Highlights
- •Placing and verifying NGT placement is commonly done by parents in the home.
- •Incorrect NGT verification in the home setting can cause life threatening sequela in children.
- •Parents are taught to replace NGTs in home based on what the nurse taught, which causes inconsistencies in procedures.
- •There is no accepted standard of care for replacement and verification of NGT in the home.
Abstract
Enteral feeding tubes are used in pediatric patients to deliver nutrition, fluids
or medications. The literature related to short-term feeding tube (nasogastric [NG],
hereafter known as NGT, or orogastric [OGT],) use in pediatric homecare patients is
sparse. This descriptive study sought to gather baseline information about these children
and how their feeding tubes are managed at home. Specifically, we sought to better
understand how the tubes are placed and the method(s) used for tube placement verification.
Two surveys were distributed: one to parents and one to homecare providers who have
direct patient contact.
Results
Responses were obtained from 144 parents and 66 homecare providers. Over half of the
children were 12 months of age or younger and had a 6 Fr feeding tube. Over 75% (108) had an NGT for
1 year or less. Predominantly parents replaced the NGT but a few children self-inserted
their tubes. Feeding tube placement was verified by auscultation (44%) or measurement
of gastric pH (25%) in the parent's survey. Twenty-six percent of parents indicated
they had misplaced an NGT at least once and 35 parents described symptoms of pulmonary
misplacement. The homecare provider data indicated auscultation (39%) and pH measurement
of gastric contents (28%) to verify NG tube placement location.
Study results confirms a need for consistency of practice among health care professionals
and in parent education for those children who require NGTs at home. It is troubling
that auscultation is still widely used for NGT location confirmation despite practice
alerts that warn against its use.
Keywords
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References
- Pediatric enteral access device management.Nutrition in Clinical Practice. 2016; 31: 748-761
- AACN practice alert: Verification of feeding tube placement (blindly inserted).American Association of Critical-Care Nurses, Aliso Viejo, CA2010
- Ergonomic risk assessment of nasogastric tube placement and implications for design and training.Work. 2012; 41: 4689-4691https://doi.org/10.3233/WOR-2012-0111-4689
- Enteral nutrition practice recommendations.Journal of Parenteral and Enteral Nutrition. 2009; 33: 122-167
- Securing of naso-gastric tubes in adults: A review.International Journal of Nursing Studies. 2014; 51: 943-950
- Oral and nasal enteral tube placement errors and complications in a pediatric intensive care unit.Pediatric Critical Care Medicine. 2007; 8: 161-164
- Use of enteral nutrition for the control of intestinal inflammation in pediatric Crohn's disease.Journal of Pediatric Gastroenterology and Nutrition. 2012; 54: 298-305
- Home enteral nutrition in children: An 11 year experience with 416 patients.Clinical Nutrition. 2005; 24 (Feb): 48-54
- Clinical costs of feeding tube placement.Journal of Parenteral and Enteral Nutrition. 2007; 31: 269-274
- Nasogastric tube position and intragastric air collection in a neonatal intensive care population.Advances in Neonatal Care. 2009; 9: 293-296
- What is known about methods of correctly placing gastric tubes in adults and children.Gastroenterology Nursing. 2004; 27: 253-259
- Gastric tube placement in young children.Clinical Nursing Research. 2005; 14: 238-252
- Comparing methods of determining insertion length for placing gastric tubes in children 1 month to 17 years of age.Journal for Specialists in Pediatric Nursing. Jan 2012; 17: 19-32
- Monitoring of home safety issues in children on enteral feeds with inherited metabolic disorders.Archives of Disease in Childhood. 2010; 95 (Sept): 668-672
- Nasogastric tube placement verification in pediatric and neonatal patients.Pediatric Nursing. 2009; 35: 17-24
- Determination of a practical pH cutoff level for reliable confirmation of nasogastric tube placement.Journal of Parenteral and Enteral Nutrition. 2011; 35: 540-544
- Ionising radiation: Promoting safety for patients, visitors, and staff.Nursing Standard. 2006; 20: 47-57
- Nasogastric tube placement and verification in children: Review of the current literature.Nutrition in Clinical Practice. 2014; 29: 267-276
- A call to action: The development of enteral access safety teams.Nutrition in Clinical Practice. 2014; 29: 264-266
- Cancer risks following diagnostic and therapeutic radiation exposure in children.Pediatric Radiology. 2006; 36: 121-125
- Best evidence: Nasogastric tube placement verification.Journal of Pediatric Nursing. 2011; 26: 373-376
- Use of temporary enteral access devices in hospitalized neonatal and pediatric patients in the United States.Journal of Parenteral and Enteral Nutrition. 2016; 40: 574-580
- pH testing of feeding tube aspirate to determine placement.Nutrition in Clinical Practice. 1994; 9: 185-190
- Blind insertion of feeding tubes in intensive care units: A national survey.American Journal of Critical Care. 2012; 21: 352-360
- (Accessed 13 December 2016)
- Reducing the harm caused by misplaced nasogastric feeding tubes in adults, children, and infants.(March 10,)
- The NOVEL project update.Journal of Pediatric Nursing. 2014; 29: 484-488
- Home enteral nutrition in children: A 10 year experience with 304 pediatric patients.Nutrición Hospitalaria. 2012; 27 (Sept-Oct): 1444-1450
- Malposition of feeding tubes in neonates: Is it an issue?.Journal of Pediatric Gastroenterology and Nutrition. 2009; 48: 608-611
- Home nasogastric feeds: Feeding status and growth outcomes in a pediatric population.Journal of Parenteral and Enteral Nutrition. 2016; 40: 350-354
- Child Healthcare Association PSO and ERCI Institute.2012
- Optimizing transition to home enteral nutrition for pediatric patients.Nutrition in Clinical Practice. 2016; 31: 762-768
- Enhancing patient safety during feeding-tube insertion: A review of more than 2000 insertions.Journal of Parenteral and Enteral Nutrition. 2006; 30: 440-445
- Confirming nasogastric feeding tube position versus the need to feed.Intensive & Critical Care Nursing. 2013; 29: 59-69
Article info
Publication history
Published online: February 07, 2017
Accepted:
January 18,
2017
Received in revised form:
December 29,
2016
Received:
May 23,
2016
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
