UK NAVA - Resources for nurses

Identifying patients who can take part in UK NAVA

Critical Care nurses working in outreach as well as within critical care units are vital to the identification of patients who are suitable for inclusion in the UK NAVA trial. It is also important that nurses feel empowered to ensure safe placement of all nasogastric tubes and have a low threshold for raising any concerns. This will ensure wrongly positioned nsaogastric tubes never occurs. Nurses are also at the bedside and vital in the weaning of patients from mechanical ventilation.

Managing patients in UK NAVA at the bedside - our two interventions are both nurse-led

Nurses will be using the NAVA catheter (specialised nasogastric tube) for feeding the patient and delivering enteral medications. Nurses play a critical role in ensuring safe placement of the tubes.
Importantly, bed-side nurses will record the patient's neural drive (peak Edi) hourly and will be the first to see any changes eg after a sedation bolus. The NAVA monitoring can continue after extubation, using the ventilator in 'standby'.
Bedside nurses as well as senior ICU nurses (Team-leaders/Nurse-in-Charge/Matrons) are vital in the delivery of safe, effective ventilatory support. This is particularly true of support of patients who are breathing spontaneously, whether this is in pressure support or NAVA mode.
Bedside nurses can also explain the potential value of the trial to patients and families. Our preliminary work certainly suggests that patients understand NAVA monitoring and NAVA mode, perhaps even better than pressure support.

NAVA technology -Two sides to one coin

Inserting the NAVA catheter - modified nasogastric tube

Catheter needs to be advanced

Catheter is positioned well

Monitoring the Edi - benefits of being able to see patient neural drive

Edi (Neural drive) Magnitude | Effect of Critical Care Interventions on Edi
Monitoring Asynchrony with Edi monitoring | Edi after extubation

The Edi signal from NAVA monitoring can be made to overlay over the standard pressure support breaths. It can monitor the level of neural drive the patient has ( level of 'dyspnoea') and tell you if the patient's respiratory drive is out-of-step with the support breaths- asyncrony) with the delivered pressure support breaths. Note: when you are using the NAVA catheter to monitor the patient like this, nothing new is being done to the patient - the patient is NOT yet in NAVA mode. There are multiple forms of asyncrony.

You will get information that you would not otherwise have known. For example, you could present this in shift handover.

In UK NAVA we want the clinical team of the patient randomised to NAVA technology to use NAVA mode in preference to standard pressure support. The presence of asyncrony may prompt this decision. If NAVA mode cannot be usede you must document WHY.