Comparison of Neonatal Nursing Practices for Determining Feeding Tube Insertion Length and Verifying Gastric Placement With Current Best Evidence

Abstract

Background: Oral-nasogastric feeding tubes (FTs) are often malpositioned, placing infants at risk for complications. Confusion exists regarding the accuracy of methods to determine FT insertion length and verify gastric FT placement, and it is unknown whether evidence-based methods are used by neonatal nurses. Purpose: To compare individual and unit-based neonatal nursing practices regarding methods used to determine FT insertion length and verify gastric FT placement. Methods: Neonatal nurses were surveyed about individual and unit-based practices regarding methods used to determine FT insertion length and verify gastric FT placement in infants in the neonatal intensive care unit. Results: Sixty neonatal nurses completed the survey, with 63% utilizing the nose-ear-midway to the umbilicus method, which was included in 50% of protocols and is associated with up to a 90% accuracy rate. Although it has an unacceptably high inaccuracy rate, the nose-to-ear-to-xiphoid method was used by 32% of nurses and recommended in 30% of protocols. To verify gastric FT placement, 98% of nurses used auscultation of a whoosh sound and 83% used aspiration of gastric contents. Neither verification method is supported by evidence or recommended for use. Implications for Practice: A lack of consistency exists between nursing practice and evidence-based methods. Implications for Research: Research is needed to determine more accurate and reliable ways to determine FT insertion depth and verify gastric FT placement in neonates.