Variation between residents and attending staff interpreting radiographs to verify placement of nutrition access devices in the neonatal intensive care unit.
BACKGROUND
Although radiography is considered the standard for confirming the position of nutrition access devices, it is sometimes difficult to visualize their tips. The purpose of this study was to evaluate how well pediatric residents could confirm placement via radiography of feeding tubes and intravenous (IV) nutrition catheter support in a neonatal intensive care unit (NICU).


METHODS
Seventy radiographs in a NICU during May 2013 were retrospectively evaluated. Eight pediatric residents (mean NICU experience, 5 months; range, 0-12 months) recorded the location of feeding tubes and IV nutrition catheters and marked their tips on computerized radiographs. Consensus review of radiographs by a radiologist and a NICU expert using a picture archiving communication system monitor in a reading room served as the reference standard. Detection rates and correct tip localization percentages were evaluated.


RESULTS
Of the 70 neonates, 38 had nutrition access devices: orogastric tube (n = 36), oroduodenal tube (n = 4), or central venous catheter (CVC) (n = 8). Detection rates were 89.6% for orogastric tubes (range, 75.0%-100%), 90.6% for oroduodenal tubes (range, 50.0%-100%), and 46.9% for CVCs (range, 12.5%-75.0%). Percentage of correct tip localizations was 85.7% for orogastric tubes (range, 74.1%-100%), 86.2% for oroduodenal tubes (range, 25.0%-100%), and 70% for CVCs (range, 50.0%-100%).


CONCLUSIONS
It is not easy for pediatrician residents to confirm the position of nutrition access devices in neonates by using radiographs. Reinforcement of radiology teaching, second opinions from radiologists or NICU experts, and other methods for verifying the positions of nutrition access devices are needed to minimize complications.
School of Medicine, Gachon University, Incheon, Republic of Korea.
Ki Hyun
KH
Lee
Department of Pediatrics, Gachon University Gil Hospital, Incheon, Republic of Korea.
Hye Jung
HJ
Cho
Department of Radiology, Gachon University Gil Hospital, Incheon, Republic of Korea oneshot0229@gmail.com.
Eun Young
EY
Kim
Department of Pediatrics, Gachon University Gil Hospital, Incheon, Republic of Korea.
Dong Woo
DW
Son
Department of Radiology, Gachon University Gil Hospital, Incheon, Republic of Korea.
Hyung Sik
HS
Kim
Department of Radiology, Gachon University Gil Hospital, Incheon, Republic of Korea.
Hye-Young
HY
Choi
Department of Radiology, Gachon University Gil Hospital, Incheon, Republic of Korea.
Jeong Ho
JH
Kim
D061605:Administration, Intravenous / Q000295:instrumentation* / Q000379:methods; D057785:Catheters; D004750:Enteral Nutrition / Q000379:methods; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D007396:Internship and Residency; D007441:Intubation, Gastrointestinal / Q000295:instrumentation* / Q000379:methods; D009752:Nutritional Status; D015588:Observer Variation; D011859:Radiography / Q000379:methods*; D011871:Radiology / Q000193:education*; D012189:Retrospective Studies
central venous catheters; enteral nutrition; feeding tube; neonatal intensive care units; patient safety; radiography