Introduction During acute illness patients can inadvertently dislodge nasogastric (NG) tubes, which results in disruption to essential feeding and hydration. Hand control mittens are a recognised form of restraint to prevent patient removal of lines. Given the ethical issues associated with the use of mittens, careful assessment with clear documentation is essential prior to the use of mittens. The aim of this audit was to investigate whether the use of hand control mittens with NG tubes at a district general hospital improved nutrition, and whether their use reduced the number of NG tubes inserted, as well as reviewing documentation.
Method Retrospective review of the use of hand control mittens with NG tubes in our institute between September 2013 and December 2015. Patient notes were reviewed and demographics, indication for NG tube and mittens, number of NG tubes inserted, reason for removal of mittens and documentation prior to and during the use of mittens were recorded. Percentage of successful nutrition was analysed, with complete nutrition defined as days where patients met their daily nutritional requirements, and partial nutrition defined as days where patients received nutrition but not meeting their daily nutritional requirement.
Results 26 patients were identified (M:F 19:7, mean age 81, range 54–95). Indications for use of mittens with NG tubes were cerebrovascular accident: 12 (46%), intracerebral bleed: 3 (12%), aspiration pneumonia: 2 (8%), non-aspiration pneumonia/other infection: 5 (19%), and delirium/confusion other cause: 4 (15%). Mean number of NG tubes inserted per patient was 4.4 (NG only), and 3.7 (NG with mittens). Complete nutrition improved from 16% with NG tube only, to 52% with NG tube plus mittens. Complete and/or partial nutrition together was 60% with NG tube only, and 84% with NG tube and mittens. Reasons for removal of mittens were patient removal: 16 (62%), patient passed SALT: 1 (4%), decision made for palliation: 4 (15%), alternative feeding: 2 (8%), and reason not documented: 3 (12%). Discussion with patients and/or relatives was documented in 58% of cases; 50% had an assessment tool completed prior to use of mittens. 35% had a completed mittens care plan, and 31% had a missing mittens care plan.
Conclusion Our results show that the addition of hand control mittens to the use of nasogastric tubes can aid us in achieving optimal nutrition. The use of mittens also seems to reduce the number of NG tubes inserted per patient, thus minimising patient distress and complications associated with repeated tube insertions as well as being more cost effective. Despite the majority of patients being able to remove the mittens themselves we still recommend their use due to a lack of alternative options.
Disclosure of Interest None Declared
- Hand control mittens
- Nasogastric tube