Evidence-Based Guidelines versus Enteral Nutrition Practices in Intensive Care Units: A Descriptive Cross-Sectional Study.

BACKGROUND

Despite established guidelines, enteral nutrition (EN) practices among critical care nurses (CCNs) often vary, leading to suboptimal nutritional delivery. Evidence regarding EN practices in Saudi Arabian intensive care units (ICUs) is limited. This study aimed to assess CCNs' EN practices in Al-Madinah and evaluate their alignment with current evidence-based guidelines.

METHODS

A cross-sectional survey was conducted among CCNs working in adult ICUs of governmental hospitals in Al-Madinah Al-Munawarah, Saudi Arabia, using a census sampling approach. Data were collected using a 61-item self-administered questionnaire comprising three sections: ICU and nurse characteristics (11 items), EN practices (34 items), and assessment and management of EN intolerance and complications (16 items). An online survey was distributed via social media platforms between November 2023 and January 2024.

RESULTS

Of 500 eligible nurses, 178 completed the questionnaire (35.6% response rate) and were included in the final analysis. Most reported the availability of EN guidelines (62.4%), performing nutritional assessments (66.9%), initiating EN early within 48 hours or less (87.2%), and using gastric access (98.31%). However, significant inconsistencies were observed in tube placement verification, monitoring and management of gastric residual volume (GRV) and feeding intolerance. Outdated methods for confirming tube placement, such as auscultation, remained common (67.4%). GRV was frequently measured more often than recommended (78.7%), and EN was often withheld at GRV thresholds below recommended (72.5%). Management of diarrhea involved non-recommended practices, although adherence to recommended tube-flushing procedures was high.

CONCLUSION

The self-reported EN practices among CCNs showed partial adherence to guidelines, with notable gaps in tube placement verification, GRV and feeding intolerance monitoring and management. These findings underscore the need for standardized protocols, targeted training, and quality improvement initiatives to optimize EN delivery and prevent underfeeding in critically ill patients.