Nasogastric Tube Position

De Boer J & Smit BJ. Nasogastric Tube Position and Intragastric Air Collection in a Neonatal Intensive Care Population. Advances in Neonatal Care (Dec 2009); 9: 293-298. PDF

PURPOSE: For neonates receiving intensive care, nasogastric tube feeding is essential. Since nasogastric tube placement techniques are not well standardized and common verification methods can be unreliable, placement errors may lead to unsafe situations. In mechanically ventilated neonates and neonates on continuous positive airway pressure, malpositioning of the nasogastric tube may prevent excess air within the stomach to escape. In this study, we aimed to relate tube position to amount of air. The hypothesis was: the better the position of the tube, the smaller the amount of air in the stomach.

SUBJECTS: A 1-year cohort of neonates in a level IIIc neonatal intensive care unit with a nasogastric tube.

DESIGN AND METHODS: We retrospectively reviewed 326 radiographs and classified nasogastric tube position and gastric air. Descriptive statistics were used to describe demographic data. Kendal’s statistic was applied to explore the relationship between nasogastric tube position and amount of gastric air. A Mann—Whitney U test was performed to confirm the differences in gastric air in neonates with Ch5 and Ch6 gastric tubes and neonates with Ch8 gastric tubes.

RESULTS: One or both orifices of nasogastric tubes were in the esophagus in 7.1% of cases, tubes were curled up in the stomach in 35.3% of cases, and tube tips were beyond the pyloric sphincter in 5.5% of cases. Substantial or excessive air was found in 37.7% of cases. Kendal’s value indicated that there was no significant correlation between nasogastric tube position and gastric air. The Mann—Whitney U value indicated that children with Ch5 and Ch6 gastric tubes had significantly more gastric air than children with Ch8 gastric tubes.

CONCLUSION: Nasogastric tubes were malpositioned in nearly half of cases, and substantial or excessive air was found in more than one-third of cases. The hypothesis—the better the position of the tube, the smaller the amount of gastric air—was not confirmed by the data. However, a significant relationship was found between tube size and gastric air.

Comments: This is an interesting descriptive study that potentially impacts daily care for our population. It brings up many questions – how competent are we in gastric tube placement, are there tools/measures to ensure better accuracy or do we need to perform routine x-ray to confirm placement, which gastric tubes should we use and how often should they be replaced, would routine manual extraction of gastric air be of benefit? We properly focus on the benefits of early enteral nutrition; perhaps we should also further investigate the safest method of delivery. Mindy Morris