Pediatric Tube Research Articles

Characterisation of information Hospitals Provide Parents on Tube Feeding, Including Tube Weaning

PurposeThe purpose of this study was to characterise the content of hospital parent guides related to pediatric tube feeding. Design and MethodsA naturalistic search strategy was used to retrieve parent guides produced by hospitals using Google. Guides were analysed and content identified as being associated with codes which were derived from previous research into the education of parents on tube feeding and the prevention and treatment of tube feeding dependency and tube weaning. ResultsOf the 17 collected guides from Australia, New Zealand, the United Kingdom, the United States of America, and Canada, most (64.7%) were published between 2009 and 2016. The guides provided comprehensive information regarding the reasons for and types of tube feeding, details of multidisciplinary teams and the practical management of tube feeding. All guides covered common medical problems and trouble-shooting solutions. Yet there was infrequent coverage of goal setting, risks and prevention of oral aversion and tube feeding dependency, social and emotional management of tube feeding and tube exit planning including tube weaning. ConclusionsA gap exists in the education of families regarding psychosocial implications of tube feeding, oral aversion and tube feeding dependency and prevention, and tube exit planning. Practice ImplicationsImprovements need to be implemented in the development of education materials for families of children who require tube feeding. Families need information on all aspects of tube feeding including practical, social, and emotional management as well as advice on tube exit planning including tube weaning.

Jones lacrimal bypass tubes in children and adults

Background/aimsAlthough a Jones tube is considered the mainstay for epiphora in patients with total blockage of the canalicular system, it has been discouraged in children for reasons of inadequate self-care...

Pediatric Nasogastric Tubes in the Home: Recommendations for Practice.

One of the dilemmas facing home healthcare nurses is the placement of a nasogastric tube (NGT) in the home setting coupled with being assured and confident that the NGT tip is in the correct position, that is, the stomach. There are very limited data to address the issue of management of an NGT in the home care setting with even less guidance for the pediatric population. Therefore, home healthcare nurses must use agency policy and procedures coupled with their own education, knowledge, experience, and skills when performing this procedure. These may vary from agency to agency, thus providing inconsistencies in teaching and techniques.

Pediatric Nasogastric Tubes in the Home: Recommendations for Practice.

Pediatric Nasogastric Tubes in the Home: Recommendations for Practice.

A Program for Weaning Children from Enteral Feeding in a General Pediatric Unit: How, for Whom, and with What Results?

To describe a series of children who were hospitalized for a tube-weaning program in the general pediatric ward of a pediatric tertiary university hospital: describe our method, to determine the success rate of our inpatient pediatric tube weaning program, and search for relevant factors linked to its success or failure. We analyzed the medical files of consecutive children who were hospitalized for gastric-tube weaning over an 8-year period. We analyzed outcomes in terms of feeding and growth with at least 2 years of data. Success (weaning within 3 months) and failure were compared by characteristics of children. We included 37 children (29 females) with mean (SD) age 31.4 (21) months. Most had a severe medical history (30% prematurity; 50% intrauterine growth restriction, 50% neurological and genetic anomalies). The weaning program was successful for half of the children. Factors linked to success of the program were female sex (p = 0.0188), normal neurodevelopment (p = 0.0016), nasogastric tube (p = 0.0098), and with <24 months on EF before the stay (p = 0.0309). Comparing the efficiency of various methods and results among teams was difficult, which indicates the need to establish consensus about the outcome criteria. We confirm the need for these types of stays and programs.

The challenge of nutritional profiling of a protein-free feed module for children on low protein tube feeds with organic acidaemias.

Enteral tube feeding for children with organic acidaemias (OA) is recommended. Protein restriction, providing minimum safe levels of protein intake, is advocated. Standard paediatric tube feeding formulae provide more than the minimum safe protein requirements and are unsuitable in OA without modification. Modified paediatric enteral feeds consist of several modular ingredients. The aim of this prospective longitudinal interventional study was to assess the efficacy of a premeasured novel protein-free module developed for children aged over 12 months compared to conventional practice. In total, 15 children with OA (11.6-31 kg) needing enteral feeding were recruited. The protein-free module, from either a protein-free infant feed or modular ingredients, was replaced by the study feed. To ensure metabolic stability, energy and protein intake were unchanged. Dietary intake, anthropometry and nutritional biochemistry were recorded at baseline and week 26. Dietary intakes of magnesium (P = 0.02), sodium (P = 0.005), vitamin D (P = 0.04), docosahexaenoic acid (P = 0.01) and arachidonic acid (P = 0.001) significantly improved; plasma selenium (P = 0.002) and whole blood glutathione peroxidase (P = 0.02) significantly increased. Feed preparation accuracy as measured by composition analysis showed consistent errors both in pre- and study feeds. A protein-free module improved nutritional intake and biochemistry, although feed preparation errors remained a common finding.

