Methods to determine the internal length of nasogastric feeding tubes: An integrative review.
OBJECTIVE
Improper placement of nasogastric tube used for feeding may lead to serious complications, including death of the patient. There are several different methods used to determine the appropriate length of nasogastric tube for optimal placement in adults. This integrative review of the literature was designed to identify the most accurate method to determine the internal length of nasogastric feeding tube in adults.


METHODS
An integrative review of the research literature (1979-2015) using the population-intervention-comparison-outcomes strategy.


METHODS
The literature search included the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Joanna Briggs, PubMed (MEDLINE), SCOPUS, and Web of Science electronic databases.


METHODS
Two researchers evaluated the literature to determine if an article met inclusion and exclusion criteria. The quality of the evidence was assessed using the Johns Hopkins Strength of the Evidence critical appraisal tool.


RESULTS
Twenty studies, published between 1979 and 2014, met inclusion criteria. Of these, nine articles were expert opinion, seven were original research, three were review articles, and one was a guideline. Despite seven original research papers being found, only five reports were about the methods to determine the internal length of nasogastric feeding tube in adults. The literature suggests that four different methods for measuring the tube length are likely to result in proper placement of the tip of the tube in the stomach and all side ports inside it: [nose-to-ear-to-xiphisternum - 50]cm/2+50cm]; [gender-weight and nose-umbilicus-flat]; [xiphisternum-to-ear-to-nose+10cm]; [earlobe to xiphisternum to umbilicus - tip of the nose to earlobe]. Four studies found nose-to-ear-to-xiphisternum was most likely to result in a tube that is positioned incorrectly, either ending in the esophagus, in the stomach but too close to the esophagus, or too far into the stomach or duodenum.


CONCLUSIONS
The nose-to-ear-to-xiphisternum and Hanson method should no longer be taught in nursing programs or used in practice by the nurse. The [gender-weight and nose-umbilicus-flat] method has been shown to be safer.
School of Nursing (Fenf) - State University of Campinas (Unicamp), Thessaly Vieira de Camargo, 126 - Campus Box: 13083-970, Campinas, SP, Brazil(3). Electronic address: sanveiga@unicamp.br.
Sandra Cristina Veiga de Oliveira
SC
Santos
Illinois State University - Mennonite College of Nursing, Edwards Hall, Room 205, Campus Box 5815, Normal, IL 61790-5815, United States. Electronic address: wlwoith@ilstu.edu.
Wendy
W
Woith
School of Nursing (Fenf) - State University of Campinas (Unicamp), Thessaly Vieira de Camargo, 126 - Campus Box: 13083-970, Campinas, SP, Brazil(3). Electronic address: beloca4@yahoo.com.br.
Maria Isabel Pedreira de
MI
Freitas
School of Nursing (Fenf) - State University of Campinas (Unicamp), Thessaly Vieira de Camargo, 126 - Campus Box: 13083-970, Campinas, SP, Brazil(3). Electronic address: elietebbz@gmail.com.
Eliete Boaventura Bargas
EB
Zeferino
D000328:Adult; D004750:Enteral Nutrition / Q000379:methods*; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000295:instrumentation*
Adult; Complications; Enteral nutrition; Evidence-based practice; Gastric feeding tubes; Methods; Review; Tube feeding