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Perry A, Kaiser J, Kruger K, Horigan AE, Bradford JY, Camarda A, DeGroot D, Dixon C, MacPherson-Dias R, Slifko A, Slivinski A, Bishop-Royse J, Delao AM. ENA Clinical Practice Guideline Synopsis: Gastric Tube Placement Verification. J Emerg Nurs 2024; 50:301-304. [PMID: 38453344 DOI: 10.1016/j.jen.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 03/09/2024]
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2
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Chen J, Huang C, Fang X, Liu L, Dai Y. A Randomized Clinical Trial to Compare Three Different Methods for Estimating Orogastric Tube Insertion Length in Newborns: A Single-Center Experience in China. Neonatal Netw 2023; 42:276-283. [PMID: 37657808 DOI: 10.1891/nn-2023-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2023] [Indexed: 09/03/2023]
Abstract
Background: Orogastric (OG) and nasogastric (NG) tubes are frequently used in the NICU. Obtaining a relatively accurate estimated length before insertion could significantly reduce complications. While previous studies have mainly focused on the NG tube, OG tubes are more commonly used in China. Purpose: The objective was to determine whether there were differences in the rate of accurate placement among the adapted nose-ear-xiphoid (NEX) method, nose-ear-midway to the umbilicus (NEMU) method, and weight-based (WB) equation in estimating the OG tube insertion distance. Methods: A randomized, controlled, open-label clinical trial to compare the three methods was conducted in a single center. After enrollment, newborns were randomly assigned into three groups. By radiological assessment, the anatomical region for OG tube placement was analyzed. The primary metric was the tip within the gastric body, and the second metric was strictly accurate placement defined as the tube was not looped back within the stomach and the end was located more than 2 cm but less than 5 cm into the stomach, referred to as T10. Results: This study recruited 156 newborns with the majority being preterm infants (n = 96; 61.5 percent), with an average birth weight of 2,200.8 ± 757.8 g. For the WB equation, 96.2 percent (50 cases) of the OG tubes were placed within the stomach, and the rates were 78.8 percent (41 cases) in the adapted NEX and NEMU methods. The strictly accurate placement rates were highest for the WB equation at 80.8 percent (42/52), followed by the adapted NEX method at 65.4 percent (34/52), and the NEMU method at 57.7 percent (30/52). Conclusion: The WB equation for estimating the insertion depth of the OG tube in newborn infants resulted in more precise placement compared to the adapted NEX and NEMU methods.
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Chau JPC, Liu X, Choi KC, Lo SHS, Lam SKY, Chan KM, Zhao J, Thompson DR. Diagnostic accuracy of end-tidal carbon dioxide detection in determining correct placement of nasogastric tube: An updated systematic review with meta-analysis. Int J Nurs Stud 2021; 123:104071. [PMID: 34520886 DOI: 10.1016/j.ijnurstu.2021.104071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/14/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Misplacement of the nasogastric tube in the respiratory tract could cause serious complications and even death. Thus, nasogastric tube verification is necessary for optimal patient safety and comfort. Although end-tidal carbon dioxide detection is considered an effective approach to determine nasogastric tube location, there is a paucity of up-to-date evidence. OBJECTIVES To review the diagnostic accuracy of end-tidal carbon dioxide detection in determining inadvertent airway intubation and verifying correct placement of nasogastric tubes. DESIGN A systematic review and meta-analysis. METHODS We searched clinical trials that evaluated the diagnostic accuracy of colorimetric capnometry or capnography in detecting nasogastric tubes located in the airway and differentiating between inadvertent airway intubation and correct nasogastric tube placement in any adult care setting. Four English language databases - Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and CINAHL - and four Chinese language databases - China Biomedical Literature Database, WanFang Data, China National Knowledge Infrastructure, and Airiti Library - were searched from July 2009 to March 2021. Clinical trial registration databases and reference lists of included studies and relevant reviews were also searched. Two reviewers extracted the data of all included studies using a data extraction form. Two reviewers assessed the methodological quality independently with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. We conducted meta-analysis using the hierarchical bivariate model and estimated the pool sensitivity and specificity of capnography and colorimetric capnometry. Forest plots were generated to display the results. Heterogeneity was investigated by meta-regression. The certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluations framework. RESULTS Of 1,155 records identified, seven new studies were added to this update and a total of 16 studies were analysed in the systematic review. The total absolute number of true positive, false negative, true negative, and false positive observations were 142, 6, 1,500, and 65 respectively. Low to very low certainty of evidence indicated that the use of colorimetric capnometry or capnography is potentially an effective method in differentiating between respiratory and nasogastric tube placement for critically ill adult patients. Pooled results (13 studies, 1,541 intubations) for sensitivity and specificity were 0.96 (95% confidence interval [0.88, 0.99]) and 0.99 (95% confidence interval [0.96, 1.00]), respectively. CONCLUSIONS Colorimetric capnometry and capnography may have the potential to be of high sensitivity and specificity for the detection of inadvertent airway nasogastric tube placements in critically ill adults. More evidence is required to generalize the updated findings to different types of patients and settings.