The clinical features of paediatric neural tube defects changed in a tertiary care centre between 1997 and 2015.

The clinical features of paediatric neural tube defects changed in a tertiary care centre between 1997 and 2015.

Multi-Center Evaluation of the Automated Immunohematology Instrument, the ORTHO VISION Analyzer.

ORTHO VISION Analyzer (Vision), is an immunohematology instrument using ID-MT gel card technology with digital image processing. It has a continuous, random sample access with STAT priority processing. The efficiency and ease of operation of Vision was evaluated at 5 medical centers. De-identified patient samples were tested on the ORTHO ProVue Analyzer (ProVue) and repeated on the Vision mimicking the daily workload pattern. Turnaround times (TAT) were collected and compared. Operators rated key features of the analyzer on a scale of 1 to 5. A total of 507 samples were tested on both instruments at the 5 trial sites. The mean TAT (SD) were 31.6 minutes (5.5) with Vision and 35.7 minutes (8.4) with ProVue, which renders a 12% reduction. Type and screens were performed on 381 samples; the mean TAT (SD) was 32.2 minutes (4.5) with Vision and 37.0 minutes (7.4) with ProVue. Antibody identification with eleven panel cells was performed on 134 samples on Vision; TAT (SD) was 43.2 minutes (8.3). The installation, training, configuration, maintenance and validation processes are all streamlined to provide a short implementation time. The average rating of main functions by the operators was 4.1 to 4.8. Opportunities for improvement, such as flexibility with editing QC results, maintenance schedule, and printing options were identified. The capabilities to perform serial dilutions, to accept pediatric tubes, and review results by e-Connectivity are enhancements over the ProVue. Vision provides shorter TAT compared to ProVue. Every site described a positive experience using Vision.

Overestimation of Hypoglycemia in Infants with a High Hematocrit.

In neonates, hypoglycemia is an emergency condition requiring urgent treatment. Therefore, rapid and reliable blood glucose measurements are necessary. However, this step has been proven difficult because of both analytical and preanalytical variables. In our children's hospital, we incidentally observed cases of hypoglycemia that were not in line with the clinical picture of the infants. Remarkably, most of these infants had a high hematocrit. Glucose concentrations were determined in blood samples from healthy participants that were collected in Li-heparin capillary and pediatric tubes. The effect of hematocrit on glucose consumption over time was studied by artificially increasing sample hematocrits. To study the effect of sample cooling, glucose concentrations were followed over time in samples stored at room temperature and on ice. In all samples, glucose concentrations declined with time. This effect was most dramatic [up to 18 mg/dL (1 mmol/L) in the first 30 min] in samples with high hematocrits and collected in capillary tubes. Cooling of samples clearly reduced glucose consumption; however, this was not evident in the first 30 min. Overestimation of hypoglycemia in infants must be considered if samples are not centrifuged or are not analyzed immediately after sampling. The extent of overestimation is more pronounced in samples with a high hematocrit, collected in capillary tubes. Cooling of samples does not prevent glucose consumption in vitro during the first 30 min. These results emphasize that, for glucose analysis, prompt handling of samples of newborns with a high hematocrit is necessary.

A descriptive comparison of approaches to paediatric tube weaning across five countries

Purpose: Many children are requiring tube weaning intervention as a result of increased survival rates of high risk infants and the temporary use of feeding tubes. This study aimed to describe service delivery models and treatment approaches in a variety of paediatric feeding/tube weaning programs.Method: A questionnaire on tube weaning was formulated based on a literature review. Purposive maximum variation sampling was used to include feeding/ weaning programs operating in a variety of settings and countries. Eight feeding teams in Australia, Europe and the USA agreed to participate and completed the questionnaire.Result: All teams employed sensori-motor interventions, with the majority also offering psychological interventions. Six of eight teams utilised hunger induction during the initiation of tube weaning, and in many cases this preceded eating skill development or controlled sensory modulation.Conclusion: A multi-model tube weaning approach is commonly adopted by many centres worldwide. In many cases, psychological theory and theoretical orientation is fundamental to tube weaning practice. Further investigation regarding the efficacy and effectiveness of weaning interventions is recommended to ensure clinical practice is based on sound evidence. This may present as a challenge given many interventions occur concomitantly and the psychotherapeutic experience is difficult to evaluate.

