1
|
Quinteiro NM, Fioravanti Dos Santos J, de Siqueira Caldas JP, Carmona EV. Procedures for a Transpyloric Feeding Tube Inserted Into Newborns and Infants: A Systematic Review. Adv Neonatal Care 2024; 24:374-381. [PMID: 38986126 DOI: 10.1097/anc.0000000000001172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
BACKGROUND Enteral feeding by a transpyloric tube in critically ill infants is indicated when there is a failure in gastric feeding. However, there is a wide variability regarding the insertion technique. PURPOSE To perform a systematic review of the methods for inserting a transpyloric feeding tube in newborns and infants. DATA SOURCES Nine databases, without date or language restrictions, accessed in September 2021. STUDY SELECTION A systematic review of experimental and nonexperimental studies, according to the "Patient/problem; Intervention; Comparison; Outcome" strategy and the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" guidelines. The clinical question was about the measurement and insertion techniques, as well as the success rates of properly placing a transpyloric tube in newborns and infants. DATA EXTRACTION Two authors (N.M.Q. and J.F.S.) analyzed 6 observational descriptive prospective studies, all of them published in peer-reviewed indexed medical journals and one in the official journal of the National Association of Neonatal Nurses. RESULTS The success rate varied between 70% and 100%. There was an important variability in the type of tube, measurement method, and insertion techniques. It was found that the most common strategies to achieve proper positioning were glabella-calcaneal measurements, gastric air insufflation, and right lateral decubitus. IMPLICATIONS FOR PRACTICE A transpyloric catheter insertion protocol needs to be established in each neonatal unit, according to the literature findings. IMPLICATIONS FOR RESEARCH Randomized controlled studies that evaluate the gastric air insufflation technique and other adjuvant measures could elucidate the knowledge gap concerning the correct positioning of transpyloric tubing in newborns and infants.
Collapse
Affiliation(s)
- Norma Mejias Quinteiro
- University of Alabama at Birmingham, School of Nursing, Birmingham, Alabama.School of Medical Sciences and Women's Hospital (Ms Quinteiro), Women's Hospital (Ms Fioravanti dos Santos), Department of Pediatrics, School of Medical Sciences (Dr de Siqueira Caldas), School of Nursing (Dr Carmona), State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | | | | | | |
Collapse
|
2
|
Tatterton M, Mulcahy J, Mankelow J, Harding M, Scrace J, Fisher M, Bethell C. Checking nasogastric tube safety in children cared for in the community: a re-examination of the evidence base. Nurs Child Young People 2024:e1493. [PMID: 38433664 DOI: 10.7748/ncyp.2024.e1493] [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: 08/07/2023] [Indexed: 03/05/2024]
Abstract
Nasogastric tube feeding is generally considered safe provided a nasogastric aspirate with a pH ≤5.5, which indicates that the end of tube is correctly located in the stomach, can be obtained. When this is not possible, hospital attendance or admission is usually required so that an X-ray can be undertaken to check the tube's position. This practice is based on an interpretation of the evidence that places undue importance on nasogastric aspirate pH testing before every use of a tube that is already in place, with potential negative consequences for children cared for in the community and their families. Following a re-examination of the evidence base, a revised approach is proposed in this article: when a child has a tube in place, provided its position has been confirmed as correct on initial placement using aspirate pH testing, nurses can use checks other than aspirate pH testing, alongside their clinical judgement, to determine whether it is safe and appropriate to use the tube. This proposed revised approach would reduce delayed or missed administration of fluids, feeds and medicines and enable more children to remain at home.