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Affiliation(s)
- Janita Pak Chun Chau
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong S.A.R., China.
| | - Xu Liu
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong S.A.R., China.
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong S.A.R., China.
| | - Suzanne Hoi Shan Lo
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong S.A.R., China.
| | - Simon Kwun Yu Lam
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong S.A.R., China.
| | - Kam Ming Chan
- Department of Paediatrics and Adolescent Medicine, United Christian Hospital, Kowloon, Hong Kong S.A.R., China.
| | - Jie Zhao
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong S.A.R., China.
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, United Kingdom.
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Furthner E, Kowalewski MP, Torgerson P, Reichler IM. Verifying the placement and length of feeding tubes in canine and feline neonates. BMC Vet Res 2021; 17:208. [PMID: 34098946 PMCID: PMC8185947 DOI: 10.1186/s12917-021-02909-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/30/2021] [Indexed: 11/20/2022] Open
Abstract
Background Tube feeding is a common procedure in neonatology. In humans, tube misplacement reportedly occurs in up to 59% of all cases and may lead to perforation in 1.1% of preterm intubated neonates. While numerous studies on optimal tube placement have been performed in human neonates, current recommendations on tube feeding in canine and feline neonatology are based, at best, on studies performed in adult animals. Herein, we aimed to test ultrasonography as a tool to verify tube placement in puppies and kittens and to compare different anatomical predictive markers used in human, canine and feline neonates. Results The predictive tube length when held bent between the last rib and the mouth may induce trauma compared to when held straight. A strong positive linear correlation was observed between birthweight and gastric cardia localization. Ultrasonography findings were similar to coeliotomy findings. Stomach volume was less than 2 mL per 100 g in the less-than-one-day-old studied puppies (n = 25) and kittens (n = 28). Conclusions A weight-based equation was calculated to help predict appropriate tube placement. Ultrasonography can be used to control gastric tube placement, and neonates less than one-day-old have a smaller stomach capacity. Further studies are required to evaluate whether more-than-one-day-old puppies follow the same linear correlation with their weight. Further in vivo studies are warranted to determine the gold standard procedure for tube feeding in neonatal puppies and kittens.
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Affiliation(s)
- Etienne Furthner
- Clinic of Reproductive Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057, Zurich, Switzerland.
