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Prevalence of feeding tube placement errors & associated risk factors in children
M L Ellett1, J Maahs, S Forsee
1Indiana University School of Nursing, Indianapolis 46202-5107, USA. mlellett@wpo.iupui.edu
Insights
Feeding tube placement errors are common in children, affecting over 20% of patients. Active children and those with specific risk factors like vomiting are more prone to these errors.
Area of Science:
- Pediatric Gastroenterology
- Medical Device Safety
Background:
- Enteral tubes are crucial for pediatric nutrition.
- Accurate tube placement is essential for effective feeding and preventing complications.
Purpose of the Study:
- To determine the prevalence of feeding tube placement errors in children.
- To identify risk factors associated with these placement errors.
Main Methods:
- Retrospective review of hospital records for 201 children with enteral tubes and radiographs.
- Chart review to identify risk factors for tube malposition.
- Definition of tube placement error included incorrect positioning in the esophagus or intestines.
Main Results:
- On day one, 15.9% of children had feeding tube placement errors.
- Overall, 13.8% of observed tube placements were erroneous.
- 20.9% of children experienced at least one placement error during the review period.
- Higher activity levels, younger age, altered consciousness, abdominal distention, vomiting, and orogastric tubes were associated with increased error rates.
Conclusions:
- Nurses must be vigilant in assessing tube placement, especially in pediatric patients with identified risk factors.
- Healthcare providers should consider the risks and benefits of different enteral tube types and placement methods.
Purpose:
The purpose of this study was to determine the prevalence of feeding tube placement errors in children.
Design And Methods:
The hospital records of 201 children having both an enteral tube and at least one radiograph showing tube placement were retrospectively reviewed. Chart review was also used to determine the risk factors associated with these errors. Tube placement error was defined as tube tip or orifices in the esophagus or intestine (if the tube was supposed to be in the stomach) or tip or orifices in the esophagus or stomach (if the tube was supposed to be in the intestine.)
Results:
On the first day, a radiograph documenting tube placement showed that 32 of the 201 children (15.9%) had tube placement errors. Overall, 53 tube placement errors were evident during the 385 observation days on which radiographs were obtained (13.8%). Of the 201 children, 42 (20.9%) had experienced tube placement errors at some time during the period reviewed. Over all radiograph days, activity level was independently related to radiographic tube placement (p = < 0.02), with more errors among active children. Also, classification regression tree analysis showed that age, level of consciousness (alert or comatose versus semicomatose), abdominal distention, vomiting, and orogastric tubes were associated with more tube placement errors.
Nursing Implications:
Nurses need to be especially careful in assessing tube placement if the pediatric client has one or more of the identified risk factors. Health care providers need to carefully weigh the benefits and risks of feeding by nasal or oral enteral tubes versus the benefits and risks of feeding by endoscopically or surgically placed enteral tubes.