Collapse
Affiliation(s)
- Michael Tatterton
- Bluebell Wood Children's Hospice, Sheffield, and associate professor of children and young people's nursing, University of Bradford, Bradford, England
| | - Jane Mulcahy
- Sussex Community NHS Foundation Trust, East Sussex, England
| | | | - Maria Harding
- Sussex Community NHS Foundation Trust, East Sussex, England
| | | | | | - Claire Bethell
- Bluebell Wood Children's Hospice, Sheffield, and lecturer in children and young people's nursing, University of Bradford, Bradford, England
| |
Collapse
|
3
|
Mohamed SMM, Salem GMM, Almushawah RA. Pediatric nurses' knowledge and practices of nasogastric tube placement and verification: A cross-sectional study. Nutrition 2023; 115:112136. [PMID: 37541143 DOI: 10.1016/j.nut.2023.112136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVES The study assesses pediatric nurses' knowledge and routine practices in relation to nasogastric tube (NGT) placement and verification procedure. By investigating these aspects, the study seeks to contribute to the enhancement of patient safety and the improvement of pediatric nursing care in the context of NGT procedures by ensuring accurate NGT placement and minimizing complications in pediatric patients. The study assesses pediatric nurses' knowledge and practices of inserting and confirming the placement of NGTs among pediatric patients in the Asir Province, Saudi Arabia. METHODS In this multihospital cross-sectional study, a total of 130 pediatric nurses participated. The study used a validated questionnaire comprising two parts: one focusing on the demographic data of the pediatric nurses and the other assessing their knowledge and practices regarding NGT placement and verification. The collected data were analyzed using descriptive statistics and linear regression tests in the SPSS software. The research question addressed in this study was to determine the knowledge and practice levels of pediatric nurses in relation to NGT placement and verification. RESULTS This study included 130 registered pediatric nurses, of whom more than half had unsatisfactory knowledge (53.1%) and incompetent practices (58.5%) related to NGT insertion. Linear regression associated with perceived nurses' practices scores explained that knowledge score, years of experience, educational qualification, and training courses had a high-frequency positive effect on the practice score, with P < 0.01. Linear regression associated with perceived nurses' knowledge scores explained that educational qualification, practice score, and training courses had a high-frequency positive effect on the knowledge score, with P < 0.01. CONCLUSIONS The study found that pediatric nurses' knowledge and practices regarding NGT were inadequate. These results highlight the importance of implementing continuous educational programs to improve care practices pertaining to nasogastric tubes and enhance patient safety and quality of care.
Collapse
|
4
|
Comparison of 3 Methods for Measuring Gastric Tube Length in Newborns: A Randomized Clinical Trial. Adv Neonatal Care 2023; 23:E79-E86. [PMID: 36806055 DOI: 10.1097/anc.0000000000001065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND Incorrectly positioned gastric tubes occur in approximately 60% of infants hospitalized in the neonatal intensive care unit (NICU), increasing the risk of potentially serious complications. PURPOSE To compare 3 methods of determining gastric tube insertion length in infants in the NICU. METHODS In this randomized triple-blind clinical trial, 179 infants admitted to the NICU were randomized to have their gastric tube insertion length determined by 1 of 3 methods: (1) the nose, earlobe, mid-umbilicus (NEMU) method, (2) a weight-based method, or (3) an age-related height-based (ARHB) method. Positioning of the gastric tube was verified by radiograph. R software was used for analyses. To compare categorical variables, Fisher's exact test, χ2 tests, and simulated χ2 tests were used. RESULTS Overall, infants had a mean gestational age of 35 weeks, 115 (58.8%) were male, and the mean birth weight was 2481.5 g. Upon radiological assessment, 145 gastric tubes (81.3%) were correctly positioned in the gastric body or greater curvature of the stomach with the weight-based method having the highest percentage of correctly positioned gastric tubes (n = 53; 36.6%), followed by the ARHB method (n = 47; 32.4%) and the NEMU method (n = 45; 31.0%). No significant differences were identified between groups (P = .128). IMPLICATION FOR PRACTICE AND RESEARCH Despite the NEMU method being the most commonly used method in clinical practice, the weight-based and ARHB methods to determine gastric tube insertion length may be more accurate.
Collapse
|
5
|
Ultrasound to Verify Gastric Tube Position in Infants and Children: A Systematic Review. Adv Neonatal Care 2022; 22:531-538. [PMID: 35587385 DOI: 10.1097/anc.0000000000001000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Placement of gastric tubes is commonly performed in infants and children but malpositioning is common and is associated with significant complications. OBJECTIVE The aim of this systematic review is to identify the evidence on the use of ultrasound to verify correct gastric tube placement in infants and children and gaps in the research. METHODS This review was performed using CINAHL, PUBMED, EMBASE and Web of Science databases. Studies were included if they used an empirical study design, were published in English, included infants or children, and evaluated the use of ultrasound to verify correct gastric tube placement compared to radiograph. Sensitivity, specificity, positive and negative predictive values were evaluated. RESULTS Four articles were included in the review. Sensitivity estimates were 0.88 to 1.00 and a positive predictive value of 0.99 was reported in one study. Specificity was not reported in any of the included studies. Ultrasound may be an important method to correctly identify gastric tube placement in infants and children with less radiation exposure and cost. IMPLICATIONS FOR PRACTICE Ultrasound could be a used to verify gastric tube positioning in infants and children for both initial placement and continued verification leading to reduced radiation exposure and cost. IMPLICATIONS FOR RESEARCH Research should focus on evaluating ultrasound specificity and the clinical feasibility of using ultrasound as a standard practice, including cost and time required to complete the exam, as well as the ability of ultrasound to verify gastric tube placement in infants weighing less than 1500 grams.
