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Bedside Placement of the Postpyloric Tube in Infants
Patricia Clifford1, Elizabeth Ely, Lauren Heimall
1The Children's Hospital of Philadelphia, Pennsylvania.
Insights
Bedside nurses can safely and effectively place postpyloric feeding tubes in most neonatal intensive care unit infants. This practice, excluding infants with congenital diaphragmatic hernia, reduces radiation exposure and improves care.
Area of Science:
- Neonatal care
- Pediatric gastroenterology
- Medical device placement
Background:
- Neonatal intensive care unit (NICU) infants have high nutritional needs.
- Some infants require postpyloric feeding due to intolerance of gastric feeds.
- Gastric insufflation is a technique for postpyloric tube placement, with limited evidence in infants.
Purpose of the Study:
- To evaluate the safety and effectiveness of bedside nurse-led postpyloric tube placement in NICU infants.
- To assess the current quality improvement practice for postpyloric tube insertion.
Main Methods:
- Prospective data collection over 8 weeks.
- Involved 38 infants requiring 60 postpyloric tube placements.
- Assessed success rates and influencing factors like nursing experience.
Main Results:
- Achieved a 95.6% success rate for tube placement, excluding infants with congenital diaphragmatic hernia (CDH).
- Success rate for infants with CDH was 40%.
- Nursing experience did not impact placement success.
Conclusions:
- Modified postpyloric tube placement policy based on project findings.
- Nurse-led placement is safe and effective for most preterm infants, except those with CDH.
- Reduced radiation exposure compared to interventional radiology placement.
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.
Purpose:
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.
Implications For Practice:
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.
Implications For Research:
Further research should be done by units that primarily care for low birth-weight premature infants.
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