| | - Mariusz Paweł Kowalewski
- Institute of Veterinary Anatomy, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057, Zurich, Switzerland
| | - Paul Torgerson
- Institute of Veterinary Epidemiology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057, Zurich, Switzerland
| | - Iris Margaret Reichler
- Clinic of Reproductive Medicine, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057, Zurich, Switzerland
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Jha P, Rupp L, Bonilla L, Gelfond J, Shah JN, Meyer AD. Electromagnetic Versus Blind Guidance of a Postpyloric Feeding Tube in Critically Ill Children. Pediatrics 2020; 146:peds.2019-3773. [PMID: 32994178 DOI: 10.1542/peds.2019-3773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Postpyloric feeding tube placement is a time-consuming procedure associated with multiple attempts and radiation exposure. Our objective with this study is to compare the time, attempts, and radiation exposure using the electromagnetic versus blind method to place a postpyloric feeding tube in critically ill children. Our hypothesis is that using electromagnetic guidance decreases the procedure time, number of x-rays, and number of attempts, compared to the blind method. METHODS Eleven pediatric nurses participated in a randomized controlled intention-to-treat study at an academic pediatric medical, surgical, and congenital cardiac ICU. University of Texas Health Epidemiology and Biostatistics generated a randomization sequence with sealed envelopes. A standard (2-sided) F-test of association between the electromagnetic and blind method yielded 40 subjects with 86% power. Data were analyzed with Fisher's exact test for categorical variables and the Wilcoxon rank test for continuous variables, with data documented as median (interquartile range [IQR]). RESULTS We randomly assigned 52 patients to either the electromagnetic (n = 28) or blind method (n = 24). The number of attempts and radiographs was at a median of 2 (IQR: 1-2.25) using the blind method, compared to the electromagnetic method at a median of 1 (IQR: 1.0-1.0; P = .001). Successful guidance was 96.4% with the electromagnetic method, compared to only 66.7% with the blind technique (P = .008). The total time required was 2.5 minutes (IQR: 2.0-7.25) with the electromagnetic method, compared to 19 minutes (IQR: 9.25-27.0) for the blind method (P = .001). CONCLUSIONS Electromagnetic guidance is a superior, faster, and overall safer method to place a postpyloric feeding tube in critically ill children.
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Affiliation(s)
- Prashant Jha
- Division of Critical Care, Department of Pediatrics, Children's Hospital of Nevada at University Medical Center, Las Vegas, Nevada; .,Department of Pediatrics, University of Nevada Las Vegas School of Medicine, Las Vegas, Nevada
| | - Lisa Rupp
- Pediatric Services, University Health System, San Antonio, Texas; and
| | - Lorraine Bonilla
- Pediatric Services, University Health System, San Antonio, Texas; and
| | - Jonathan Gelfond
- Department of Epidemiology and Biostatistics, University of Texas Health San Antonio, San Antonio, Texas
| | - Jay N Shah
- Pediatric Services, University Health System, San Antonio, Texas; and.,Divisions of Pediatric Gastroenterology and
| | - Andrew D Meyer
- Pediatric Services, University Health System, San Antonio, Texas; and.,Pediatric Critical Care, Department of Pediatrics and
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Methods of Gastric Tube Placement Verification in Neonates, Infants, and Children: A Systematic Review and Meta-Analysis. Am J Gastroenterol 2020; 115:653-661. [PMID: 31464742 DOI: 10.14309/ajg.0000000000000358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The objective was to evaluate diagnostic performance of multiple methods used to assess gastric tube placement verification in neonates, infants, and children. METHODS A systematic review using the methods outlined in the Cochrane Handbook for Reviews of Diagnostic Test Accuracy was conducted. Eight databases were searched. Studies on neonates, infants, and children in which researchers compared different methods for gastric tube placement verification with x-ray reference standard were eligible in the review. RESULTS Eight studies involving 911 participants that evaluated 9 index tests for gastric tube placement verification were included. Most studies were of moderate methodological quality, and most index tests were assessed in small individual studies. pH testing with cutoff values ≤ 6 for gastric tube position confirmation was the only index test subjected to meta-analysis, with the summary sensitivity and specificity being 0.77 (95% confidence interval [CI] 0.56-0.90) and 0.42 (95% CI 0.16-0.73). Other tests for gastric tube placement verification showed great variations in sensitivities and specificities. DISCUSSION pH ≤ 6 is not sufficiently accurate to be recommended for gastric tube placement verification in neonates, infants, and children. Diagnostic performance of pH ≤ 4 or 5 and other methods cannot be determined because of the paucity of data and methodological variations in studies. Clinical practice related to the diagnostic tests used will continue to be dictated by local preferences and cost factors, until stronger evidence becomes available.
