Enteral nutrition (EN) pathway implantation had limited feasibility in children undergoing hematopoietic stem cell transplantation (HSCT) due to difficulties in implanting and maintaining the nasojejunal tube (NJT). These findings were published in the Clinical Journal of Oncology Nursing.

Children undergoing HSCT are at increased risk for malnutrition due to adverse effects of nausea, vomiting, pain, food aversions, altered taste perceptions, and fatigue. This evidence-based practice (EBP) quality improvement project was designed to evaluate the feasibility and safety of implanting an EN pathway to address malnutrition in pediatric HSCT. To that end, bed-side implantation of NJT was performed in 24 patients undergoing HSCT on or around the day of HSCT, and outcomes were compared with a pre-EBP cohort of 24 patients.

The pre- and postimplementation groups were mean age 8.48 (range, 0.5 to 17) and 6.71 (range, 0.5 to 21) years, 13 and 13 were male, 16 and 15 had oncologic indications for HSCT, and 21 and 21 underwent an allogenic transplantation, respectively.

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In the postimplementation cohort, the EN tube was successfully placed transpyloric (17) or in the stomach (4). During the placement process, 9 patients required more than 1 attempt.

During HSCT admission, all patients experienced a dislodgement event either from vomiting or the patient pulling out the tube. Replacement tubes were required for 7 patients.

Tube maintenance difficulties included vomiting (12), mucositis (4), patient resistance (2), and nosebleed (1). No pneumothorax or perforation events occurred.

In each cohort, 18 patients required parenteral nutrition. The groups did not differ for the number of patients who received EN feeding (P =.136) or the number of feeding days (P =.073).

This study was limited by its small sample size.

These data indicated that although there remains a clinical need for EN support among children undergoing HSCT, additional work is needed to investigate more effective NJT placement and maintenance strategies.


Oratz T, Bate C, Smith A, Bryson EW, Justice C, Cherven B. Nutritional support: enteral nutrition pathway for children undergoing hematopoietic stem cell transplantation. Clin J Oncol Nurs. 2022;26(6):651-658. doi:10.1188/22.CJON.651-658