System to establish a new standard of healing in intensive care settings. 

For RDNs, their day is well-deserved. And the advances offered by the ENvue System are a new and welcome part of their specialty-and their day.