Notice bibliographique
Résumé
Q: Is any evidence available to support practices for verifying nasogastric tube (NGT) placement in critically ill pediatric patients?A: Beth Lyman, RN, MSN, CNSC, replies: Yes, there is evidence to guide this practice; there is even an international work group addressing this issue.The American Society for Parenteral and Enteral Nutrition has a task force called the NOVEL (New Opportunities for Verification of Enteral tube Location) project. This group of physicians and nurses from Australia, Canada, and the United States is working to promote best practice for verification of NGT placement.Twenty-four percent of hospitalized pediatric patients require an NGT. Of those patients, approximately 18% are in a pediatric intensive care unit.1 A 1999 pediatric study by Ellett and Beckstrand2 documented that 22% to 44% of NGTs were misplaced when verified by abdominal radiography. A study by Quandt et al3 documented that the odds of an NGT being in the distal esophagus are 2.74 times higher if a neonate is intubated.A patient safety alert issued in 2012 recommended immediate discontinuation of the use of auscultation to verify correct NGT placement.4 Despite this recommendation, a study published by Metheny and colleagues5 in 2012 documented continued use of this method. The Lyman study conducted in 2015 asked the 63 participating centers to share their primary and secondary method(s) to verify NGT placement, with responses of aspiration (n = 21), auscultation (n = 18), measurement (n = 8), pH (n = 10), and radiography (n = 6).1Although the gold-standard method for verification of NGT placement for adult patients is considered an abdominal radiograph, pediatric clinicians have been reluctant to embrace this practice because of concerns over the long-term cumulative effects of radiation exposure. In addition to the concerns about radiation exposure, there is growing evidence that radiographs can be interpreted incorrectly.6,7 A 2011 study looked at 4330 pH aspirates from NGTs along with 635 pH aspirates from pediatric intensive care unit patients with an endotracheal tube.8 In this population, 27% of the patients received an acid-suppressing medication, resulting in an average pH of 4.2, compared with 3.4 from those patients who did not receive any of these medications.Investigators also found nurses were not able to discern gastric from pulmonary secretions upon visual inspection. Gilbertson et al8 concluded that a pH of 5 or less predicted gastric placement 90% of the time. The average pH for aspirates from the endotracheal tube was 8.3 (95% CI, 6–9.5). A pH of 5 to 5.5 or less is what is used in Canada, Australia, and the United Kingdom as a means of verifying NGT placement. The pH measurement is to be done at the bedside even when an abdominal radiograph or other device, such as an electromagnetic device, is used.9Accurate measurement of how far to insert an NGT is associated with better outcomes. The previously mentioned patient safety alert recommended use of NEMU (nose-earlobe-midumbilicus, or the midpoint between the xiphoid process and umbilicus). Previous studies have documented that use of the NEX (nose-earlobe-xiphoid) method can result in the NGT being in the distal esophagus.10The use of an electromagnetic device to place an NGT or postpyloric feeding tube has been studied repeatedly in critically ill adults and the pediatric population, with mixed results due to the potential for misinterpretation of the screen and time needed to place the tubes.11–14 The National Patient Safety Agency’s (United Kingdom) recommendation to obtain an abdominal radiograph or pH in conjunction with such a device is echoed by others in the United States who have studied this device in adult patients.15,16 The recommendation to check an abdominal radiograph or pH, even when an electromagnetic device is used, should pertain to children as well.When placing an NGT, consider the following approach:
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,054 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,008 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».