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Intensivvårdssjuksköterskans mätning av gastrisk residualvolym hos patienter med enteral nutrition

Källman, Beatrice LU and Adamczewski, Malgorzata LU (2022) SINM22 20221
Department of Health Sciences
Abstract (Swedish)
Bakgrund: Kontroll av gastrisk residualvolym (GRV) via aspiration sker på
intensivvårdsavdelningar med syfte att säkerställa tillräcklig nutritionstillförsel och utvärdera risken för komplikationer relaterade till enteral nutrition (EN). Studier visar på oenighet huruvida stor GRV faktiskt ökar risken för negativa effekter, dessutom varierar rutiner för GRV-mätning gällande teknik, frekvens och mängd som aspireras och om aspiratet kasseras eller returneras till patienten. Internationella riktlinjer finns men saknas i Sverige där
stor variation gällande GRV-rutiner råder. Syfte: Syftet var att undersöka om
intensivvårdssjuksköterskans rutinmässiga kontroll av GRV hos patienter med EN var
motiverad och om detta kunde medföra negativa... (More)
Bakgrund: Kontroll av gastrisk residualvolym (GRV) via aspiration sker på
intensivvårdsavdelningar med syfte att säkerställa tillräcklig nutritionstillförsel och utvärdera risken för komplikationer relaterade till enteral nutrition (EN). Studier visar på oenighet huruvida stor GRV faktiskt ökar risken för negativa effekter, dessutom varierar rutiner för GRV-mätning gällande teknik, frekvens och mängd som aspireras och om aspiratet kasseras eller returneras till patienten. Internationella riktlinjer finns men saknas i Sverige där
stor variation gällande GRV-rutiner råder. Syfte: Syftet var att undersöka om
intensivvårdssjuksköterskans rutinmässiga kontroll av GRV hos patienter med EN var
motiverad och om detta kunde medföra negativa effekter. Metod: Litteraturöversikt med systematisk ansats baserad på resultatet av 14 vetenskapliga artiklar av kvantitativ design, analyserade med narrativ syntes. Resultat: Fem huvudteman identifierades vid syntes av artiklarnas resultat: Rutinmässig GRV-mätning ej motiverad; Rutinmässig GRV-mätning motiverad; Nutritionstillförsel; Gastrointestinal (GI) intolerans; samt Negativa effekter i kontext av GRV rutiner. Tolv av artiklarna fastslog att rutinmässig mätning av GRV inte var
motiverad. Vidare påvisades att utesluten GRV-mätning kunde bidra till förbättrad
nutritionstillförsel men ingen skillnad kunde ses avseende GI intolerans och andra negativa effekter. Slutsats: De sammanlagda resultaten styrker tidigare forskning och indikerar att fördelar med rutinmässig GRV-mätning är obefintliga. Fler RCT-studier behövs samt en enhetlig definition av begreppet GI intolerans. Uteslutning av GRV-mätning kan leda till förbättrad tillförsel av EN utan att påverka förekomst av GI intolerans eller övriga negativa effekter. EN och dess tillförsel har en central betydelse i förbättring av patientens hälsa och minskning av negativa effekter associerat med intensivvård. Intensivvårdssjuksköterskan bör därmed göra en individuell och personcentrerad bedömning kring behov av och relevans med GRV-mätning. (Less)
Abstract
Background: Checking gastric residual volumes (GRV) by aspiration is a method practiced on intensive care units with the purpose of lowering the risk of complications due to enteral nutrition (EN) as well as to ensure adequate delivery of EN. Studies have shown disagreement whether large GRVs increase the risk of negative effects, also the methods of measuring vary by technique, frequency and amount aspirated. Routines vary across intensive care units in Sweden and measuring GRV is not recommended by international guidelines. Aim: The aim of this study was to examine if the intensive care nurse’s routinely measuring of GRVs on patients with enteral nutrition (EN) was motivated and if it could be associated with negative effects. Methods:... (More)
