Examining biofilm development within fine-bore nasogastric tubes used by adults and exploring the nursing perspective of tube management

Abstract

The consequences of malnutrition are wide ranging, making it an important patient safety issue. Enteral tube feeding can support adults unable to meet their nutritional requirements through oral intake, with fine bore nasogastric tubes preferred for patient comfort. Over a third of nasogastric tubes in use block, resulting in compromised nutrient provision and poor patient experience. Biofilm can interrupt fluid flow through indwelling devices. Evidence of biofilm on the inner surface of nasogastric tubes and its potential to contribute to blockage development had not been investigated. The purpose of this thesis was to determine the presence and distribution of biofilm on the inner surface of fine bore nasogastric tubes used by adults. In addition, to explore the nursing perspective of nasogastric tube management and the maintenance of patency.

A series of laboratory studies enabled the control of known variables, allowing detailed investigation of characteristics of biofilm development. A convenience sample of patient-used tubes were used to investigate the potential for patient variables to influence biofilm development. Statistical analysis was undertaken. A purposive sample of acute care nurses participated in a qualitative semi-structured interview study exploring the nursing perspective of nasogastric tube management through nurses’ beliefs and reported practices. Thematic analysis was conducted.

The findings demonstrate the rapid development of biofilm, which can influence the pH of its environment. No advantage was demonstrated to flushing tubes with sterile water compared with tap water. No correlation between patient variables and bacterial colonisation was indicated. The semi-structured interviews illustrate current practice on busy modern hospital wards with competing priorities. Results were examined using thematic analysis, finding three main themes; looking after the patient, using the nasogastric tube, and stopping the NG tube blocking.

This research has achieved its aim of investigating the presence and distribution of biofilm within nasogastric tubes used by adults, and of exploring the nursing perspective of NG tube management and the maintenance of patency. A greater understanding of the optimal care for nasogastric tubes and the rationale behind that care could potentially lead to a reduction in biofilm development. Historical literature identified little significant change to UK practice regarding nasogastric tube management in the past 20 years. Further research is required investigating the potential role of biofilm in the development of fine bore nasogastric tube blockage.

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Identifiers

ORCID for Susan Green: orcid.org/0000-0003-1760-3679

ORCID for Sandra Wilks: orcid.org/0000-0002-4134-9415

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