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Gimenes FRE, Pereira MCA, Prado PRD, Carvalho REFLD, Koepp J, Freitas LMD, Teixeira TCA, Miasso AI. Nasogastric/Nasoenteric tube-related incidents in hospitalised patients: a study protocol of a multicentre prospective cohort study. BMJ Open 2019; 9:e027967. [PMID: 31345968 PMCID: PMC6661907 DOI: 10.1136/bmjopen-2018-027967] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 06/26/2019] [Accepted: 07/01/2019] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Hospitalised patients with nasogastric/nasoenteric tube (NGT/NET) are at constant risk of incidents; therefore, healthcare professionals need to routinely monitor risks and adopt strategies for patient safety and quality of care. AIM This study aimed to evaluate the NGT/NET-related incidents in hospitalised patients and associated factors. METHODS This is a multicentre study, with a prospective cohort design. Data will be collected at the general medical ward of seven Brazilian hospitals in the north, northeast, southeast and south. The sample will consist of 391 patients that require an NGT/NET during hospitalisation. Three different methods will be used to identify the incidents: (1) healthcare professionals and patients/caregivers will be required to report any NGT/NET-related incidents; (2) researchers will visit the wards to get information about the incidents with healthcare professionals and patients/caregivers; (3) the researchers will review the medical records looking for information on the occurrence of any NGT/NET-related incidents. Demographic, clinical and therapeutic details will be obtained from the medical records and will be registered in an electronic data collection tool developed for the purposes of this study. The complexity of patients will be assessed by the Patient Classification System, and the severity of comorbid diseases will be assessed through the Charlson Comorbidity Index. IMPLICATION FOR PRACTICE The results may encourage the use of evidence effectively to influence the scientific foundation for clinical practice and the development of evidence-based policies that will prevent, manage and eliminate complications caused by NGT/NET-related incidents, and improve the quality and safety of care provided to hospitalised patients. ETHICS AND DISSEMINATION The study has been approved by the Research Ethics Committee. Detailed information about the study can be provided by the principal investigator. The findings will be reported through academic journals, seminar and conference presentations, social media, print media, the internet and community/stakeholder engagement activities.
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Affiliation(s)
- Fernanda Raphael Escobar Gimenes
- General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirao Preto, Sao Paulo, Brazil
| | - Marta Cristiane Alves Pereira
- General and Specialized Nursing, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirao Preto, Sao Paulo, Brazil
| | | | | | - Janine Koepp
- Nursing Department, University of Santa Cruz do Sul, Santa Cruz do Sul, Rio Grande do Sul, Brazil
| | - Ligia Menezes de Freitas
- Nursing Department, Faculty of Science and Technology of Campos Gerais, Campos Gerais, Minas Gerais, Brazil
| | | | - Adriana Inocenti Miasso
- Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, Brazil
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Abstract
BACKGROUND The use of gastric tubes in newborns admitted to a neonatal intensive care unit is fairly high, and there is a risk of serious complications related to this procedure. PURPOSE Considering the need to find a method that does not involve the patient's exposure to radiation, this study aimed to evaluate the diagnostic accuracy of ultrasonography for verifying gastric tube placement in newborns. METHODS This was a prospective, double-blind, observational study performed in a neonatal intensive care unit, in which 159 infants had gastric intubation using ultrasound examination and radiological imaging, to verify positioning. Results were analyzed in terms of diagnostic accuracy. RESULTS The tubes were correctly positioned in 157 cases (98.7%), according to radiological images, and in 156 cases (98.1%), according to ultrasound. The sensitivity analysis was 0.98 and the positive predictive value was 0.99. It was not possible to perform a specificity analysis, as there were not enough negative cases in the sample. IMPLICATIONS FOR PRACTICE The use of ultrasonography to identify correct positioning of gastric tubes in infants and newborns shows good sensitivity. IMPLICATIONS FOR RESEARCH It was not possible to evaluate the ultrasonography specificity; further studies with greater samples are probably necessary, so that this objective can be achieved.Video Abstract available at https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?videoId=29&autoPlay=true.