Collapse
|
6
|
France DJ, Schremp E, Rhodes EB, Slagle J, Moroz S, Grubb PH, Hatch LD, Shotwell M, Lorinc A, Robinson J, Crankshaw M, Newman T, Weinger MB, Blakely ML. A pilot study to determine the incidence, type, and severity of non-routine events in neonates undergoing gastrostomy tube placement. J Pediatr Surg 2022; 57:1342-1348. [PMID: 34839947 PMCID: PMC9050962 DOI: 10.1016/j.jpedsurg.2021.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 10/13/2021] [Accepted: 10/20/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Non-routine events (NRE) are defined as any suboptimal occurrences in a process being measured in the opinion of the reporter and comes from the field of human factors engineering. These typically occur well up-stream of an adverse event and NRE measurement has not been applied to the complex context of neonatal surgery. We sought to apply this novel safety event measurement methodology to neonates in the NICU undergoing gastrostomy tube placement. METHODS A prospective pilot study was conducted between November 2016 and August 2020 in the Level IV NICU and the pediatric operating rooms of an urban academic children's hospital to determine the incidence, severity, impact, and contributory factors of clinician-reported non-routine events (NREs, i.e., deviations from optimal care) and 30-day NSQIP occurrences in neonates receiving a G-tube. RESULTS Clinicians reported at least one NRE in 32 of 36 (89%) G-tube cases, averaging 3.0 (Standard deviation: 2.5) NRE reports per case. NSQIP-P review identified 7 cases (19%) with NSQIP-P occurrences and each of these cases had multiple reported NREs. One case in which NREs were not reported was without NSQIP-P occurrences. The odds ratio of having a NSQIP-P occurrence with the presence of an NRE was 0.695 (95% CI 0.06-17.04). CONCLUSION Despite being considered a "simple" operation, >80% of neonatal G-tube placement operations had at least one reported NRE by an operative team member. In this pilot study, NRE occurrence was not significantly associated with the subsequent reporting of an NSQIP-P occurrence. Understanding contributory factors of NREs that occur in neonatal surgery may promote surgical safety efforts and should be evaluated in larger and more diverse populations. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Daniel J. France
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA,Center for Research and Innovation in Systems Safety, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emma Schremp
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA,Center for Research and Innovation in Systems Safety, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Evan B. Rhodes
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA,Center for Research and Innovation in Systems Safety, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jason Slagle
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA,Center for Research and Innovation in Systems Safety, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah Moroz
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA,Center for Research and Innovation in Systems Safety, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Peter H. Grubb
- Department of Pediatrics, Division of Neonatology, University of Utah, Salt Lake City,UT,USA
| | - Leon D. Hatch
- Department of Pediatrics, Division of Neonatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew Shotwell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Amanda Lorinc
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA,Center for Research and Innovation in Systems Safety, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jamie Robinson
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA,Department of Pediatric Surgery, Monroe Carell Jr. Children’s Hospital at Vanderbilt, TN, USA
| | - Marlee Crankshaw
- Neonatal Intensive Care Unit, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, TN, USA
| | - Timothy Newman
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA,Center for Research and Innovation in Systems Safety, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew B. Weinger
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA,Center for Research and Innovation in Systems Safety, Institute for Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Martin L. Blakely
- Department of Pediatric Surgery, Monroe Carell Jr. Children’s Hospital at Vanderbilt, TN, USA
| |
Collapse
|
7
|
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.
