GASTRIC TUBE PLACEMENT IN YOUNG CHILDREN

本子项目是利用由NIH/NCRR资助的中心赠款提供的资源的众多研究子项目之一。子项目和研究者（PI）可能已经从另一个NIH来源获得了主要资金，因此可以在其他CRISP条目中表示。列出的机构是中心的，不一定是研究者的机构。当胃肠系统功能正常且需要辅助喂养的时间较短时，首选鼻胃/口胃（NG/OG）管喂养。据估计，在美国，每年大约有100万成人和儿童植入肠内管。对儿童的初步研究表明，21%到44%的试管放置不正确。当管子放错位置时，儿童可能受到严重伤害，导致发病率增加，有时甚至死亡。儿童插管的研究尤其不足。在这一人群中提高NG/OG喂养的安全性需要三个方面的知识发展-预测正确放置管的插入距离，确定管的位置和保持正确的管的位置。拟议的研究解决了前两个知识需求。目的是确定预测NG/OG管置入距离的最佳方法，确定NG/OG管置入后检测其位置的最佳临床方法。此外，由于CO2监测器之前没有经过充分的测试，因此本研究将提供有关该方法的关键初步信息。样本将是300名年龄< 100个月需要胃管的住院儿童。受试者将使用三种随机分配的插入长度预测因素之一放置管子：与年龄相关，基于身高；nose-ear-xiphoid;或nose-ear-midumbilicus。在插入导管后，将立即通过测量导管内的二氧化碳（CO2）水平来检测导管是否在意料之外的情况下误插入呼吸树。接下来，将测量管吸出液的pH值和胆红素水平，以确定胃或肠道的位置。然后通过腹部x线片确定实际的管道位置，以评估插入长度预测和放置定位方法的充分性。逻辑回归将用于比较插入长度预测器中未预料到的错位的比例，并比较放置定位方法之间的准确性。这项研究的结果将提高幼儿使用胃管的安全性。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. 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 < 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-ear-xiphoid; 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.