Neonatal Tracheostomy

ABSTRACT Tracheostomy is an established and widely practiced surgical technique. Neonates and young children represent a special population with unique tracheostomy-related concerns. A tracheostomy may be of substantial benefit to the child but is associated with significant morbidity and potential mortality risk. We describe surgical techniques, review pediatric tracheostomy tubes, and discuss relevant care issues. How to cite this article Stephenson KA, Wyatt ME. Neonatal Tracheostomy. Int J Head Neck Surg 2016;7(2):136-142.

Restoration of 'red plug' to rescue a ProSeal(®) laryngeal mask airway.

Sir, Use of supraglottic airway devices has become an important part of anaesthesia practice since the introduction of classic laryngeal mask airway (cLMA®) by A. J. Brain in 1983. The induction of gastric channel into the basic design as in a ProSeal® laryngeal mask airway (PLMA®) proved to be a major advancement over cLMA® due to various reasons, the most important being the protection of lower airways from aspiration of gastric contents.[1] The reusable PLMA is made up of medical grade silicon that can be sterilized by autoclaving and manufacturers recommend it to be used not more than 40 times. However, there is supporting evidence that a PLMA can be used till it fails the pre-use check test rather than till it has been used a specific number of times.[2] During one such pretest of a PLMA, we found the occluder of the red plug of a size 4 PLMA to be broken. The cuff, shaft, inflation line, and valve were all intact. Since the reusable PLMA is expensive, options to repair the red plug were sought. The plug at the proximal end of a paediatric size nasogastric tube (12 Fr Gauge) was cut and checked whether it fitted the red plug. It fitted over the red plug snugly and was secured using a water proof commercial adhesive (‘Quickfix®’) over the red plug [Figure 1]. Since this part of the PLMA remains outside the patient at all times, the risk of the new plug to break off inside the patient was not there. Further, the device cleared the pre-test including the inflation and deflation and has been used in patients without any failure due to the new ‘red plug’. Figure 1 The ‘repaired’ ProSeal laryngeal mask airway. Arrow a shows the broken red plug without occluder and the cut end of nasogastric tube is encircled (inset showing the broken red plug repaired with cut end of a nasogastric tube) There have been reports of damaged LMA devices where the one's with damage to cuff and shaft were disposed but the damages to inflation line and valve were repaired using different methods.[3,4] And our ‘innovation’ to repair the red plug is a further step to save an otherwise reusable device when resources are limited. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Compare of passive and active humidification on artificial airway: a Meta-analysis

Objective To compare the effect of passive humidification and active humidification on artificial airway. Methods We collected all related RCTs from CNKI, Wangfang database, VIP database for the information of passive and active humidification of artificial airways, and its effects, rate of tube plugging, rate of pulmonary infection as outcome indicator by computer. Results We included 11 RCTs involved 1531 participants. The 95% CI were 0.47(0.3—0.73, P=0.000 9), 1.32(1.01—1.73, P=0.04) and 0.88(0.43—1.78, P=0.71) for passive and active humidification, satisfaction of humidification, inadequate humidification, and rate of tube plugging 0.88 (0.43—1.78, P=0.71), rate of pulmonary infection 0.57 (0.50—0.90, P=0.008). Conclusions Based on present RCTs in China, there is a significant increase in the humidifier′s performances in patients humidified with passive humidification during the upper airway, but this finding is limited by pediatric, neonatal and high-risk tube plugging groups. Further RCTs are necessary to examine the wider applicability of heat and moisture exchangers and their extended use. Key words: Artificial nose; Heat and moisture exchanger; Humidifier′s performances; Meta-analysis

Underestimation of unfractionated heparin therapy assessment due to platelet activation when using partial-draw (pediatric) citrate collection tubes

