Nasogastric Tube Position and Intragastric Air Collection in a Neonatal Intensive Care Population

Boer, Jacoba Coby de; Smit, Bert; Mainous, Rosalie O.

doi:10.1097/anc.0b013e3181c1fc2f

Cited by 26 publications

(22 citation statements)

References 21 publications

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“…The reported incidence of gastric tube misplacements in neonates ranges from 38% to 61% 86,87 and from 20.9% to 43.5% in infants and children. [88][89][90] Feeding through a tube in which any of the orifices are in the respiratory …”

Section: Best Methods To Prevent Harm When Inserting Feeding Tubes Anmentioning

confidence: 99%

“…The presence of a "whoosh" sound heard over the epigastrum during air insufflation though a feeding tube is the traditional method used to confirm placement and continues to be used by pediatric nurses despite evidence in the adult literature of its lack of reliability for detecting misplacement in the lungs. 105,114 Researchers in 1 study 86 reported that when nurses verified placement of nasogastric tubes in neonates by using auscultation, radiographic evidence indicated that 47.5% of these tubes were not in the correct place, with 7.1% of tubes having orifices in the esophagus. In infants and children, reported error rates with auscultation range from 3.4% to 50%.…”

Section: Implications For Practice: Predicting Insertion Lengthmentioning

confidence: 99%

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Examining the Evidence to Guide Practice: Challenging Practice Habits

Makic

Rauen

Watson

et al. 2014

Critical Care Nurse

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I n 2001, the Institute of Medicine challenged all health care professionals to decrease variation in practice through adoption of practice interventions based on best evidence to improve patients' outcomes.1 Current reviews of clinical practice suggest that only 10% to 15% of clinicians consistently implement evidence-based care 2 and indicate that it may take up to 2 decades for original research to be put into routine clinical practice.3 It is well established that evidence-based practice (EBP) is associated with higher quality care and better outcomes for patients than care that is steeped in tradition. 4 Yet at times, clinicians continue to practice on the basis of tradition.

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Section: Best Methods To Prevent Harm When Inserting Feeding Tubes Anmentioning

confidence: 99%

Section: Implications For Practice: Predicting Insertion Lengthmentioning

confidence: 99%

Examining the Evidence to Guide Practice: Challenging Practice Habits

Makic

Rauen

Watson

et al. 2014

Critical Care Nurse

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“…(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). (4,5) There are also measurements based on formulas that consider weight or height classified by the child's age.…”

Section: Introductionmentioning

confidence: 99%

“…(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). (4,5) There are also measurements based on formulas that consider weight or height classified by the child's age. (3) In a review of cases of inadvertent insertion of nasogastric tubes into the respiratory tract of children, the presence of serious injuries and even death was evident.…”

Section: Introductionmentioning

confidence: 99%

“…For this reason, authors affirm it is essential to verify the placement of all inserted tubes without the aid of direct visualization methods prior to feeding or medication administration. (6) In the aforementioned measurement methods, placement errors occur (4,5) thus, tests to confirm the precise localization of the tube are extremely important given the need of its use for feeding preterm infants. This procedure is of nurses' responsibility and frequently repeated during hospitalization.…”

Section: Introductionmentioning

confidence: 99%

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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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Randomized Clinical Trial Comparing Two Methods of Measuring Insertion Length of Nasogastric Tubes in Newborns

Dias

Jales

Álvares

et al. 2020

J Parenter Enteral Nutr

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IntroductionThe 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.ObjectiveThe 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.MethodsThis 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.ResultsOf 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).ConclusionBased 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.

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Nasogastric Tube Position and Intragastric Air Collection in a Neonatal Intensive Care Population

Cited by 26 publications

References 21 publications

Examining the Evidence to Guide Practice: Challenging Practice Habits

Examining the Evidence to Guide Practice: Challenging Practice Habits

Posicionamento de sonda enteral em neonatos segundo técnica modificada de mensuração

Randomized Clinical Trial Comparing Two Methods of Measuring Insertion Length of Nasogastric Tubes in Newborns

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