Ellett M L, Maahs J, Forsee S
Indiana University School of Nursing, Indianapolis 46202-5107, USA.
MCN Am J Matern Child Nurs. 1998 Sep-Oct;23(5):234-9. doi: 10.1097/00005721-199809000-00004.
The purpose of this study was to determine the prevalence of feeding tube placement errors in children.
The hospital records of 201 children having both an enteral tube and at least one radiograph showing tube placement were retrospectively reviewed. Chart review was also used to determine the risk factors associated with these errors. Tube placement error was defined as tube tip or orifices in the esophagus or intestine (if the tube was supposed to be in the stomach) or tip or orifices in the esophagus or stomach (if the tube was supposed to be in the intestine.)
On the first day, a radiograph documenting tube placement showed that 32 of the 201 children (15.9%) had tube placement errors. Overall, 53 tube placement errors were evident during the 385 observation days on which radiographs were obtained (13.8%). Of the 201 children, 42 (20.9%) had experienced tube placement errors at some time during the period reviewed. Over all radiograph days, activity level was independently related to radiographic tube placement (p = < 0.02), with more errors among active children. Also, classification regression tree analysis showed that age, level of consciousness (alert or comatose versus semicomatose), abdominal distention, vomiting, and orogastric tubes were associated with more tube placement errors.
Nurses need to be especially careful in assessing tube placement if the pediatric client has one or more of the identified risk factors. Health care providers need to carefully weigh the benefits and risks of feeding by nasal or oral enteral tubes versus the benefits and risks of feeding by endoscopically or surgically placed enteral tubes.
本研究旨在确定儿童喂养管放置错误的发生率。
回顾性分析201例同时留置肠内营养管且至少有一张显示导管位置的X光片的儿童的医院记录。还通过病历审查来确定与这些错误相关的危险因素。导管放置错误的定义为：导管尖端或开口位于食管或肠道（如果导管应置于胃内），或者导管尖端或开口位于食管或胃内（如果导管应置于肠道内）。
第一天，记录导管位置的X光片显示，201例儿童中有32例（15.9%）存在导管放置错误。总体而言，在获取X光片的385个观察日中，共发现53例导管放置错误（13.8%）。在201例儿童中，有42例（20.9%）在回顾期内的某个时间出现过导管放置错误。在所有X光片检查日中，活动水平与X光片显示的导管位置独立相关（p = < 0.02），活动较多的儿童中错误更多。此外，分类回归树分析显示，年龄、意识水平（清醒或昏迷与半昏迷）、腹胀、呕吐和口胃管与更多的导管放置错误有关。
如果儿科患者有一个或多个已确定的危险因素，护士在评估导管位置时需要格外小心。医疗保健提供者需要仔细权衡经鼻或经口肠内营养管喂养的利弊与经内镜或手术放置肠内营养管喂养的利弊。