The “so-called” pediatric tubes are often used when collecting smaller blood volume is necessary, particularly in pediatric patients or in case of difficult/recurrent sampling. The aim of this multicenter study was to compare coagulation test results evaluated in evacuated polymer tubes containing 0.109M citrate (1 vol./9 vol.) specifically designed to allow either a partial (2.0mL,“pediatric”) or a total (3.5mL) filling. No significantly relevant discrepancy was found between routine coagulation test results in both tubes collected from untreated patients and from patients on vitamin K antagonist or low molecular weight heparin. In contrast, aPTT was significantly shorter and anti-FXa activity was significantly lower in partial-draw than in full-draw tubes collected from 46 patients receiving unfractionated heparin (UFH). This discrepancy was likely related to increased platelet activation in partial-draw tubes, as suggested by higher platelet factor 4 plasma concentrations and platelet P-Selectin expression in partial-draw than in full-draw citrate tubes. To confirm this hypothesis, we then evaluated partial-draw tubes containing CTAD, a mixture of anticoagulant and antiplatelet agents. In 25 patients on UFH, aPTT and anti-FXa activity were not significantly different in partial-draw CTAD tubes and in full-draw citrate tubes. In conclusion, despite increased platelet activation, samples collected into partial-draw citrate tubes allow accurate routine coagulation testing in all patients but those requiring UFH assessment, in which their use could lead to significant underestimation of anticoagulation. In such cases, partial-draw tubes containing CTAD could be validly used to monitor heparin therapy as well as to perform routine coagulation testing.

Incidence of very high international normalised ratio (INR) and factors contributing to discrepant results

Background Healthscope Pathology offers a warfarin dosing service in Victoria and Queensland with a large number of patients. Very high INR results will inevitably occur and we routinely recommend hospital presentation for patients with INR > 9. Discrepant results compared to the subsequent hospital INR test are sometimes seen. Aims To identify the incidence of INR > 9 in Healthscope Pathology across Victoria and Queensland, the factors contributing to discrepant results, the incidence of bleeding in patients with INR>9 and the incidence of repeat INRs before therapeutic intervention. Methods Retrospective follow-up phone calls to patients and health care providers for all episodes of INR>9 from 01/07/ 2013 to 09/10/2013. Results INR>9 was detected in 130 episodes out of 100,321 INRs done (0.13%). Among 130 episodes, there was a discrepant result in 10 cases, a difficult venepuncture was documented in three cases, five cases were collected in paediatric tubes implying a difficult venepuncture, transfer of underfilled adult citrate tube to paediatric tube occurred in one case and the reason was unknown in one case. Fourteen out of 130 had a bleeding episode. In 41 episodes, vitamin K was given without rechecking INR first, among them only two were actively bleeding. Discussion In a busy dosing service, our rates of very high INR are very low. Even in very high INR, bleeding complications were uncommon. Problems at the point of collection are the major cause for discrepant INR results. Education of phlebotomists, doctors and nurses about the importance of proper collection technique will improve quality of INR result. Repeating INR is also crucial before instituting therapeutic measures. Healthscope Pathology offers a warfarin dosing service in Victoria and Queensland with a large number of patients. Very high INR results will inevitably occur and we routinely recommend hospital presentation for patients with INR > 9. Discrepant results compared to the subsequent hospital INR test are sometimes seen. To identify the incidence of INR > 9 in Healthscope Pathology across Victoria and Queensland, the factors contributing to discrepant results, the incidence of bleeding in patients with INR>9 and the incidence of repeat INRs before therapeutic intervention. Retrospective follow-up phone calls to patients and health care providers for all episodes of INR>9 from 01/07/ 2013 to 09/10/2013. INR>9 was detected in 130 episodes out of 100,321 INRs done (0.13%). Among 130 episodes, there was a discrepant result in 10 cases, a difficult venepuncture was documented in three cases, five cases were collected in paediatric tubes implying a difficult venepuncture, transfer of underfilled adult citrate tube to paediatric tube occurred in one case and the reason was unknown in one case. Fourteen out of 130 had a bleeding episode. In 41 episodes, vitamin K was given without rechecking INR first, among them only two were actively bleeding. In a busy dosing service, our rates of very high INR are very low. Even in very high INR, bleeding complications were uncommon. Problems at the point of collection are the major cause for discrepant INR results. Education of phlebotomists, doctors and nurses about the importance of proper collection technique will improve quality of INR result. Repeating INR is also crucial before instituting therapeutic measures.

Nursing Management of Pediatric Gastrostomy Tubes

Nursing Management of Pediatric Gastrostomy Tubes

Managing severe anemia when the patient is a Jehovahʼs Witness: Explaining to patients who cannot accept major blood fractions how available therapies are produced can help them decide which therapies do not violate their religious beliefs.