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9
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Long C, Yu Y, Cui B, Jagessar SAR, Zhang J, Ji G, Huang G, Zhang F. A novel quick transendoscopic enteral tubing in mid-gut: technique and training with video. BMC Gastroenterol 2018. [PMID: 29534703 PMCID: PMC5850973 DOI: 10.1186/s12876-018-0766-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background This study aimed to evaluate the feasibility, safety, and value of a quick technique for transendoscopic enteral tubing (TET) through mid-gut. Methods A prospective interventional study was performed in a single center. A TET tube was inserted into mid-gut through the nasal orifice and fixed on the pylorus wall by one tiny titanium endoscopic clip under anesthesia. The feasibility, safety, success rate, and satisfaction with TET placement were evaluated for enteral nutrition or fecal microbiota transplantation. Results A total of 86 patients underwent mid-gut TET. The success rate of the TET procedure was 98.8% (85/86). Mean tubing time of the TET procedure was 4.2 ± 1.9 min. 10 cases of procedure was enough for training of general endoscopist to shorten the procedure time (7.0 min vs 4.0 min, p < 0.05). 97.7% (84/86) of patients were satisfied with the TET placement. Procedure-related and tube-related adverse events were observed in 8.1% (7/86) and 7.0% (6/86) of patients respectively. There were no moderate to severe adverse events during tube extubation. Conclusions TET through mid-gut is a novel, convenient, reliable and safe procedure for mid-gut administration with a high degree of patient satisfaction. Trial registration This research was retrospectively registered with clinicaltrials.gov. Trial registration date: 29th November 2017. Trial registration number: NCT03335982. Electronic supplementary material The online version of this article (10.1186/s12876-018-0766-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chuyan Long
- Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, 121 Jiang Jia Yuan, Nanjing, 210011, China.,Key Lab of Holistic Integrative Enterology, Nanjing Medical University, 121 Jiang Jia Yuan, Nanjing, 210011, China
| | - Yan Yu
- Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, 121 Jiang Jia Yuan, Nanjing, 210011, China.,Changshu No.2 People's Hospital, 68 Hai Yu Nan road, Jiangsu, 215500, China
| | - Bota Cui
- Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, 121 Jiang Jia Yuan, Nanjing, 210011, China.,Key Lab of Holistic Integrative Enterology, Nanjing Medical University, 121 Jiang Jia Yuan, Nanjing, 210011, China
| | - Sabreen Abdul Rahman Jagessar
- Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, 121 Jiang Jia Yuan, Nanjing, 210011, China.,Key Lab of Holistic Integrative Enterology, Nanjing Medical University, 121 Jiang Jia Yuan, Nanjing, 210011, China
| | - Jie Zhang
- Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, 121 Jiang Jia Yuan, Nanjing, 210011, China
| | - Guozhong Ji
- Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, 121 Jiang Jia Yuan, Nanjing, 210011, China.,Key Lab of Holistic Integrative Enterology, Nanjing Medical University, 121 Jiang Jia Yuan, Nanjing, 210011, China
| | - Guangming Huang
- Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, 121 Jiang Jia Yuan, Nanjing, 210011, China.,Key Lab of Holistic Integrative Enterology, Nanjing Medical University, 121 Jiang Jia Yuan, Nanjing, 210011, China
| | - Faming Zhang
- Medical Center for Digestive Diseases, the Second Affiliated Hospital of Nanjing Medical University, 121 Jiang Jia Yuan, Nanjing, 210011, China. .,Key Lab of Holistic Integrative Enterology, Nanjing Medical University, 121 Jiang Jia Yuan, Nanjing, 210011, China. .,National Clinical Research Center for Digestive Diseases, Xi'an, China.
