Page 184 - Encyclopedia of Nursing Research

ENTERAL TUBE PLACEMENT n 151

enteral tubes to maintain the structure and
EntEral tubE placEMEnt function of the small intestine. For many cli-
ents, feeding by enteral tubes is a lifesaving E
procedure.
An enteral tube is broadly defined as any Previous studies found NG/OG/Ni tube
tube passed through the nose or mouth into placement errors to be common, with prev-
the stomach or small intestine, or directly alence rates in adults ranging from 1.3% to
into the stomach or jejunum for the pur- 89.5% depending on how narrow or broad
pose of decompression, medication instilla- the definition of error was (McWey, Curry,
tion, and/or feeding. Feeding by nasogastric Schabel, & Reines, 1988; Niv & Abu-Avid,
(NG), orogastric (OG), or nasointestinal (Ni) 1988). Studies in children found between
tubes is preferred when the gastrointestinal 20.9% and 43.5% of NG/OG tubes are placed
(Gi) system is functional and the need for incorrectly when placement error is broadly
assisted feeding is expected to be short term defined as placement of the tube tip or orifices
(usually 6 weeks or less). Thus, many prema- outside the stomach (Ellett & Beckstrand,
ture infants are fed through these tubes until 1999; Ellett, Croffie, Cohen, & Perkins, 2005;
their suck and swallow mechanisms mature Ellett, Maas, & Forsee, 1998). Although esti-
sufficiently so they are able to coordinate mates of error rates vary, there is no doubt
sucking, swallowing, and breathing. Older they are too high.
children and adults requiring enteral nutri- Errors in placement of NG/OG feeding
tional support may also be fed through NG/ tubes, which include initial erroneous place-
OG/Ni tubes until a decision can be made ments as well as displacements over time,
whether or not long-term enteral nutritional can lead to serious complications. if a tube
support will be needed. For clients requir- ends in the airway, feeding through the tube
ing longer term support, a gastrostomy or will result in pulmonary aspiration or other
jejunostomy tube can be inserted surgically, pulmonary complications. Feeding through
endoscopically, or using ultrasound guid- a tube ending in the esophagus increases the
ance into the stomach or jejunum. it is also risk of pulmonary aspiration. When an NG/
possible to insert a jejunal tube through a OG tube erroneously passes into the duo-
gastrostomy tube allowing simultaneous denum and the client is fed formula requir-
decompression of the stomach and feeding ing both gastric and pancreatic enzymes for
into the jejunum. Because placement issues complete digestion, malabsorption resulting
related to gastrostomy/jejunostomy tubes in inadequate weight gain (or weight loss),
are different, only the issues surrounding diarrhea, and possibly dumping syndrome
NG/OG/Ni tubes will be discussed herein. may occur. increasing the safety of NG/OG
Enteral feeding is physiologic, achieves feeding requires knowledge development in
a positive nitrogen balance sooner than total at least two of the following areas: predicting
parenteral nutrition, enhances gut heal- the insertion length for correct tube place-
ing, reduces bacterial translocation, is asso- ment, determining tube position once placed,
ciated with low rates of sepsis, and is less and intermittent monitoring before feeding
costly (Ackerman, Ciechoski, & Marx, 1992; and medication instillations between inser-
Jolliet et al., 1999; Kiyama, Witte, Thornton, tions. The current state of the science regard-
& Barbul, 1998; Lipman, 1995; Schroeder, ing each of these knowledge needs will be
Gillanders, Mahr, & Hill, 1991; Strong et al., reviewed.
1992; Van Leeuwen et al., 1994; Zaloga, 1991). As far as researchers have been able
Even in clients maintained primarily by total to determine, the evidence for measuring
parenteral nutrition, small amounts of nutri- from the nose to the bottom of the earlobe
ents are fed into the lumen of the gut through to the xiphoid (NEX) to predict the insertion