K: Keep pressure off of skin or
septum; knowledge
Prevention of pressure necrosis
or erosion at the nares is an essential
component of the securement strategy.
The nurse must be vigilant in assessing
skin condition at the feeding
tube’s exit site, to ensure there is no
indication of pressure that can lead to
skin breakdown. For tubes secured at
the nose, also ensure that the tube is
secured to the patient’s face, to prevent
undue pressure on the nasal septum.
K also represents knowledge. One
cannot overemphasize the value of
imbedding—creating a culture of safety
by repeatedly enforcing safe practice
in policy and procedures—as it
relates to enteral tubes. It is critically
important to 1) increase awareness of
the potential risks of dislodgement, 2)
prevent tube displacement, and 3) detect
it, should it occur. Working closely
with nursing and other clinical staff
to provide tips and suggestions for
preventing tube dislodgment can help
reduce staff and patient frustration,
and can also help optimize patient
benefits related to the ongoing delivery
of nutrition, fluid and medication
via these tubes.