McMahon et al developed a checklist for preparing a patient for the placement of a long-term enteral feeding tube. The authors are from the Mayo Clinic College of Medicine.
(1) Confirm need for enteral tube placement.
(2) Document swallowing difficulty and/or dysphagia.
(3) Confirm consent by patient or surrogate decision-maker.
(4) Confirm scheduling and availability of necessary resources.
(5) Review implications for oral medications (change in absorption, need for acid exposure, etc.).
Clinical evaluation - The patient should be:
(1) medically stable (not unstable)
(2) The INR should be < 1.7.
(3) The platelet count should be > 50,000 per µL.
(4) Oxygen saturation should be > 92%.
(5) The mean systolic pressure should be > 90 mm Hg.
The physician placing the tube should be notified if:
(1) The patient has difficulty opening the mouth wide.
(2) The patient is unable to be supine for the procedure.
(3) The patient cannot have the head moved safely (restricted head movement).
(4) The patient is immunosuppressed or has impaired host defenses.
(5) The patient has issues related to airway protection.
A respiratory technician should be available if the patient:
(1) may have impaired airway protection
(2) has underlying respiratory disease
(3) at the request of the person placing the tube
Orders prior to the placement:
(1) Discontinue clopidgrel for 5 days before and for 5 days after the procedure.
(2) Discontinue warfarin until the INR is < 1.7 unless contraindicated.
(3) Discontinue heparin prior to placement (at least 4 hours) unless contraindicated.
(4) Administer an appropriate antibiotic (cefazolin 1 gram IV, other) 1 hour prior to the procedure.
(5) Discontinue oral intake as indicated by the physician placing the tube.
• Aspirin does not need to be discontinued prior to placement (although it should not be taken shortly before the procedure.
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Purpose: To make sure a patient is prepared for the placement of an enteric feeding tube using the checklist of McMahon et al.
Specialty: Nutrition, Gastroenterology, Critical Care
Objective: administration, quality of life