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Abidali A, Mangram A, Shirah GR, Wilson W, Abidali A, Moeser P, Dzandu JK. Bilateral Pneumothoraces in a Trauma Patient After Dobhoff Tube Insertion. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:244-248. [PMID: 29503437 PMCID: PMC5850843 DOI: 10.12659/ajcr.906846] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Patient: Male, 74 Final Diagnosis: Pneumothorax Symptoms: Hypoxemia • shortness of breath Medication: — Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
- Ali Abidali
- Department of General Surgery, HonorHealth John C. Lincoln Medical Center, Phoenix, AZ, USA
| | - Alicia Mangram
- Department of General Surgery, HonorHealth John C. Lincoln Medical Center, Phoenix, AZ, USA.,Department of Trauma Surgery, HonorHealth John C. Lincoln Medical Center, Phoenix, AZ, USA
| | - Gina R Shirah
- Department of General Surgery, HonorHealth John C. Lincoln Medical Center, Phoenix, AZ, USA.,Department of Trauma Surgery, HonorHealth John C. Lincoln Medical Center, Phoenix, AZ, USA
| | - Whitney Wilson
- Department of General Surgery, HonorHealth John C. Lincoln Medical Center, Phoenix, AZ, USA
| | - Ahmed Abidali
- New College of Interdisciplinary Arts and Sciences, Arizona State University, Glendale, AZ, USA
| | - Phillip Moeser
- Medical Diagnostic Imaging Group, HonorHealth John C. Lincoln Medical Center, Phoenix, AZ, USA
| | - James K Dzandu
- Department of General Surgery, HonorHealth John C. Lincoln Medical Center, Phoenix, AZ, USA.,Department of Trauma Surgery, HonorHealth John C. Lincoln Medical Center, Phoenix, AZ, USA
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Dias FDSB, Emidio SCD, Lopes MHBDM, Shimo AKK, Beck ARM, Carmona EV. Procedures for measuring and verifying gastric tube placement in newborns: an integrative review. Rev Lat Am Enfermagem 2017; 25:e2908. [PMID: 28699995 PMCID: PMC5511002 DOI: 10.1590/1518-8345.1841.2908] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 04/06/2017] [Indexed: 11/21/2022] Open
Abstract
Objective: to investigate evidence in the literature on procedures for measuring gastric tube
insertion in newborns and verifying its placement, using alternative procedures to
radiological examination. Method: an integrative review of the literature carried out in the Cochrane, LILACS,
CINAHL, EMBASE, MEDLINE and Scopus databases using the descriptors “Intubation,
gastrointestinal” and “newborns” in original articles. Results: seventeen publications were included and categorized as “measuring method” or
“technique for verifying placement”. Regarding measuring methods, the measurements
of two morphological distances and the application of two formulas, one based on
weight and another based on height, were found. Regarding the techniques for
assessing placement, the following were found: electromagnetic tracing, diaphragm
electrical activity, CO2 detection, indigo carmine solution,
epigastrium auscultation, gastric secretion aspiration, color inspection, and
evaluation of pH, enzymes and bilirubin. Conclusion: the measuring method using nose to earlobe to a point midway between the xiphoid
process and the umbilicus measurement presents the best evidence. Equations based
on weight and height need to be experimentally tested. The return of secretion
into the tube aspiration, color assessment and secretion pH are reliable
indicators to identify gastric tube placement, and are the currently indicated
techniques.
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Affiliation(s)
| | - Suellen Cristina Dias Emidio
- Doctoral student, Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas, SP, Brazil. Scholarship holder at Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | | | | | - Ana Raquel Medeiros Beck
- PhD, Professor, Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Elenice Valentim Carmona
- PhD, Professor, Faculdade de Enfermagem, Universidade Estadual de Campinas, Campinas, SP, Brazil
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12
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Wegner W, Silva MUMD, Peres MDA, Bandeira LE, Frantz E, Botene DZDA, Predebon CM. Patient safety in the care of hospitalised children: evidence for paediatric nursing. ACTA ACUST UNITED AC 2017; 38:e68020. [PMID: 28492813 DOI: 10.1590/1983-1447.2017.01.68020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 01/11/2017] [Indexed: 12/28/2022]
Abstract
Objectives To describe evidence of international literature on the safe care of the hospitalised child after the World Alliance for Patient Safety and list contributions of the general theoretical framework of patient safety for paediatric nursing. Method An integrative literature review between 2004 and 2015 using the databases PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus, Web of Science and Wiley Online Library, and the descriptors Safety or Patient safety, Hospitalised child, Paediatric nursing, and Nursing care. Results Thirty-two articles were analysed, most of which were from North American, with a descriptive approach. The quality of the recorded information in the medical records, the use of checklists, and the training of health workers contribute to safe care in paediatric nursing and improve the medication process and partnerships with parents. Conclusion General information available on patient safety should be incorporated in paediatric nursing care.
