Purpose/Objectives:
The aims of this study were to determine the best method to predict the insertion distance for placing nasogastric/orogastric (NG/OG) tubes and to determine the best clinical methods of testing the location of NG/OG tubes once they were inserted.
Significance:
Feeding by an NG/OG tube is preferred when the gastrointestinal system is functional, and the need for assisted feeding is expected to be short term. Preliminary studies in children show that between 21% and 44% of these tubes are placed incorrectly. When tubes are out of place, children can be seriously harmed, causing increased morbidity and mortality.
Design:
Increasing the safety of children's NG/OG feeding requires knowledge development in predicting the insertion distance for correct tube placement and determining tube position; therefore, a randomized clinical trial was conducted.
Methods:
Three insertion-distance prediction methods were tested: nose-ear-xiphoid (NEX); nose-ear-mid-umbilicus (NEMU); and age-related, height-based (ARHB). An abdominal radiograph was obtained following tube insertion to determine the internal location of the tube tip and orifice(s). The 3 clinical methods of testing tube location were CO2 monitoring and measuring pH and bilirubin in tube aspirate.
Findings:
Based on the data from 95 children aged 1 to 215 months (mean, 51.8 [SD, 54.9] months; median, 33.4 months), both ARHB and NEMU had higher percentages for placing the NG/OG tube in the stomach compared with NEX (P = .0064); NEX was too short in 43.8% of the children, leaving the tube tip and/or orifices in the esophagus. Aspirate was available for testing in 82 children (88.42%). Based on a pH cutoff of 5, the sensitivity for detecting NG/OG tube misplacement was 26.67 (low), specificity was 80.60 (high), positive predictive value was 23.53 (low), and negative predictive value was 83.08 (high).
Conclusions:
Measuring the NEX distance is the method most commonly used by nurses in practice; therefore, based on the results of this study and studies of other researchers, a practice change to either ARHB or NEMU should improve the safety of enteral feeding in children.
Implications for Practice:
Because of the low sensitivity in predicting misplaced tubes using pH, the superior clinical method, obtaining an abdominal x-ray to ensure placement in the stomach at the time of tube insertion is recommended.
Section Description
The journal is proud to share the student abstracts accepted for poster presentation at the 2010 National Association of Clinical Nurse Specialists Conference. These abstracts are submitted under a separate, later deadline and therefore did not appear in the journal with the general abstracts. Congratulations to these CNS students and their faculty mentors.