Clifford Patricia, Ely Elizabeth, Heimall Lauren
The Children's Hospital of Philadelphia, Pennsylvania.
Adv Neonatal Care. 2017 Feb;17(1):19-26. doi: 10.1097/ANC.0000000000000364.
Patients in the neonatal intensive care unit are a vulnerable population with specific nutritional requirements, which include increased protein and caloric needs for adequate growth. Some infants cannot tolerate gastric feeds and need to have postpyloric feeds to grow. Placement of a postpyloric tube can be done by gastric insufflation. Gastric insufflation is a technique where air is inserted into the stomach as a nasogastric tube is advanced through the pylorus to the duodenum. There is research to support this technique in pediatrics, but scant evidence exists for placement of postpyloric tubes in the infant population.
The aim of this quality improvement practice project was to determine whether the current practice for postpyloric tube placement by the bedside nurses in the neonatal intensive care unit is safe and effective.
Data were prospectively collected on 38 infants requiring placement of 60 postpyloric tubes over an 8-week period.
The results indicate a success rate of 95.6% for tube placement when a subset of infants diagnosed with congenital diaphragmatic hernia (CDH) (n = 15) was excluded. Six (40%) of the 15 infants with CDH had postpyloric tubes placed successfully. Nursing years of experience did not affect successful postpyloric tube placement.
The postpyloric tube placement policy was modified as a result of findings from this project. Placement of a postpyloric tube with one attempt by the bedside nurse was safe and effective in most preterm infants in our care excluding patients with CDH. The new policy reduced infants' exposure to radiation due to a decrease in the number of x-rays in comparison to interventional radiology placement.
Further research should be done by units that primarily care for low birth-weight premature infants.
新生儿重症监护病房的患者是弱势群体，有特定的营养需求，包括为实现充分生长而增加蛋白质和热量需求。一些婴儿无法耐受经胃喂养，需要进行幽门后喂养以实现生长。幽门后管的放置可通过胃内注气法完成。胃内注气法是一种在鼻胃管经幽门推进至十二指肠时向胃内注入空气的技术。有研究支持该技术在儿科中的应用，但关于在婴儿群体中放置幽门后管的证据却很少。
本质量改进实践项目的目的是确定新生儿重症监护病房床边护士当前进行幽门后管放置的做法是否安全有效。
在8周期间前瞻性收集了38例需要放置60根幽门后管的婴儿的数据。
当排除一组诊断为先天性膈疝（CDH）的婴儿（n = 15）时，管放置成功率为95.6%。15例CDH婴儿中有6例（40%）成功放置了幽门后管。护士的工作年限并未影响幽门后管的成功放置。
根据该项目的研究结果，对幽门后管放置政策进行了修改。床边护士一次尝试放置幽门后管对我们护理的大多数早产儿（不包括CDH患者）是安全有效的。与介入放射学放置相比，新政策减少了X射线照射次数，从而减少了婴儿的辐射暴露。
主要照顾低出生体重早产儿的单位应进一步开展研究。
