Gastric tube placement in young children.
In this study, the internal position of a nasogastric/orogastric tube was determined in 72 children, prior to an abdominal radiograph, by measuring CO2 and pH and bilirubin of tube aspirate. Fifteen of the 72 tubes (20.8%) were incorrectly placed on radiograph. Using the suggested adult cutoff of pH 5, pH of aspirate correctly predicted misplacement outside the stomach in 7/28 (25%) of children and correctly predicted correct placement in the stomach in 34 of 40 children (85%). Using the suggested adult cutoff of bilirubin > or = 5 mg/dL, bilirubin monitoring failed to identify either of two incorrectly placed tubes. In this study, using an algorithm of assuming stomach placement if the pH of aspirate is < or = 5 and obtaining an abdominal radiograph when either no aspirate is obtained or the pH is >5 would have resulted in 92% accuracy. Alternatively, obtaining an abdominal radiograph would result in nearly 100% accuracy.
Indiana University School of Nursing, Indianapolis, USA.
Marsha L Cirgin
ML
Ellett
Joseph M B
JM
Croffie
Mervyn D
MD
Cohen
Susan M
SM
Perkins
D000367:Age Factors; D000704:Analysis of Variance; D001314:Auscultation; D001663:Bilirubin / Q000378:metabolism; D002245:Carbon Dioxide / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005750:Gastric Juice / Q000737:chemistry*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D007231:Infant, Newborn; D007441:Intubation, Gastrointestinal / Q000379:methods*; D008297:Male; D019300:Medical Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D011860:Radiography, Abdominal; D012680:Sensitivity and Specificity
D002245:Carbon Dioxide; D001663:Bilirubin