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Learning Objective 1: compare the accuracy of four methods of predicting the distance to insert a nasogastric/orogastric tube.
Learning Objective 2: discuss study results and previous research in considering changing practice.
Design: Randomized clinical trial
Method: The four methods tested were nose-ear-xiphoid (NEX), nose-ear-mid-umbilicus (NEMU), length-based, and weight-based. In neonates whose length was > 47 cm, one of the first three methods was randomly selected to predict the distance to insert the tube. If the neonate was ≤ 47 cm in length, one of the first two methods was used. Weight was obtained so that the fourth method could also be tested in all infants. An abdominal radiograph was obtained immediately following tube insertion to determine the internal location of the tube tip and orifice(s).
Results: Based on data from 110 neonates (< 1 month of age), the NEMU and length-based methods were more accurate in the longer (older) infants and NEMU and weight were more accurate in the shorter (younger) infants. NEX was the least accurate method; it was frequently too short leaving the tube tip and/or orifices in the esophagus. A new regression equation using length specific to neonates is proposed.
Conclusion: Measuring the NEX distance is the method most commonly used by nurses in practice; therefore, based on the results of this study and studies of other researchers, a practice change may need to be considered to improve the safety of enteral feeding in neonates.