Nasogastric Tube Placement Verification in Pediatric and Neonatal Patients
Nasogastric Tube Placement Verification in Pediatric and Neonatal Patients
This article reports an evidence-based practice project using the Iowa Model of Evidence-Based Practice to Promote Quality Care for a common nursing procedure, nasogastric tube placement verification in children. Little research exists regarding the care of nasogastric tubes in children, and traditional verification methods prevail. Auscultation of air insufflation over the abdomen is still used to check placement in many settings, despite research dating back to the 1980s questioning this approach. X-ray remains the only certain way to verify placement, but getting an X-ray before each feeding would be costly and impractical. Additional bedside methods are needed. Project results demonstrate a decrease (93.3% to 46.2%) in the use of auscultation and improved use of other, more reliable methods to determine nasogastric tube placement. Changing practice can be challenging. However, with persistence and re-infusion, this project provides an important example of how the evidence-based practice process leads to excellence and improves patient care.
Pediatric nurses have always been strong advocates of providing high-quality patient care. The evidence-based practice process offers an opportunity to support updating nursing practice based on the strongest research evidence available, in combination with patient and family values and sound clinical judgment (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000). Using the evidence-based practice process results in improved patient outcomes, often while reducing costs, and provides an opportunity for bedside clinicians to demonstrate an important impact on health care. Traditional nursing practices provide a wonderful opportunity to question practice and potentially improve patient care, which can be very empowering for staff nurses.
Nasogastric (NG) tube placement is a routine procedure used for pedi-atric and neonatal patients. However, little research exists regarding the verification of NG tubes in children. Several clinical studies and anecdotal reports questioning the use of auscultation to verify NG tube placement have been reported, some dating back more than 20 years (Ghahremani & Gould, 1986). However, the vast majority of nurses continue to check NG tube placement by auscultation of air insufflation over the abdomen.
Abstract and Introduction
Abstract
This article reports an evidence-based practice project using the Iowa Model of Evidence-Based Practice to Promote Quality Care for a common nursing procedure, nasogastric tube placement verification in children. Little research exists regarding the care of nasogastric tubes in children, and traditional verification methods prevail. Auscultation of air insufflation over the abdomen is still used to check placement in many settings, despite research dating back to the 1980s questioning this approach. X-ray remains the only certain way to verify placement, but getting an X-ray before each feeding would be costly and impractical. Additional bedside methods are needed. Project results demonstrate a decrease (93.3% to 46.2%) in the use of auscultation and improved use of other, more reliable methods to determine nasogastric tube placement. Changing practice can be challenging. However, with persistence and re-infusion, this project provides an important example of how the evidence-based practice process leads to excellence and improves patient care.
Introduction
Pediatric nurses have always been strong advocates of providing high-quality patient care. The evidence-based practice process offers an opportunity to support updating nursing practice based on the strongest research evidence available, in combination with patient and family values and sound clinical judgment (Sackett, Straus, Richardson, Rosenberg, & Haynes, 2000). Using the evidence-based practice process results in improved patient outcomes, often while reducing costs, and provides an opportunity for bedside clinicians to demonstrate an important impact on health care. Traditional nursing practices provide a wonderful opportunity to question practice and potentially improve patient care, which can be very empowering for staff nurses.
Nasogastric (NG) tube placement is a routine procedure used for pedi-atric and neonatal patients. However, little research exists regarding the verification of NG tubes in children. Several clinical studies and anecdotal reports questioning the use of auscultation to verify NG tube placement have been reported, some dating back more than 20 years (Ghahremani & Gould, 1986). However, the vast majority of nurses continue to check NG tube placement by auscultation of air insufflation over the abdomen.