Collapse
|
8
|
Dias FDSB, Jales RM, Alvares BR, Caldas JPDS, Carmona EV. Randomized Clinical Trial Comparing Two Methods of Measuring Insertion Length of Nasogastric Tubes in Newborns. JPEN J Parenter Enteral Nutr 2020; 44:912-919. [PMID: 32026495 DOI: 10.1002/jpen.1786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 12/06/2019] [Accepted: 12/19/2019] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The selection of a method for measuring the insertion length of nasogastric tubes in newborns is an important factor in establishing the safe use of this device. OBJECTIVE The objective was to verify whether there is a difference in the proportion of correctly placed nasogastric tubes when using the nose, earlobe, mid-umbilicus (NEMU) method and the weight-based equation for measuring the insertion length. METHODS This study is a randomized, controlled, blinded study comparing 2 methods of nasogastric insertion at a neonatal unit, with intensive and intermediate care, on 162 randomized individuals. Radiological assessment and pH test were conducted to verify tube placement. Data were collected on sex, birth weight, gestational age, and days of life. A log-binomial model was used to verify whether there were placement differences between investigated methods. RESULTS Of the patients, 56.1% were male, who had a mean birth weight of 1886.8 g and gestational age of 32.9 weeks and were 10.8 days old. Radiological images demonstrated that tubes were properly placed in the gastric body in 67.5% of patients using the NEMU method and in 91.5% using the weight-based equation: the weight-based equation was superior to the NEMU method, with a prevalence ratio of 1.36 (95% CI, 1.15-1.44). There was no difference between the 2 methods, according to pH test (P-value: .7179). CONCLUSION Based on radiographic confirmation, the weight-based equation for measuring the insertion length of the nasogastric tube in newborns resulted in significantly more nasogastric tubes being placed in the correct intragastric location.
Collapse
Affiliation(s)
| | - Rodrigo Menezes Jales
- Department of Obstetrics and Gynecology, School of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Beatriz Regina Alvares
- Department of Radiology, School of Medical Sciences, University of Campinas, São Paulo, Brazil
| | | | | |
Collapse
|
9
|
Craig SS, Seith RW, Cheek JA, Wilson K, Egerton-Warburton D, Paul E, West A. Lidocaine and phenylephrine versus saline placebo nasal spray for the pain and distress of nasogastric tube insertion in young children and infants: a randomised, double-blind, controlled trial. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 3:391-397. [DOI: 10.1016/s2352-4642(19)30058-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/20/2019] [Accepted: 02/21/2019] [Indexed: 11/24/2022]
|
10
|
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.
Collapse
|
11
|
Dias FDSB, Almeida BPD, Alvares BR, Jales RM, Caldas JPDS, Carmona EV. Use of pH reagent strips to verify gastric tube placement in newborns. Rev Lat Am Enfermagem 2019; 27:e3227. [PMID: 31826168 PMCID: PMC6896807 DOI: 10.1590/1518-8345.3150.3227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 09/11/2019] [Indexed: 11/26/2022] Open
Abstract
Objective: to confirm the accuracy of the pH test in identifying the placement of the gastric tube in newborns. Method: double-blind, diagnostic test study conducted with 162 newborns admitted to a neonatal intensive care unit and an intermediate care unit. The subjects were submitted to enteral intubation, followed by pH test with reagent strip, which was analyzed by a nurse, and radiological examination, analyzed by radiologist. Blinding was kept among professionals regarding test results. Diagnostic accuracy analysis of the pH test in relation to the radiological exam was performed. Results: the sample consisted of 56.17% boys, with average birth weight of 1,886.79g (SD 743,41), 32.92 (SD 2.99) weeks of gestational age and the mean pH was 3.36 (SD 1.27). Considering the cutoff point of pH≤5.5, the sensitivity was 96.25%, specificity 50%, positive predictive value 99.35% and negative predictive value 14.29%. Conclusion: The pH test performed with reagent strips is sensitive to identify the correct placement of the gastric tube, so it can be used as an adjuvant technique in the evaluation of the gastric tube placement. In interpreting the results, pH ≤5.5 points to correct placement and values > 5.5 require radiological confirmation.
Collapse
|
12
|
Parker LA, Withers JH, Talaga E. Comparison of Neonatal Nursing Practices for Determining Feeding Tube Insertion Length and Verifying Gastric Placement With Current Best Evidence. Adv Neonatal Care 2018; 18:307-317. [PMID: 29889728 DOI: 10.1097/anc.0000000000000526] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Oral-nasogastric feeding tubes (FTs) are often malpositioned, placing infants at risk for complications. Confusion exists regarding the accuracy of methods to determine FT insertion length and verify gastric FT placement, and it is unknown whether evidence-based methods are used by neonatal nurses. PURPOSE To compare individual and unit-based neonatal nursing practices regarding methods used to determine FT insertion length and verify gastric FT placement. METHODS Neonatal nurses were surveyed about individual and unit-based practices regarding methods used to determine FT insertion length and verify gastric FT placement in infants in the neonatal intensive care unit. RESULTS Sixty neonatal nurses completed the survey, with 63% utilizing the nose-ear-midway to the umbilicus method, which was included in 50% of protocols and is associated with up to a 90% accuracy rate. Although it has an unacceptably high inaccuracy rate, the nose-to-ear-to-xiphoid method was used by 32% of nurses and recommended in 30% of protocols. To verify gastric FT placement, 98% of nurses used auscultation of a whoosh sound and 83% used aspiration of gastric contents. Neither verification method is supported by evidence or recommended for use. IMPLICATIONS FOR PRACTICE A lack of consistency exists between nursing practice and evidence-based methods. IMPLICATIONS FOR RESEARCH Research is needed to determine more accurate and reliable ways to determine FT insertion depth and verify gastric FT placement in neonates.
