Evaluation of methods used to verify nasogastric feeding tube placement in hospitalized infants and children - A follow-up study.

BACKGROUND: Nasogastric (NG) feeding tubes are used to deliver nutrition, hydration, and medications to hospitalized infants and children but the ongoing use of non-evidence-based practice (EBP) methods to confirm NG tube (NGT) placement has been associated with adverse patient events. METHODS: A study was undertaken to ascertain if practice changes have occurred since findings from a previous study were published by the New Opportunities for Verification of Enteral tube Location (NOVEL) project. The NOVEL project was an initiative of the American Society of Parenteral and Enteral Nutrition (ASPEN). A survey was distributed to member organizations participating in the NOVEL project. Respondents were also asked if and when a change in practice occurred in the policy for NGT placement verification, if there was variation within the institutional units and if there were barriers to practice change. FINDINGS: Respondents were primarily nurses (205/245) from 166 institutions that provided care to combined adult/pediatric/neonatal (122/166) patients. Respondents indicated a radiograph (64%) or pH measurement (24%) were best practice but in actual practice 42% use pH measurement and 23% use a radiograph to verify NGT placement. There was variability within institutions, with the Neonatal Intensive Care Unit (NICU) most often using aspiration and direct eye visualization to verify placement and the other units within the institutions using EBP method(s). DISCUSSION: Comparing these results to previous work by the NOVEL project shows an increase toward the use of EBP method(s) to verify NGT placement verification. APPLICATION TO PRACTICE: This study demonstrates variation within units at the same facility using methods unsupported by the literature, demonstrating that many centers still rely on non-EBP methods of NG placement confirmation, despite cautions issued by many major healthcare organizations.

A call to action: the development of enteral access safety teams.

Safety concerns regarding the verification of nasogastric feeding tube placement prompted the American Society for Parenteral and Enteral Nutrition to call for an interdisciplinary, interorganizational group to work on best practices and new technologies to address this issue in pediatric patients. This commentary calls for the development of specialized teams within hospitals to improve the quality of care provided to children and infants who require nasogastric feeding tubes. It is expands on the information presented in an article in the issue by Irving et al regarding the current status of nasogastric tube placement and verification methods.