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Affiliation(s)
- Wiliam Wegner
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | | | - Merianny de Avila Peres
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Larissa Edom Bandeira
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Elemara Frantz
- Centro Universitário Metodista IPA, Curso de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | | | - Caroline Maier Predebon
- Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
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13
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Investigation of the efficacy of colorimetric capnometry method used to verify the correct placement of the nasogastric tube. Intensive Crit Care Nurs 2016; 38:46-52. [PMID: 27843027 DOI: 10.1016/j.iccn.2016.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 08/01/2016] [Accepted: 08/21/2016] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This present study was designed to determine the efficacy of the colorimetric capnometry method used to verify the correct placement of the nasogastric tube. METHODS The present study comprised forty patients who had a nasogastric tube inserted and were being monitored in the adult intensive care unit. After the insertion of the nasogastric tube, 40 colorimetric capnometry and 40 auscultation measurements were performed. Auscultation and colorimetric capnometry results were compared with tube placement results confirmed radiologically. RESULTS In the confirmation of the placement of the nasogastric tube, the consistency was 97.5% (p<0.05) between the colorimetric capnometry method and the radiological method, and 82.5% (p>0.05) between the auscultatory method and the radiological method. The oesophageal placement of the nasogastric tube was detected with the colorimetric capnometry method, but the gastric and duodenal insertions were not determined. While the sensitivity and specificity of the colorimetric capnometry method in determining the correct placement of the nasogastric tube were 1.00 and 0.667 respectively, those of the auscultatory method were 0.89 and 0.0 respectively. CONCLUSION As a result, for the confirmation of the NGT placement, the colorimetric capnometry method is considered more reliable than the auscultatory method and is compatible with the radiological method. However, the colorimetric capnometry method is inadequate to distinguish between the gastric or duodenal insertion.
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Abdelhadi RA, Rahe K, Lyman B. Pediatric Enteral Access Device Management. Nutr Clin Pract 2016; 31:748-761. [DOI: 10.1177/0884533616670640] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
- Ruba A. Abdelhadi
- Enteral Access Team, Children’s Mercy Kansas City, Kansas City, Missouri, USA
| | - Katina Rahe
- Enteral Access Team, Children’s Mercy Kansas City, Kansas City, Missouri, USA
| | - Beth Lyman
- Nutrition Support Team, Children’s Mercy Kansas City, Kansas City, Missouri, USA
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Initial and Ongoing Verification of Feeding Tube Placement in Adults (applies to blind insertions and placements with an electromagnetic device). Crit Care Nurse 2016; 36:e8-e13. [DOI: 10.4037/ccn2016141] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Milsom SA, Sweeting JA, Sheahan H, Haemmerle E, Windsor JA. Naso-enteric Tube Placement: A Review of Methods to Confirm Tip Location, Global Applicability and Requirements. World J Surg 2016; 39:2243-52. [PMID: 25900711 DOI: 10.1007/s00268-015-3077-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The insertion of a tube through the nose and into the stomach or beyond is a common clinical procedure for feeding and decompression. The safety, accuracy and reliability of tube insertion and methods used to confirm the location of the naso-enteric tube (NET) tip have not been systematically reviewed. The aim of this study is to review and compare these methods and determine their global applicability by end-user engagement. METHODS A systematic literature review of four major databases was performed to identify all relevant studies. The methods for NET tip localization were then compared for their accuracy with reference to a gold standard method (radiography or endoscopy). The global applicability of the different methods was analysed using a house of quality matrix. RESULTS After applying the inclusion and exclusion criteria, 76 articles were selected. Limitations were found to be associated with the 20 different methods described for NET tip localization. The method with the best combined sensitivity and specificity (where n > 1) was ultrasound/sonography, followed by external magnetic guidance, electromagnetic methods and then capnography/capnometry. The top three performance criteria that were considered most important for global applicability were cost per tube/disposable, success rate and cost for non-disposable components. CONCLUSION There is no ideal method for confirming NET tip localisation. While radiography (the gold standard used for comparison) and ultrasound were the most accurate methods, they are costly and not universally available. There remains the need to develop a low-cost, easy-use, accurate and reliable method for NET tip localization.
