Barriers to the delivery of enteral nutrition in intensive care unit patients – a descriptive cross-sectional study

Method: We conducted a cross-sectional study with a descriptive design.A slightly adapted, professionally translated version of an internationally validated questionnaire mapping the prevalence of 21 barriers to enteral nutrition was sent to all ICUs in Norway with adult patients as their main treatment group.A total of 129 of 1,213 RNs from 24 different units answered the questionnaire. Results:The most commonly reported barriers were ' Enteral nutrition halted before procedures or operations' , ' In critically ill patients, other aspects of patient care still take priority over nutrition' , and ' Delays and difficulties in obtaining small bowel access in patients not tolerating enteral nutrition (e.g.ventricle retention)' .RNs with more than ten years' clinical experience evaluated the first two items as less challenging than colleagues with less experience.Four of the ten greatest barriers were reported to occur more commonly at university hospitals than local/regional hospitals.No differences were found for the other six barriers. Conclusion:The study shows a significant number of barriers to enteral nutrition in the ICUs in the study.Over half of the respondents specifically mentioned fasting prior to procedures as a significant problem.The prevalence of barriers seemed to vary somewhat between hospital departments and among personnel with different levels of experience.The respondents frequently reported the lack of availability of a dietician, but the statements in the questionnaire should be revised before further use.We recommend that future research and quality improvement efforts target the most common barriers in order to achieve the greatest clinical benefit. Explanation of termsEnteral nutrition: Nutritional liquid administered directly into the gastrointestinal tract.Parenteral nutrition: Nutrition directly administered into the bloodstream.Haemodynamic instability: Insufficient blood flow to the body' s organs.Catecholamines: Group of chemical compounds that are common in the sympathetic nervous system.They are involved in activating receptors in the cardiovascular system.Some key catecholamines are adrenaline, noradrenaline and dopamine.Jejunum: Middle part of the small bowel between the duodenum and the ileum.There is no clear demarcation between the jejunum and the ileum.Jejunum access: Use of a nasal jejunostomy tube, jejunostomy or percutaneous endoscopic gastrostomy catheter.Access is by means of a catheter or tube for direct delivery of nutrition and/or medications to the jejunum.Ventricle retention: A condition where large amounts of liquid and food are retained in the stomach due to delayed emptying to the small intestine.