Gastric Tube Placement in Young Children

幼儿胃管置入术

• 批准号: 6819813
• 负责人: MARSHA L ELLETT
• 金额: $ 26.06万
• 依托单位: INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-01 至 2009-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6819813
• 关键词: acid base balance; bilirubin; body physical characteristic; carbon dioxide; child (0-11); clinical research; gastrointestinal agents; human subject; imaging /visualization /scanning; nursing research; nursing skill /technique; patient oriented research; patient safety /medical error; pediatric nursing; radiography; respiratory gas analyzer; technology /technique development; tube feeding

DESCRIPTION (provided by applicant): Feeding by a nasogastric/orogastric (NG/OG) tube is preferred when the gastrointestinal system is functional and the need for assisted feeding is expected to be short-term. It is estimated that approximately one million enteral tubes are placed in adults and children in the United States annually. Preliminary studies in children show that between 21% and 44% of these tubes are placed incorrectly. When tubes are out of place, children can be seriously harmed, causing increased morbidity and occasionally death. Tube placement in children is especially understudied. Increasing the safety of NG/OG feeding in this population requires knowledge development in three areas---predicting the insertion distance for correct tube placement, determining tube position, and maintaining correct tube positioning. The proposed study addresses the first two of these knowledge needs. Goals are to determine the best method to predict the insertion distance for placing NG/OG tubes and to determine the best clinical methods of testing the location of NG/OG tubes once they are inserted. In addition, because the CO2 monitor has not been adequately tested previously, this study will provide critical preliminary information about this method. The sample will be 300 hospitalized children equal to or more than 100 months of age requiring gastric tubes. Subjects will have their tubes placed using one of three randomly assigned insertion-length predictors: age-related, height-based; nose-earxiphoid; or nose-ear midumbilicus. Immediately after insertion the position of the tube will be tested for unsuspected misplacement into the respiratory tree by measuring carbon dioxide (CO2) levels within the tube. Next pH and bilirubin levels of tube aspirate will be measured to detect gastric or intestinal location. Actual tube location will then be determined by abdominal radiograph to assess the adequacy of both the insertion length predictors and placement locating methods. Logistic regression will be used to compare the proportions of unsuspected misplacements among the insertion-length predictors and to compare the accuracies among the placement-locating methods. Results from this study will increase the safety of using gastric tubes in young children.

描述（由申请方提供）：当胃肠道系统功能正常且预计需要短期辅助喂养时，首选鼻胃/口胃（NG/OG）管喂养。据估计，在美国每年大约有一百万个肠内管被放置在成人和儿童中。对儿童的初步研究表明，21%至44%的这些管放置不正确。当管子不合适时，儿童可能受到严重伤害，导致发病率增加，有时甚至死亡。尤其是在儿童中放置管的研究不足。提高NG/OG喂养在这一人群中的安全性需要在三个方面的知识发展-预测插入距离以正确放置管，确定管的位置，并保持正确的管定位。拟议的研究涉及这些知识需求中的前两个。目标是确定预测放置NG/OG管的插入距离的最佳方法，并确定插入NG/OG管后测试其位置的最佳临床方法。此外，由于CO2监测仪之前未进行充分测试，因此本研究将提供有关该方法的关键初步信息。 样本将为300名年龄等于或大于100个月需要胃管的住院儿童。受试者将使用三个随机分配的插入长度预测因子之一来放置输卵管：年龄相关的、基于身高的;鼻-耳剑突;或鼻-耳中脐。插入后，立即通过测量插管内的二氧化碳（CO2）水平，检测插管位置是否意外错位到呼吸树中。接下来将测量管抽吸物的pH值和胆红素水平，以检测胃或肠位置。然后通过腹部X线片确定实际插管位置，以评估插入长度预测值和放置定位方法的适当性。将使用逻辑回归比较插入长度预测因子中意外错位的比例，并比较放置定位方法的准确度。这项研究的结果将增加幼儿使用胃管的安全性。