Collapse
|
13
|
André RR, Mendes CQDS, Avelar AFM, Balieiro MMFG. Posicionamento de sonda enteral em neonatos segundo técnica modificada de mensuração. ACTA PAUL ENFERM 2017. [DOI: 10.1590/1982-0194201700083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo: Avaliar a efetividade da mensuração de sonda enteral pela técnica modificada, nariz - orelha - apêndice xifoide, com desconto dos orifícios distais da sonda, para posicionamento na câmara gástrica de neonatos. Métodos: Estudo prospectivo, desenvolvido em unidade neonatal de um hospital de ensino do município de São Paulo, a partir da análise radiográfica de 60 radiografias de 28 neonatos em uso de sonda enteral mensurada pela técnica modificada, submetidos à radiografia toracoabdominal. Resultados: O índice de posicionamento correto, de acordo com a análise por posições, foi de 68,3% e 71,7%, segundo os avaliadores 1 e 2, respectivamente, enquanto na análise por vértebras, 95% das sondas estavam adequadamente locadas na câmara gástrica. Ocorreu associação estatisticamente significante entre estatura e localização da sonda enteral, segundo o avaliador 2. Conclusão: A técnica de mensuração avaliada apresenta risco para posicionamento inadequado da sonda enteral utilizada em neonatos, devendo ser desencorajada sua aplicação na prática clínica.
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Atalay YO, Aydin R, Ertugrul O, Gul SB, Polat AV, Paksu MS. Does Bedside Sonography Effectively Identify Nasogastric Tube Placements in Pediatric Critical Care Patients? Nutr Clin Pract 2016; 31:805-809. [PMID: 27029283 DOI: 10.1177/0884533616639401] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND A nasogastric tube (NGT) insertion is a common procedure in intensive care units, with some serious complications that result from the malposition of the NGT tip. This pilot study was designed to investigate the efficiency of ultrasound in verifying correct NGT placement and to compare these results with radiographic findings. MATERIALS AND METHODS This was a single-center, double-blind prospective study of patients who had received an NGT in the pediatric critical care unit. Twenty-one patients aged 1 month to 18 years were included in this study. All NGTs were inserted by the same critical care physician. After insertion, the physician first confirmed NGT placement by the auscultation of the epigastrium following the insufflation of air. Confirmation was supplemented with an abdominal radiograph. A radiologist who was unaware of the radiographic findings performed bedside sonography on all patients and verified the location of the NGTs. The findings from these 2 physicians were then compared. RESULTS NGTs were inserted without any complications, and none of the NGTs were positioned in the respiratory tract in any of the patients. All NGT tips were visualized by radiography and sonography with a sensitivity of 100%. CONCLUSION Bedside sonography performed by a radiologist is an effective and sensitive diagnostic procedure for confirming the correct NGT position in patients in the pediatric critical care unit.
Collapse
Affiliation(s)
- Yunus Oktay Atalay
- 1 Ondokuz Mayis University, Faculty of Medicine, Department of Radiology, Outpatient Anesthesia Service, Samsun, Turkey
| | - Ramazan Aydin
- 2 Kirikkale High Specialty Hospital, Department of Radiology, Kirikkale, Turkey
| | - Omer Ertugrul
- 3 Ondokuz Mayis University, Faculty of Medicine, Department of Pediatrics, Samsun, Turkey
| | - Selim Baris Gul
- 4 Aksaray Goverment Hospital, Department of Radiology, Aksaray, Turkey
| | - Ahmet Veysel Polat
- 5 Ondokuz Mayis University, Faculty of Medicine, Department of Radiology, Samsun, Turkey
| | - Muhammet Sukru Paksu
- 6 Ondokuz Mayis University, Faculty of Medicine, Pediatric Intensive Care Unit, Samsun, Turkey
| |
Collapse
|