Page 185 - Encyclopedia of Nursing Research

152 n ENTERAL TUBE PLACEMENT

length to place a gastric tube was presented in 103 older children (>1 month of age), 97%
by Royce, Tepper, Watson, and Day (1951) in inserted using NEMU, 89% of the tubes
E which they reported their 6-month experi- inserted using ARHB, and 59% using NEX
ence of feeding 30 premature infants weigh- were correctly placed in the stomach, duode-
ing less than 1,800 g with indwelling NG num, or pylorus regions (Ellett, Cohen, et al.,
tubes with 28/30 of the infants surviving. in preparation). Many tubes were inserted
What Royce et al. actually wrote was that the lengths longer than the direct distance from
NG tube was inserted until it was “estimated the gastroesophageal junction (GEJ) to the
by rough measurement to have entered the pylorus, but most followed the natural cur-
stomach” (p. 79). A nursing textbook cited vature of the stomach. A few passed into the
this article as a reference for the NEX inser- pylorus or through the pylorus into the duo-
tion-length predictor. After that, authors/ denum. There appears to be no way to pre-
editors of other nursing textbooks either dict which way a tube will curve. Therefore,
cited this nursing textbook or a previous only high tube placements in the esophagus
edition of their nursing textbook as a refer- or at the GEJ were considered placement
ence for NEX. This insertion-length predictor errors in this analysis. During insertion, five
remains the most commonly used method in tubes coiled in the esophagus leaving the tips
clinical practice. Although several research of the tubes near the entrance to the respira-
groups over the years have found the NEX tory tract. These placement errors would not
insertion-length predictor to be too short in have been known before feeding through
children frequently leaving the tube tip and the tubes without the abdominal radiograph
orifices, through which liquid feeding exits required as part of the study. A new regres-
the tube, in the esophagus (Beckstrand, Ellett, sion equation specific to neonates <1 month
& McDaniel, 2007; Ellett, Croffie, et al., 2005; corrected age was developed as an outcome
Weibley, Adamson, Clinkscales, Curran, & of this study (Ellett et al., submitted).
Bramson, 1987; Ziemer & Carroll, 1978), a Two studies investigated insertion-length
recent randomized controlled trial, involving predictors for gastric tube placement in adults.
276 children with chronological ages ranging in a study of 99 adult cadavers and 5 normal
from 27 weeks gestational age + 1.7 weeks to volunteers, Hanson (1979) concluded that the
17 years 8 months, will hopefully lead to the use of the NEX length to determine the inser-
demise of using the NEX insertion-length tion length for NG tubes was less accurate
predictor in clinical practice. This group than the formula ([NEX – 50 cm]/2 + 50 cm)
found that two NG/OG tube insertion-length adapted from a regression equation using
predictors: (a) measuring from the nose to the NEX, resulting in 91.4% accuracy for estimat-
bottom of the ear lobe to the mid-umbilicus ing the distance for placing the NG tube tip
(half way between the umbilicus and the correctly in the stomach. Ellett, Beckstrand,
xiphoid) (NEMU) and (b) age-related, height- et al. (2005) recommended a three-variable
based (ARHB) regression equations—were regression model using gender, weight, and
significantly superior to NEX in children the length measured from the nose to the
(Ellett et al., submitted; Ellett, Cohen, et al., umbilicus (NU) with the client lying supine
in preparation). in 173 neonates (<1 month with no pillow. Two nomograms, one for each
corrected age), 92% of NG/OG tubes inserted gender, were provided to make this insertion
using NEMU, 100% inserted using ARHB, distance predictor easier to use in practice.
and 61% inserted using NEX were correctly Currently, an abdominal radiograph
placed in the stomach, duodenum, or pylorus is the only consistently valid and reliable
regions (Ellett et al., submitted). in this study, way to verify the position of flexible small-
ARHB was only used in neonates >44.5 cm bore NG/OG/Ni tubes. Radiographs have
in length (Ellett et al., submitted). Similarly, been recommended by many to determine