Gastric Tube Use and Care in the NICU

Wallace, Tamara; Steward, Deborah K.

doi:10.1053/j.nainr.2014.06.011

Cited by 17 publications

(30 citation statements)

References 44 publications

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“…However, significant variation exists for both practices. 31 Research demonstrates that placement of enteral tubes using the NEX method accounts for up to 21% of tubes being malpositioned. 14 Use of the NEX method allows for the highest risk for misplacement and aspiration among the methods reviewed.…”

Section: Discussionmentioning

confidence: 99%

“…As no other single verification method provides the accuracy of a radiograph, combining 2 or more methods may provide nurses with the information they need to feel confident that an enteral tube is in the correct location. 1,11,31 Use of a decision tool, such as an algorithm (see Figure 2), may provide a standardized, evidence-based approach for safe and effective use of enteral tubes in neonates and young children. Once the recommendations presented here are implemented into daily practice by interdisciplinary care teams, it is important to use quality improvement methods to frequently monitor the unit's success.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, only one method, x-ray study, provides 100% accuracy in determining enteral tube tip location 4,11,14,18,22 and is considered the criterion standard by which to compare other verification methods. 31,35 A variety of other methods have been studied, but none afford the conclusive findings that an x-ray study provides. Patients receive a minimal amount of radiation from single x-ray exposure; however, the potential cumulative effect from multiple x-ray exposures for enteral tube verification may cause harm.…”

Section: Tube Placement Verification Methodsmentioning

confidence: 99%

“…Aspirates of patients receiving H 2 blockers demonstrated only slightly higher pH levels than the aspirates of subjects who did not receive H 2 -blocking medication, and the pH remained 5 or less. 31 Ellett and colleagues 14,17 compared the gastric pH values of children receiving acid-blocking medications with those of children not receiving such medications. The authors found no significant difference in the pH aspirate between the 2 groups and also found that the feeding method-fasting, bolus, intermittent, or continuous-did not alter the mean pH.…”

Section: Tube Placement Verification Methodsmentioning

confidence: 99%

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Following the Evidence

Clifford

Heimall

Brittingham

et al. 2015

Journal of Perinatal &Amp; Neonatal Nursing

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Tube Placement Verification Methodsmentioning

confidence: 99%

Section: Tube Placement Verification Methodsmentioning

confidence: 99%

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Following the Evidence

Clifford

Heimall

Brittingham

et al. 2015

Journal of Perinatal &Amp; Neonatal Nursing

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“…(1) The use of enteral tubes is one of the most common nursing procedures in the Neonatal Intensive Care Unit (NICU) and usually indicated for gastric decompression, enteral nutrition and medication administration. (2,3) In the neonatal population, enteral tube placement techniques are not well standardized and errors in correct positioning often occur. (4) In care practice, enteral tube placement techniques use several measurements to estimate the length of the tube to be introduced into the newborn (NB), namely the measurement from the tip of the nose to the ear lobe and until the xiphoid (NEX); from the tip of the nose to the ear lobe and from this point to the midline between the xiphoid and the umbilicus (NEMU); and from the tip of the nose to the ear lobe and from this to the umbilicus (NEU).…”

Section: Introductionmentioning

confidence: 99%

Posicionamento de sonda enteral em neonatos segundo técnica modificada de mensuração

et al. 2017

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Objective: To evaluate the effectiveness of the enteral tube measurement using the modified nose -ear -xiphoid (NEX) technique by disregarding the tube distal orifices for placement in newborns' neonatal gastric cavity. Methods: A prospective study conducted in a neonatal unit of a teaching hospital in the city of São Paulo, based on the radiographic analysis of 60 radiographs of 28 newborns using enteral tubes measured by the modified technique, and who had thoracoabdominal radiography. Results: The correct placement index according to analysis by position was 68.3% and 71.7%, according to evaluators 1 and 2, respectively. In the analysis by vertebrae, 95% of tubes were properly placed in the gastric cavity. There was a statistically significant association between height and location of the enteral tube according to evaluator 2. Conclusion: The evaluated measurement technique presents a risk for inadequate enteral tube placement in newborns, and its application in clinical practice should not be encouraged. ResumoObjetivo: 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.

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Gastric Residual to Predict Necrotizing Enterocolitis in Preterm Piglets As Models for Infants

Kappel

Sangild

Hilsted

et al. 2020

J Parenter Enteral Nutr

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Background Necrotizing enterocolitis (NEC) is a serious intestinal inflammatory disease in preterm infants. High volume of gastric residual (GR) after oral feedings is often used as a predictor of NEC, but evidence is limited. Using NEC‐sensitive preterm piglets as models, we hypothesized that GR mass and related plasma biomarkers predict early onset of NEC. Methods In total, 258 newborn preterm piglets were fed bovine milk–based formulas for 5 days. At euthanasia, the stomach, small intestine, and colon were evaluated for NEC lesions. Mass, acidity, gastrin, and bile acid levels were determined for GR content, together with gastrin, glucagon‐like peptide 2 (GLP‐2), and gastric inhibitory polypeptide (GIP) levels in plasma. Results In total, 48% of piglets had NEC lesions in the small intestine and/or colon. These piglets had higher GR mass (+32%, P < 0.001) and lower gastric bile acid concentrations (−22%, P < 0.05) than piglets without NEC lesions. The positive and negative predictive values for these markers were 34%–61%. Gastric acidity, gastrin, GLP‐2, and GIP levels were similar for piglets with and without NEC lesions. Conclusion Elevated GR mass correlates positively with NEC lesions but may be a poor predictor of NEC, even when combined with other biomarkers. More knowledge about gastric emptying and gut transit in preterm neonates is required to understand how GR volume and composition relate to morbidities, such as NEC, in preterm neonates.

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Gastric Tube Use and Care in the NICU

Cited by 17 publications

References 44 publications

Following the Evidence

Following the Evidence

Posicionamento de sonda enteral em neonatos segundo técnica modificada de mensuração

Gastric Residual to Predict Necrotizing Enterocolitis in Preterm Piglets As Models for Infants

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