RESUMEN
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.
Asunto(s)
Jugo Gástrico/química , Intubación Gastrointestinal/métodos , Errores Médicos/prevención & control , Radiografía Abdominal , Factores de Edad , Análisis de Varianza , Auscultación , Bilirrubina/metabolismo , Dióxido de Carbono/metabolismo , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Concentración de Iones de Hidrógeno , Lactante , Recién Nacido , Masculino , Errores Médicos/estadística & datos numéricos , Sensibilidad y EspecificidadRESUMEN
PURPOSE: The purpose of this study was to compare the accuracy and predictive validity of pH, bilirubin, and CO2 in identifying gastric tube placement errors in children. DESIGN AND METHODS: After the tube was inserted into 276 children, the CO2 monitor reading was obtained. Fluid was then aspirated to test pH and bilirubin. RESULTS: Lack of ability to obtain tube aspirate was the best predictor of NG/OG placement errors with a sensitivity of 34.9% and a positive predictive value of 66.7%. Measuring pH, bilirubin, and CO2 of tube aspirate was less helpful. PRACTICE IMPLICATIONS: Healthcare providers should suspect NG/OG tube misplacement when no fluid is aspirated.
Asunto(s)
Intubación Gastrointestinal , Bilirrubina/metabolismo , Líquidos Corporales , Dióxido de Carbono/metabolismo , Niño , Humanos , Concentración de Iones de Hidrógeno , Intubación Gastrointestinal/métodos , Intubación Gastrointestinal/enfermería , Errores Médicos , Enfermería Pediátrica , Sistemas de Atención de Punto , Sensibilidad y EspecificidadRESUMEN
PURPOSE: The purpose was to compare three methods of predicting the gastric tube insertion length in children 1 month to 17 years of age: age-related, height-based (ARHB); nose-ear-xiphoid (NEX); and nose-ear-mid-umbilicus (NEMU). DESIGN AND METHODS: The design was a randomized controlled trial. Children were randomly assigned to the ARHB, NEX, or NEMU groups. Tubes placed high were considered to be misplaced. RESULTS: There were significant differences in percentages of correctly placed tubes, with ARHB and NEMU being more accurate than NEX. PRACTICE IMPLICATIONS: NEX should no longer be used as a gastric tube insertion-length predictor. Either ARHB or NEMU should be used.