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Affiliation(s)
- S A Milsom
- Department of Biomedical Engineering, University of Auckland, Auckland, New Zealand
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Makic MBF, Rauen C, Watson R, Poteet AW. Examining the evidence to guide practice: challenging practice habits. Crit Care Nurse 2015; 34:28-45; quiz 46. [PMID: 24692464 DOI: 10.4037/ccn2014262] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Nurses are the largest segment of the nation's health care workforce, which makes nurses vital to the translation of evidence-based practice as a practice norm. Critical care nurses are in a position to critically appraise and apply best evidence in daily practice to improve patients' outcomes. It is important for critical care nurses to continually evaluate their current practice to ensure that they are applying the current best evidence rather than practicing on the basis of tradition. This article is based on a presentation at the 2013 National Teaching Institute of the American Association of Critical-Care Nurses. Four practice interventions that are within the realm of nursing are critiqued on the basis of current best evidence: (1) turning critically ill patients, (2) sleep promotion in the intensive care unit, (3) feeding tube management in infants and children, and (4) prevention of venothromboembolism…again. The related beliefs, current evidence, and implications for practice associated with each topic are described.
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Following the evidence: enteral tube placement and verification in neonates and young children. J Perinat Neonatal Nurs 2015; 29:149-61; quiz E2. [PMID: 25919605 DOI: 10.1097/jpn.0000000000000104] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Enteral tube placement in hospitalized neonates and young children is a common occurrence. Accurate placement and verification are imperative for patient safety. However, despite many years of research that provides evidence for a select few methods and clearly discredits the safety of others, significant variation in clinical practice is still common. Universal adoption and implementation of evidence-based practices for enteral tube placement and verification are necessary to ensure consistency and safety of all patients. This integrative review synthesizes current and seminal literature regarding the most accurate enteral tube placement and verification methods and proposes clinical practice recommendations.
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Smith F, Holland A, Penny K, Elen M, McGirr D. Carbon dioxide detection for diagnosis of inadvertent respiratory tract placement of enterogastric tubes in children. Hippokratia 2014. [DOI: 10.1002/14651858.cd011196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Fiona Smith
- Faculty of Health, Life & Social Sciences, Edinburgh Napier University; School of Nursing, Midwifery and Social Care; Sighthill Campus Edinburgh UK EH11 4BN
| | - Agi Holland
- Faculty of Health, Life & Social Sciences, Edinburgh Napier University; School of Nursing, Midwifery and Social Care; Sighthill Campus Edinburgh UK EH11 4BN
| | - Kay Penny
- Edinburgh Napier University; School of Management; Craiglockhart Campus Edinburgh UK EH14 1DJ
| | - Marie Elen
- Faculty of Health, Life & Social Sciences, Edinburgh Napier University; School of Nursing, Midwifery and Social Care; Sighthill Campus Edinburgh UK EH11 4BN
| | - Deborah McGirr
- Faculty of Health, Life & Social Sciences, Edinburgh Napier University; School of Nursing, Midwifery and Social Care; Sighthill Campus Edinburgh UK EH11 4BN
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A review of published case reports of inadvertent pulmonary placement of nasogastric tubes in children. J Pediatr Nurs 2014; 29:e7-12. [PMID: 24071621 DOI: 10.1016/j.pedn.2013.08.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 08/24/2013] [Indexed: 01/12/2023]
Abstract
PROBLEM Little is known about the incidence of inadvertent pulmonary placement of nasogastric tubes during blind insertions in children. PURPOSE The purpose of this paper was to conduct a review of published case reports over the past two decades. METHODS An OVID Medline search was conducted of articles published from 1993 through 2012. RESULTS Fifteen published case reports were located; four patients died as a result of their malpositioned tubes. The auscultatory bedside method failed to detect the malpositioned tubes in all seven cases in which it was used. CONCLUSIONS The incidence of inadvertent pulmonary placement of nasogastric tubes is relatively low but can lead to serious and even lethal results in children. The auscultatory method to predict tube location is unreliable.
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Christian BJ. Improving the lives of children and their families-integrating clinical research into everyday pediatric nursing practice. J Pediatr Nurs 2012; 27:594-7. [PMID: 22819748 DOI: 10.1016/j.pedn.2012.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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