Ferda HARMANDAR, İsmail GÖMCELİ, Ayhan ÇEKİN, Orbay HARMANDAR, Feyzi BOSTAN

Nazointestinal tüp yerleştirilmesi ve sonuçları

Giriş ve Amaç: Enteral nütrisyon uygulamalarında gastrointestinal sistemi fonksiyonel olan olgularda, kusma, yüksek gastrik rezidüel volüm gibi nedenlerle aspirasyon riski artmıştır. Aynı zamanda gastrointestinal kanaldan fistülü olan veya pankreatit tanısı olan hastalarda nazointestinal tüp kullanımı klinik sonuçları açısından parenteral beslenmeye göre daha avantajlıdır. Nazointestinal tüple beslenme yöntemine, klinik sonuçları açısından avantajlı olmasına rağmen, yüksek maliyeti ve yerleştirme zorluğu nedeniyle dikkatli karar vermek gerekir. Gereç ve Yöntem: Bu çalışmada 01.01.2018-01.01.2019 tarihleri arasında nütrisyon polikliniği ve kliniklerde takip edilen hastalar retrospektif olarak değerlendirilmiş ve tüpün beslenme tedavisinde kullanımındaki sorunlar değerlendirilerek etkinlik açısından analiz edilmiştir. Bulgular: Çalışmada 1 yıl içinde nazointestinal tüp yerleştirilen 85 hasta retrospektif olarak tarandı. Bu hastaların %41.1’i (n=37) nörolojik hastalıklar tanılı, %43.53’ü (n=37) dahili hastalıklar tanılı, %15.3’ü (n=13) cerrahi hastalıklar tanılıydı. Hastaların %8.23’üne (n=7) fistül varlığı nedeniyle, %31.8’ine (n=27) kusma ve yüksek rezidüel volüm nedeniyle, %7.05’ine (n=6) pankreatit nedeniyle, %52.9’una (n=45) yüksek aspirasyon riski nedeniyle nazointestinal tüp yerleştirildi. Nazointestinal tüp; hastaların %69.41’inde (n=59) 1. gün, %11.76’sında (n=10) 2. gün, %9.41’inde (n=8) 3. gün jejunal bölgeye yerleştirildi. Hastaların %90.58’inde nazointestinal tüp istenilen bölgeye yerleştirilirken, %9.41’inde (n=8) istenilen bölgeye yerleştirilemedi. Hastaların %15.29’u (n=13) tüpü çektiği için, %15.29’u (n=13) tüp tıkandığı için yöntem tedavi planında etkin kullanılamadı. Hastaların %60’ında ise planlanan süre boyunca yöntem etkin kullanıldı. Sonuç: Nazointestinal tüple beslenme yöntemi, enteral beslenmenin sürekliliği açısından avantajlı bir yöntem olmasına rağmen yerleştirme işleminde başarı oranları tartışmalıdır. Ancak yerleştirme yöntemiyle ilgili deneyimin artması yöntemin başarısını yükseltmektedir. Nazointestinal tüp yerleştirme endikasyonunun doğru konulduğu durumlarda da istenilen etkin enteral beslenme sağlanmış olmaktadır.

Anahtar Kelimeler:

Nazointestinal tüp, enteral beslenme, nazojejunal tüp

Nasointestinal tube placement and its consequences

Background and Aims: The risk of aspiration in enteral nutrition applications increases in patients with a functional gastrointestinal system due to reasons such as vomiting and high gastric residual volume. However, the use of nasointestinal tube is generally more advantageous than parenteral nutrition for better clinical outcomes in patients with fistula from the gastrointestinal tract or in those with pancreatitis. Despite the merits of nasointestinal tube feeding with respect to the clinical outcomes, it is necessary to make a careful decision owing to its high cost and difficulty in placement. Materials and Methods: Here, we retrospectively evaluated the patients who underwent follow-up examination at the nutrition outpatient clinic and other clinics between 01/01/2018 and 01/01/2019, we also evaluated and analyzed the overall effectiveness and problems associated with the use of the nasointestinal tube (NIT) for enteral nutrition. Results: In the study, 85 patients who underwent NIT insertion in the past 1 year were retrospectively examined. Among these, 41.1% (n = 37) patients were diagnosed with neurological diseases, 43.53% (n = 37) with internal diseases, and 15.3% (n = 13) with surgical diseases. NIT was placed in 8.23% (n = 7) of the patients due to the presence of fistula, in 31.8% (n = 27) for vomiting and high residual volume, in 7.05% (n = 6) for pancreatitis, and in 52.9% (n = 45) for high aspiration risk. The NIT was placed in the jejunal region on the 1st day in 69.41% (n = 59) of patients, on the 2nd day in 11.76% (n = 10), and on the 3rd day in 9.41% (n = 8). Although the NIT was placed in the desired region in 90.58% of the patients, it was not placed in the desired region in 9.41% (n = 8) of the patients. This method could not be used effectively in the treatment plan, because 15.29% (n = 13) of the patients pulled the tube and the tube in 15.29% (n = 13) patients was clogged. In 60% of the patients, the method was used effectively during the planned period. Conclusion: Although the nasointestinal tube feeding method is an advantageous method to continue enteral nutrition, the success rates with respect to the placement are controversial. However, the knowledge and understanding of the placement method increases with the success of this method. The desired effective enteral nutrition can be ensured in cases where the indication for nasointestinal tube placement is accurate.

Keywords:

Nasointestinal tube, enteral nutrition, nasojejunal tube,

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