Procedures for measuring and verifying gastric tube placement in newborns: an integrative review

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.

Posicionamento de sonda enteral em neonatos segundo técnica modificada de mensuração

“…Although the NEX technique has been used for years in pediatrics, this method has not been validated in the literature and studies have shown that tubes inserted with use of this technique are mostly misplaced, located above the gastroesophageal junction. (3) The most recommended indication for measuring the enteral tube is the nose -ear -half the distance between the xiphoid appendix and the umbilicus (NEMU) technique, (11,(12)(13)(14) as it allows the tube location inside the body of the stomach. Such a recommendation is supported by the American Academy of Pediatrics Neonatal Resuscitation Program and the National Association of Neonatal Nurses.…”

“…(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).…”

“…(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. 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.…”

“…(8) Different techniques of measurement of the tube are identified in different neonatal services and in the literature, and there is no consensus on the best method for the correct placement in the gastric cavity. (3,9) The aim of this study was to evaluate the effectiveness of the measurement of enteral tube using the nose -ear -xiphoid (NEX) technique by disregarding the distal orifices of the tube, for placement in the gastric cavity of newborns.…”

Cuidados a criança em terapia nutricional enteral: conhecimento teórico e prático de técnicos de enfermagem

“…Dentre as iatrogenias relacionadas ao uso de sondas de alimentação, destaca-se a localização inadequada 11,18 . Diversos são os métodos que a enfermagem utiliza para se certificar sobre a locação correta da sonda alimentadora, inclusive alguns não recomendados na atualidade por não atenderem a padrões de segurança do paciente 19 .…”