title: [Reducing the Feeding-Tube Obstruction Rate in Esophageal Cancer Patients With Jejunostomy].
abstract: OBJECTIVE
  Patients with esophageal cancer experience chronic dysphagia. This condition typically necessitates the use of a jejunal feeding tube to provide the patient with adequate nutrition. Obstruction of the jejunal feeding tube is common in clinical practice and results in malnutrition in most patients and mortality in the most serious cases. An analysis of the status of jejunostomy-tube use in our unit found that these tubes were obstructed in 27.6% of the cases. The causes of this obstruction were: tube bending due to tight suturing, small inner-tube diameter, the absence of adequate jejunal-feeding standards, and failure to implement relevant training strategies. These findings motivated us to attempt to reduce the incidence of jejunostomy-tube obstruction at our center.
  
  
  OBJECTIVE
  This project was designed to reduce the incidence of jejunostomy-tube obstruction in esophageal cancer patients from 27.6% to ≤ 3%.
  
  
  METHODS
  Clear strategies, including modification of the stitching method used at the implantation end of the central venous catheter-type jejunostomy tube, establishment of feeding standards, creation of educational guidelines and leaflets, classroom teaching, and technical examinations, were used to reduce the prevalence of obstruction incidents.
  
  
  RESULTS
  The jejunostomy-tube obstruction rate was reduced from 27.6% to 6.7%. While the study objective was not achieved, the magnitude of the reduction was still significant at 75.7%.
  
  
  CONCLUSIONS
  
  
  
  CONCLUSIONS
  Cross-disciplinary collaboration, continuous education and training, and the promotion of standards of practice were used to significantly reduce the jejunostomy tube obstruction rate in esophageal cancer patients. This result substantially increased the nutrition and quality of care received by this patient population.
authors.affiliation: Department of Nursing, National Taiwan University Hospital, Taiwan, ROC.
authors.forename: Ying-Chun
authors.initials: YC
authors.lastname: Chin
authors.affiliation: Department of Nursing, National Taiwan University Hospital, Taiwan, ROC.
authors.forename: Pei-Yin
authors.initials: PY
authors.lastname: Hsieh
authors.affiliation: Department of Nursing, National Taiwan University Hospital, Taiwan, ROC. cth1964@ntuh.gov.tw.
authors.forename: Tsyr-Huei
authors.initials: TH
authors.lastname: Chang
mesh_terms: D004938:Esophageal Neoplasms / Q000628:therapy*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects*; D007582:Jejunostomy / Q000009:adverse effects*
keywords: esophageal cancer; jejunostomy tube; obstruction rate