title: Bedside Placement of the Postpyloric Tube in Infants.
abstract: BACKGROUND
  Patients in the neonatal intensive care unit are a vulnerable population with specific nutritional requirements, which include increased protein and caloric needs for adequate growth. Some infants cannot tolerate gastric feeds and need to have postpyloric feeds to grow. Placement of a postpyloric tube can be done by gastric insufflation. Gastric insufflation is a technique where air is inserted into the stomach as a nasogastric tube is advanced through the pylorus to the duodenum. There is research to support this technique in pediatrics, but scant evidence exists for placement of postpyloric tubes in the infant population.
  
  
  OBJECTIVE
  The aim of this quality improvement practice project was to determine whether the current practice for postpyloric tube placement by the bedside nurses in the neonatal intensive care unit is safe and effective.
  
  
  METHODS
  Data were prospectively collected on 38 infants requiring placement of 60 postpyloric tubes over an 8-week period.
  
  
  RESULTS
  The results indicate a success rate of 95.6% for tube placement when a subset of infants diagnosed with congenital diaphragmatic hernia (CDH) (n = 15) was excluded. Six (40%) of the 15 infants with CDH had postpyloric tubes placed successfully. Nursing years of experience did not affect successful postpyloric tube placement.
  
  
  CONCLUSIONS
  The postpyloric tube placement policy was modified as a result of findings from this project. Placement of a postpyloric tube with one attempt by the bedside nurse was safe and effective in most preterm infants in our care excluding patients with CDH. The new policy reduced infants' exposure to radiation due to a decrease in the number of x-rays in comparison to interventional radiology placement.
  
  
  CONCLUSIONS
  Further research should be done by units that primarily care for low birth-weight premature infants.
authors.affiliation: The Children's Hospital of Philadelphia, Pennsylvania.
authors.forename: Patricia
authors.initials: P
authors.lastname: Clifford
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ely
authors.forename: Lauren
authors.initials: L
authors.lastname: Heimall
mesh_terms: D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000451:nursing; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007327:Insufflation; D007441:Intubation, Gastrointestinal / Q000379:methods*; D008297:Male; D017283:Neonatal Nursing / Q000379:methods*; D011446:Prospective Studies; D011708:Pylorus; D058996:Quality Improvement; D013270:Stomach; D016896:Treatment Outcome