Northington LaDonna, Kemper Carol, Rempel Gina, Lyman Beth, Pauley Rosemary, Visscher Deahna, Moore Candice, Guenter Peggi
University of Mississippi Medical Center School of Nursing, 2500 North State Street, Jackson, MS 39216, United States of America.
Sr. Vice President, Service & Performance Excellence Improvement Center, Children's Mercy Kansas City, United States of America.
J Pediatr Nurs. 2022 Mar-Apr;63:72-77. doi: 10.1016/j.pedn.2021.10.018. Epub 2021 Nov 8.
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.
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.
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).
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.
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.
鼻胃管用于为住院婴幼儿和儿童提供营养、补液及药物，但持续采用非循证实践（EBP）方法来确认鼻胃管（NGT）位置与不良患者事件相关。
开展一项研究，以确定自肠内管位置验证新机遇（NOVEL）项目发表前一项研究的结果以来，实践是否发生了变化。NOVEL项目是美国肠外与肠内营养学会（ASPEN）发起的一项倡议。向参与NOVEL项目的成员组织发放了一份调查问卷。还询问了受访者NGT位置验证政策是否以及何时发生了实践变化、机构内部单位之间是否存在差异以及实践变革存在哪些障碍。
受访者主要是来自166家机构的护士（205/245），这些机构为成人/儿科/新生儿混合患者（122/166）提供护理。受访者表示，X线片（64%）或pH值测量（24%）是最佳实践，但在实际操作中，42%的人使用pH值测量，23%的人使用X线片来验证NGT位置。各机构内部存在差异，新生儿重症监护病房（NICU）最常使用抽吸和直接肉眼观察来验证位置，而机构内的其他单位则使用循证实践方法。
将这些结果与NOVEL项目之前的工作进行比较，结果表明在使用循证实践方法来验证NGT位置方面有所增加。
本研究表明，同一机构内各单位在使用文献未支持的方法，这表明许多中心仍依赖非循证实践方法来确认鼻胃管位置，尽管许多主要医疗保健组织已发出警告。
