Abstract
ABSTRACTObjective:to investigate evidence in the literature on procedures for measuring gastric tube insertion in newborns and verifying its placement, using alternative procedures to radiological examination. Method:an integrative review of the literature carried out in the Cochrane, LILACS, CINAHL, EMBASE, MEDLINE and Scopus databases using the descriptors “Intubation, gastrointestinal” and “newborns” in original articles. Results:seventeen publications were included and categorized as “measuring method” or “technique for verifying placement”. Regarding measuring methods, the measurements of two morphological distances and the application of two formulas, one based on weight and another based on height, were found. Regarding the techniques for assessing placement, the following were found: electromagnetic tracing, diaphragm electrical activity, CO2 detection, indigo carmine solution, epigastrium auscultation, gastric secretion aspiration, color inspection, and evaluation of pH, enzymes and bilirubin. Conclusion:the measuring method using nose to earlobe to a point midway between the xiphoid process and the umbilicus measurement presents the best evidence. Equations based on weight and height need to be experimentally tested. The return of secretion into the tube aspiration, color assessment and secretion pH are reliable indicators to identify gastric tube placement, and are the currently indicated techniques.
Highlights
Insertion of Gastric Tube (GT) in Newborns (NB) hospitalized in the Neonatal Intensive Care Unit (NICU) is one of the most commonly performed nursing procedures. It is indicated for gastric decompression, administration of medications, and mainly for feeding the gastric tube process, and despite being a standard procedure for nurses working in the NICU, it is not risk free and involves decisions that may compromise patient safety[1]
The included studies were classified into two categories for data analysis: “Methods for measuring gastric tube” and “techniques for assessing gastric tube placement”
Minimum insertion measures proposed in this study are 13cm for newborns weighing less than 750g, 15cm for newborns weighing between 750 and 999g, 16cm for newborns weighing between 1,000 and 1,249g, and 17cm for those weighing between 1,250 and 1,499g. Application of this minimum insertion length method to a sample of 27 NBs weighing less than 1,500 g showed an increase in the proportion of correct gastric tube positioning from 62 to 86%
Summary
Insertion of Gastric Tube (GT) in Newborns (NB) hospitalized in the Neonatal Intensive Care Unit (NICU) is one of the most commonly performed nursing procedures. It is indicated for gastric decompression, administration of medications, and mainly for feeding the gastric tube process, and despite being a standard procedure for nurses working in the NICU, it is not risk free and involves decisions that may compromise patient safety[1]. Serious respiratory complications may occur due to bronchopulmonary aspiration of gastric contents or inadequate tube placement reaching the respiratory tract. The occurrence of errors in GT placement is very frequent: studies show proportions of 47.5 to 59% inadequate placement between neonatal and pediatric patients[3,4]
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