Gastric Tube Placement in Young Children

Overview

Journal Clin Nurs Res

Specialty Nursing

Date 2005 Jul 5

PMID 15995153

Citations 9

Authors

Marsha L Cirgin Ellett

Joseph M B Croffie

Mervyn D Cohen

Susan M Perkins

Affiliations

Soon will be listed here.

Abstract

In this study, the internal position of a nasogastric/orogastric tube was determined in 72 children, prior to an abdominal radiograph, by measuring CO2 and pH and bilirubin of tube aspirate. Fifteen of the 72 tubes (20.8%) were incorrectly placed on radiograph. Using the suggested adult cutoff of pH 5, pH of aspirate correctly predicted misplacement outside the stomach in 7/28 (25%) of children and correctly predicted correct placement in the stomach in 34 of 40 children (85%). Using the suggested adult cutoff of bilirubin > or = 5 mg/dL, bilirubin monitoring failed to identify either of two incorrectly placed tubes. In this study, using an algorithm of assuming stomach placement if the pH of aspirate is < or = 5 and obtaining an abdominal radiograph when either no aspirate is obtained or the pH is >5 would have resulted in 92% accuracy. Alternatively, obtaining an abdominal radiograph would result in nearly 100% accuracy.

Citing Articles

Carbon dioxide detection for diagnosis of inadvertent respiratory tract placement of enterogastric tubes in children.

Smith F, McFarland A, Elen M Cochrane Database Syst Rev. 2025; 2:CD011196.

PMID: 39968844 PMC: 11837240. DOI: 10.1002/14651858.CD011196.pub2.

Verifying the placement and length of feeding tubes in canine and feline neonates.

Furthner E, Kowalewski M, Torgerson P, Reichler I BMC Vet Res. 2021; 17(1):208.

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Use of pH reagent strips to verify gastric tube placement in newborns.

Dias F, Almeida B, Alvares B, Jales R, de Siqueira Caldas J, Carmona E Rev Lat Am Enfermagem. 2019; 27:e3227.

PMID: 31826168 PMC: 6896807. DOI: 10.1590/1518-8345.3150.3227.

Bedside ultrasonography for the confirmation of gastric tube placement in the neonate.

Atalay Y, Polat A, Ozyazici Ozkan E, Tomak L, Aygun C, Tobias J Saudi J Anaesth. 2019; 13(1):23-27.

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

Dias F, Emidio S, Lopes M, Shimo A, Beck A, Carmona E Rev Lat Am Enfermagem. 2017; 25:e2908.

PMID: 28699995 PMC: 5511002. DOI: 10.1590/1518-8345.1841.2908.

References

Neumann M, Meyer C, Dutton J, Smith R . Hold that x-ray: aspirate pH and auscultation prove enteral tube placement. J Clin Gastroenterol. 1995; 20(4):293-5. View

Shiao S, DiFiore T . A survey of gastric tube practices in level II and level III nurseries. Issues Compr Pediatr Nurs. 1996; 19(3):209-20. DOI: 10.3109/01460869609026862. View

Metheny N, Stewart B . Testing feeding tube placement during continuous tube feedings. Appl Nurs Res. 2002; 15(4):254-8. DOI: 10.1053/apnr.2002.35946. View

Ellett M, Maahs J, Forsee S . Prevalence of feeding tube placement errors & associated risk factors in children. MCN Am J Matern Child Nurs. 1998; 23(5):234-9. DOI: 10.1097/00005721-199809000-00004. View

Metheny N . Minimizing respiratory complications of nasoenteric tube feedings: state of the science. Heart Lung. 1993; 22(3):213-23. View

Thomas B, Falcone R . Confirmation of nasogastric tube placement by colorimetric indicator detection of carbon dioxide: a preliminary report. J Am Coll Nutr. 1998; 17(2):195-7. DOI: 10.1080/07315724.1998.10718746. View

Metheny N, McSweeney M, Wehrle M, Wiersema L . Effectiveness of the auscultatory method in predicting feeding tube location. Nurs Res. 1990; 39(5):262-7. View

Theodore A, Frank J, Ende J, Snider G, Beer D . Errant placement of nasoenteric tubes. A hazard in obtunded patients. Chest. 1984; 86(6):931-3. DOI: 10.1378/chest.86.6.931. View

Metheny N, Stewart B, Smith L, Yan H, Diebold M, Clouse R . pH and concentrations of pepsin and trypsin in feeding tube aspirates as predictors of tube placement. JPEN J Parenter Enteral Nutr. 1997; 21(5):279-85. DOI: 10.1177/0148607197021005279. View

10.

Metheny N, Smith L, Stewart B . Development of a reliable and valid bedside test for bilirubin and its utility for improving prediction of feeding tube location. Nurs Res. 2000; 49(6):302-9. DOI: 10.1097/00006199-200011000-00002. View

11.

Burns S, Carpenter R, Truwit J . Report on the development of a procedure to prevent placement of feeding tubes into the lungs using end-tidal CO2 measurements. Crit Care Med. 2001; 29(5):936-9. DOI: 10.1097/00003246-200105000-00004. View

12.

Miller K, Sahn S . Mycosis fungoides presenting as ARDS and diagnosed by bronchoalveolar lavage. Radiographic and pathologic pulmonary manifestations. Chest. 1986; 89(2):312-4. DOI: 10.1378/chest.89.2.312. View

13.

Metheny N, Stewart B, Smith L, Yan H, Diebold M, Clouse R . pH and concentration of bilirubin in feeding tube aspirates as predictors of tube placement. Nurs Res. 1999; 48(4):189-97. DOI: 10.1097/00006199-199907000-00001. View

14.

Harris M, Huseby J . Pulmonary complications from nasoenteral feeding tube insertion in an intensive care unit: incidence and prevention. Crit Care Med. 1989; 17(9):917-9. DOI: 10.1097/00003246-198909000-00016. View

15.

Ellett M, Beckstrand J . Examination of gavage tube placement in children. J Soc Pediatr Nurs. 1999; 4(2):51-60. DOI: 10.1111/j.1744-6155.1999.tb00035.x. View

16.

El-Gamel A, Watson D . Transbronchial intubation of the right pleural space: a rare complication of nasogastric intubation with a polyvinylchloride tube--a case study. Heart Lung. 1993; 22(3):224-5. View

17.

Aronchick J, Epstein D, Gefter W, Miller W . Pneumothorax as a complication of placement of a nasoenteric tube. JAMA. 1984; 252(23):3287-8. View

18.

Metheny N, Reed L, Wiersema L, McSweeney M, Wehrle M, Clark J . Effectiveness of pH measurements in predicting feeding tube placement: an update. Nurs Res. 1993; 42(6):324-31. View

19.

Metheny N, Spies M, Eisenberg P . Frequency of nasoenteral tube displacement and associated risk factors. Res Nurs Health. 1986; 9(3):241-7. DOI: 10.1002/nur.4770090309. View