title: Nasogastric tube placement and verification in children: review of the current literature.
abstract: Placement of a nasogastric enteral access device (NG-EAD), often referred to as a nasogastric tube, is common practice and largely in the domain of nursing care. Most often an NG-EAD is placed at the bedside without radiographic assistance. Correct initial placement and ongoing location verification are the primary challenges surrounding NG-EAD use and have implications for patient safety. Although considered an innocuous procedure, placement of an NG-EAD carries risk of serious and potentially lethal complications. Despite acknowledgment that an abdominal radiograph is the gold standard, other methods of verifying placement location are widely used and have success rates from 80% to 85%. The long-standing challenges surrounding bedside placement of NG-EADs and a practice alert issued by the Child Health Patient Safety Organization on this issue were the stimuli for the conception of The New Opportunities for Verification of Enteral Tube Location Project sponsored by the American Society for Parenteral and Enteral Nutrition. Its mission is to identify and promote best practices with the potential of technology development that will enable accurate determination of NG-EAD placement for both the inpatient and outpatient pediatric populations. This article presents the challenges of bedside NG-EAD placement and ongoing location verification in children through an overview of the current state of the science. It is important for all health care professionals to be knowledgeable about the current literature, to be vigilant for possible complications, and to avoid complacency with NG-EAD placement and ongoing verification of tube location.
authors.affiliation: Sharon Y. Irving is a pediatric critical care nurse practitioner at The Children's Hospital of Philadelphia and an assistant professor at the University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania. She is the AACN liaison for the New Opportunities for Verification of Enteral Tube Location (NOVEL) project sponsored by the American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.).Beth Lyman is a senior program coordinator for the nutrition support team at Children's Mercy Hospital in Kansas City, Missouri, and is the chair of the NOVEL project sponsored by A.S.P.E.N.LaDonna Northington is director of the traditional undergraduate program at the University of Mississippi, School of Nursing, in Jackson, and a member of the Society of Pediatric Nursing.Jacqueline A. Bartlett is director of evidence-based practice at Children's Mercy Hospital in Kansas City, Missouri.Carol Kemper is vice president of quality and safety at Children's Mercy Hospital in Kansas City, Missouri and a steering committee member for the Children Health Patient Safety Organization/Children's Hospital Association. ysha@nursing.upenn.edu.
authors.forename: Sharon Y
authors.initials: SY
authors.lastname: Irving
authors.affiliation: Sharon Y. Irving is a pediatric critical care nurse practitioner at The Children's Hospital of Philadelphia and an assistant professor at the University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania. She is the AACN liaison for the New Opportunities for Verification of Enteral Tube Location (NOVEL) project sponsored by the American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.).Beth Lyman is a senior program coordinator for the nutrition support team at Children's Mercy Hospital in Kansas City, Missouri, and is the chair of the NOVEL project sponsored by A.S.P.E.N.LaDonna Northington is director of the traditional undergraduate program at the University of Mississippi, School of Nursing, in Jackson, and a member of the Society of Pediatric Nursing.Jacqueline A. Bartlett is director of evidence-based practice at Children's Mercy Hospital in Kansas City, Missouri.Carol Kemper is vice president of quality and safety at Children's Mercy Hospital in Kansas City, Missouri and a steering committee member for the Children Health Patient Safety Organization/Children's Hospital Association.
authors.forename: Beth
authors.initials: B
authors.lastname: Lyman
authors.affiliation: Sharon Y. Irving is a pediatric critical care nurse practitioner at The Children's Hospital of Philadelphia and an assistant professor at the University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania. She is the AACN liaison for the New Opportunities for Verification of Enteral Tube Location (NOVEL) project sponsored by the American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.).Beth Lyman is a senior program coordinator for the nutrition support team at Children's Mercy Hospital in Kansas City, Missouri, and is the chair of the NOVEL project sponsored by A.S.P.E.N.LaDonna Northington is director of the traditional undergraduate program at the University of Mississippi, School of Nursing, in Jackson, and a member of the Society of Pediatric Nursing.Jacqueline A. Bartlett is director of evidence-based practice at Children's Mercy Hospital in Kansas City, Missouri.Carol Kemper is vice president of quality and safety at Children's Mercy Hospital in Kansas City, Missouri and a steering committee member for the Children Health Patient Safety Organization/Children's Hospital Association.
authors.forename: LaDonna
authors.initials: L
authors.lastname: Northington
authors.affiliation: Sharon Y. Irving is a pediatric critical care nurse practitioner at The Children's Hospital of Philadelphia and an assistant professor at the University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania. She is the AACN liaison for the New Opportunities for Verification of Enteral Tube Location (NOVEL) project sponsored by the American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.).Beth Lyman is a senior program coordinator for the nutrition support team at Children's Mercy Hospital in Kansas City, Missouri, and is the chair of the NOVEL project sponsored by A.S.P.E.N.LaDonna Northington is director of the traditional undergraduate program at the University of Mississippi, School of Nursing, in Jackson, and a member of the Society of Pediatric Nursing.Jacqueline A. Bartlett is director of evidence-based practice at Children's Mercy Hospital in Kansas City, Missouri.Carol Kemper is vice president of quality and safety at Children's Mercy Hospital in Kansas City, Missouri and a steering committee member for the Children Health Patient Safety Organization/Children's Hospital Association.
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Bartlett
authors.affiliation: Sharon Y. Irving is a pediatric critical care nurse practitioner at The Children's Hospital of Philadelphia and an assistant professor at the University of Pennsylvania, School of Nursing, Philadelphia, Pennsylvania. She is the AACN liaison for the New Opportunities for Verification of Enteral Tube Location (NOVEL) project sponsored by the American Society of Parenteral and Enteral Nutrition (A.S.P.E.N.).Beth Lyman is a senior program coordinator for the nutrition support team at Children's Mercy Hospital in Kansas City, Missouri, and is the chair of the NOVEL project sponsored by A.S.P.E.N.LaDonna Northington is director of the traditional undergraduate program at the University of Mississippi, School of Nursing, in Jackson, and a member of the Society of Pediatric Nursing.Jacqueline A. Bartlett is director of evidence-based practice at Children's Mercy Hospital in Kansas City, Missouri.Carol Kemper is vice president of quality and safety at Children's Mercy Hospital in Kansas City, Missouri and a steering committee member for the Children Health Patient Safety Organization/Children's Hospital Association.
authors.forename: Carol
authors.initials: C
authors.lastname: Kemper
mesh_terms: D002648:Child; D004750:Enteral Nutrition / Q000295:instrumentation / Q000451:nursing*; D019317:Evidence-Based Medicine; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007202:Indicators and Reagents; D007297:Inpatients; D007441:Intubation, Gastrointestinal / Q000009:adverse effects / Q000451:nursing*; D019300:Medical Errors / Q000451:nursing* / Q000517:prevention & control; D010045:Outpatients; D017410:Practice Guidelines as Topic; D011860:Radiography, Abdominal / Q000451:nursing*; D012956:Societies, Nursing
chemical_list: D007202:Indicators and Reagents