Predicting the Insertion Distance for Placing Gastric Tubes

Abstract

Approximately 1 million enteral tubes are placed through the nose or mouth in adults and children in the United States annually. Previous studies found gastric tube placement errors to be common. A primary issue in ensuring safe and effective gastric feeding by tube is achieving optimal tube position on insertion. The purpose of this study is to use 24 variables to develop a clinical prediction rule for gastric tube insertion distance in adults, using the internal-nares-to-distal-lower esophageal-sphincter distance. A three-variable model using gender, weight, and nose-umbilicus-flat was selected. This new model, validated using nonparametric bootstrap cross-validation, correctly predicted gastric tube insertion distance 85.3% of the time. This new model is compared to two other methods, one evidence based and one commonly used in practice, and was found to be superior. Two nomograms, one for each gender, are drawn to make this new model easier to use.

Methods to determine the internal length of nasogastric feeding tubes: An integrative review

“…According to Hanson's (1979) results, the best placement of a NGT should be the body or fundus of the stomach, located between 1 cm and 10 cm beyond the lower esophageal sphincter. Ellett et al (2005) determined best placement to be 3-10 cm beyond the lower esophageal sphincter.…”

“…Ellett et al (2005) used continuous transduced pressure recordings during esophageal motility studies to identify the location of the lower esophageal sphincter. Malta et al (2013) used an endoscope to mark and compare internal anatomical points with external anatomical points to determine the internal length of NGT.…”

“…Given the importance of correct placement of the NGT, it is necessary to have evidence demonstrating which external anatomical landmarks provide the best measure for correct placement (Malta et al, 2013). The NEX method remains the method most widely taught in nursing programs and used by practicing nurses for tube insertion in adults (Ellett et al, 2005;Taylor et al, 2014), but it may not be the safest approach.…”

„Neurally adjusted ventilatory assist“ (NAVA)

“…Sie wird blind weiter in den Ösopha gus vorgeschoben. Die Voraussage der idealen Tiefe der EAdiSonde wird an hand der Distanz zwischen Nase, Ohr und Xiphoid bestimmt und beruht auf anato mischen Messungen [18]. Die Berechnung ist von der Körpergröße und davon, ob die Sonde oral oder nasal platziert wird, ab hängig (Faktor 0,9 für nasale bzw.…”

Accurate positioning of the 24-hour pH monitoring catheter: Agreement between manometry and pH step-up method in two patient positions

“…The most popular method used for detecting this location is prior esophageal manometry. However, several measures have been employed to accurately determine the location of the LES, since manometric measurement (despite being essential to recognize motility disorders) is time consuming, is an invasive procedure [4][5][6][7][8][9][10] , is uncomfortable for patients, and leads to an increase in the cost of the diagnostic work-up. In the past, the pH step-up method has been used for this purpose, but the results obtained were conflicting [5,11] .…”