Background: Checking gastric residual volumes (GRV) by aspiration is a method practiced on intensive care units with the purpose of lowering the risk of complications due to enteral nutrition (EN) as well as to ensure adequate delivery of EN. Studies have shown disagreement whether large GRVs increase the risk of negative effects, also the methods of measuring vary by technique, frequency and amount aspirated. Routines vary across intensive care units in Sweden and measuring GRV is not recommended by international guidelines. Aim: The aim of this study was to examine if the intensive care nurse’s routinely measuring of GRVs on patients with enteral nutrition (EN) was motivated and if it could be associated with negative effects. Methods: Literature review with systematic approach based on the results of 14 scientific articles of quantitative methods analyzed with narrative synthesis. Results: Five main themes were identified after synthesis of the results: routinely measuring GRV not motivated; routinely measuring GRV motivated; nutritional supply; gastrointestinal (GI) intolerance; and negative effects in the context of GRV routines. Twelve of the articles stated that routinely measuring GRVs was not motivated. Further stated was that eliminating GRV measures could contribute to increased nutritional supplies, but no difference was found between GI intolerance and other negative effects. Summary: The total results agree with previous studies and indicate that there are no benefits to routinely measure GRVs. More randomized controlled trials are needed, as well as a united definition of the term GI intolerance. Eliminating GRV measures could lead to increased feedings of EN without affecting the presence of GI intolerance or negative effects. EN and its supply is key in improving the patient’s health and lowering negative effects associated with intensive care. The intensive care nurse therefore must make an individual evaluation carrying a person-centered approach in the necessity of and relevance in measuring GRVs. (Less)
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author
Källman, Beatrice LU and Adamczewski, Malgorzata LU
supervisor
organization
course
SINM22 20221
year
type
H1 - Master's Degree (One Year)
subject
keywords
Gastrisk residualvolym, Enteral nutrition, Intensivvård, Mekanisk ventilation, Nutritionssond.
language
Swedish
id
9086367
date added to LUP
2022-06-16 10:28:14
date last changed
2022-12-31 03:41:04
@misc{9086367,
  abstract     = {{Background: Checking gastric residual volumes (GRV) by aspiration is a method practiced on intensive care units with the purpose of lowering the risk of complications due to enteral nutrition (EN) as well as to ensure adequate delivery of EN. Studies have shown disagreement whether large GRVs increase the risk of negative effects, also the methods of measuring vary by technique, frequency and amount aspirated. Routines vary across intensive care units in Sweden and measuring GRV is not recommended by international guidelines. Aim: The aim of this study was to examine if the intensive care nurse’s routinely measuring of GRVs on patients with enteral nutrition (EN) was motivated and if it could be associated with negative effects. Methods: Literature review with systematic approach based on the results of 14 scientific articles of quantitative methods analyzed with narrative synthesis. Results: Five main themes were identified after synthesis of the results: routinely measuring GRV not motivated; routinely measuring GRV motivated; nutritional supply; gastrointestinal (GI) intolerance; and negative effects in the context of GRV routines. Twelve of the articles stated that routinely measuring GRVs was not motivated. Further stated was that eliminating GRV measures could contribute to increased nutritional supplies, but no difference was found between GI intolerance and other negative effects. Summary: The total results agree with previous studies and indicate that there are no benefits to routinely measure GRVs. More randomized controlled trials are needed, as well as a united definition of the term GI intolerance. Eliminating GRV measures could lead to increased feedings of EN without affecting the presence of GI intolerance or negative effects. EN and its supply is key in improving the patient’s health and lowering negative effects associated with intensive care. The intensive care nurse therefore must make an individual evaluation carrying a person-centered approach in the necessity of and relevance in measuring GRVs.}},
  author       = {{Källman, Beatrice and Adamczewski, Malgorzata}},
  language     = {{swe}},
  note         = {{Student Paper}},
  title        = {{Intensivvårdssjuksköterskans mätning av gastrisk residualvolym hos patienter med enteral nutrition}},
  year         = {{2022}},
}