A new practice alert from the American Association of Critical-Care Nurses offers a checklist for aspiration prevention in critically ill patients, especially those who are tube-fed.

These patients may experience small-volume, clinically silent aspirations called micro-aspirations, according to the AACN, greatly increasing the risk of pneumonia and other complications. The alert includes prevention tips such as head-of-bed elevation, assessment of sedation levels and feeding-tube placement.

About half of critically ill, mechanically ventilated, tube-fed patients experience frequent micro-aspirations, according to a study cited in the practice alert. The study also found these patients had a fourfold greater risk of developing pneumonia.

Because no bedside tests exist to detect micro-aspirations, according to AACN, efforts to prevent or minimize aspiration take on additional importance. Based on the latest available evidence, the expected practice to prevent aspiration includes:

• Maintaining head-of-bed elevation at an angle of 30 to 45 degrees unless contraindicated.

• Using sedatives as sparingly as feasible.

• Assessing patients every four hours for proper feeding-tube placement.

• Assessing gastric tube-fed patients every four hours for gastrointestinal intolerance.

• Avoiding bolus feeding in tube-fed patients at high risk for aspiration.

• Consulting with the physician about obtaining a swallowing assessment before oral feedings are started for recently extubated patients after prolonged intubation.

• Maintaining appropriate endotracheal cuff pressures and ensuring secretions are cleared from above the cuff before deflation.

The alert is the latest in a series of guidelines issued by AACN to standardize practice and update nurses and other healthcare providers on new healthcare advances and trends. All alerts are available to download for free at www.aacn.org/practicealerts.