Managing severe anemia when the patient is a Jehovahʼs Witness: Explaining to patients who cannot accept major blood fractions how available therapies are produced can help them decide which therapies do not violate their religious beliefs.

A new endotracheal tube for infants – laboratory and clinical assessment: a preliminary study

Conventional endotracheal pediatric tubes offer high resistance due to their small diameters and relatively high flow during ventilation. Any increase of the diameter of the tube lumen decreases the airway resistance and subsequently, the work of breathing (WOB). We compared ventilation mechanics using a new, cone-shaped endotracheal tube of our design to the Cole and standard tubes. The study has been divided into three parts: (i) preliminary laboratory tests, (ii) in vitro study with infant lung model, and (iii) clinical study in infants. Flow resistance and WOB were compared, using standard, Cole (in experimental phase only) and cone tubes. We proved that inspiratory (Ri ) and expiratory (Re ) resistance, and WOB, were significantly lower in patients ventilated via a cone tube. Mean Ri decreased by 37%, compared with the baseline values, Re - by 35%, and total WOB - by 12%. The cone tube offers lower resistance to gas flow than the standard, used nowadays in clinical practice. It can be especially beneficial to spontaneously breathing patients reducing WOB and improving gas exchange.

Effect evaluation of three-level monitoring mode on reducing complications of PICC and improving the quality of care for children patients in pediatric department

Objective To study the effect of three-level monitoring mode in reducing complications of pediatric PICC catheter tube and improving the quality of care for children. Methods 64 cases of children with PICC catheter in our hospital from September 2009 to August 2011 receiving three-level monitoring modes were set as the experimental group.67 patients with conventional care from September 2007 to August 2009 were set as the control group.The incidence of catheter complications in children,success rate of catheter puncture and tube indwelling time for the two groups were observed. Results The complications occurred in 9 cases,accounting for 14.06％ in the experimental group.The complications occurred in 25 cases in the control group,accounting for 37.31％.The puncture success rate was 89.06％ in the experimental group,and the control group was 79.10％.The average time of tube indwelling in the experimental group was higher than the control group.The difference was significant. Conclusions The effect of three-level monitoring modes to reduce pediatric PICC catheter complications and improve quality of care in children with catheter is significant,it can increase the success rate of puncture and prolong tube in-dwelling time. Key words: Three-level monitoring modes; Pediatric department; PICC; Complications; Quality of care

Prehospital Pediatric King LT-D Use: A Pilot Study

Objective. To determine whether prehospital providers can successfully place a pediatric King laryngeal tube (LT-D) and ventilate a Laerdal SimBaby pediatric simulator during a respiratory arrest simulation. Methods. We studied the ability of 45 paramedics and flight nurses to place the pediatric King LT-D in a SimBaby manikin. For the purposes of this study, paramedics and flight nurses were considered equivalent, because in this air medical system they have the same scope of practice in regard to airway skills. Because the participants had previous training and field experience with the adult King LT-D, we limited pediatric King LT-D training to our standard adult training plus selecting the correct size and inflation volumes for the device. Outcomes included rate of successful pediatric King LT-D placement, number of attempts to correctly place the tube, and time to first adequate ventilation. The subjects were evaluated on airway management using an 11-point skill test. A score of 8 or greater (≥73%) was considered passing. The subjects indicated their perceptions and preferences for the pediatric King LT-D using a five-point Likert scale. Data were analyzed using descriptive statistics. Results. Crew members successfully placed the pediatric King LT-D 95.5% (43/45) of the time. The median number of attempts was one. Four subjects required a second attempt; two of these subjects failed at placement. Mean time to placement was 34 seconds (95% confidence interval [CI]: 26.4–67.3 sec). Ninety percent of the participants (40/45) successfully completed the skill test, with a mean score of 78.2% (95% CI: 73.6–82.7). The subjects strongly agreed that their previous training on the adult King LT-D and using it in the field had adequately prepared them to use the pediatric King LT-D. The subjects agreed that the pediatric King LT-D was easier to place than a pediatric endotracheal tube; they strongly agreed that they would use the pediatric King LT-D as an alternative airway. The participants disagreed that they would prefer the pediatric King LT-D as a primary means of securing pediatric airways. Conclusions. The pediatric King LT-D was quickly and reliably placed. Providers perceived the pediatric King LT-D to be easier to use than pediatric endotracheal intubation in this setting.