Gastric Tube Placement in Young Children

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...

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Bibliographic Details
Published in:Clinical nursing research 2005-08, Vol.14 (3), p.238-252
Main Authors: Ellett, Marsha L. Cirgin, Croffie, Joseph M.B., Cohen, Mervyn D., Perkins, Susan M.
Format: Article
Language:English
Subjects:
Abdomen
Age Factors
Analysis of Variance
Artificial feeding
Auscultation
Bilirubin - metabolism
Carbon Dioxide - metabolism
Child
Child, Preschool
Children
Cross-Sectional Studies
Female
Gastric Juice - chemistry
Humans
Hydrogen-Ion Concentration
Infant
Infant, Newborn
Intubation, Gastrointestinal - methods
Male
Medical Errors - prevention & control
Medical Errors - statistics & numerical data
Nasogastric tubes
Radiography, Abdominal
Sensitivity and Specificity
Stomach
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Summary: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 ≥ 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 ≤ 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.
ISSN:1054-7738
1552-3799
DOI:10.1177/1054773805275121