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Objective: The objective is to test in children potentially better ways to determine the internal position of nasogastric/orogastric (NG/OG) tubes. Design: A cross-sectional, non-experimental design is used. Sample/Setting: A total of 100 hospitalized children < 7 years already having a NG/OG tube in place are being recruited; 56 have been recruited thus far. Variables: The independent variables are CO2 and pH readings and bilirubin levels, and the dependent variable is tube position on radiograph. Methods: The position of the tube is tested in all children for tube placement error at the bedside by (a) measuring CO2 and (b) measuring tube aspirate for pH and bilirubin. Actual tube position is determined by radiograph within 15 minutes of bedside testing. Findings: Data collection will continue through 6-30-03. Preliminary analysis of data thus far reveals a 27.3% tube placement error rate with most of the errors involving placement into the esophagus putting the children at risk for aspiration of feedings. pH testing alone, using a cutoff of < 6 in fed children and a pH < 5 in fasting children is superior. Conclusions: The tube placement error rate in children is unacceptably high; this has been demonstrated three times by this research team. It now needs to be studied by other researchers at other sites. The three methods of testing placement need to be studied further in a larger sample under more controlled conditions, i.e., at the time a tube is inserted when the child is fasting. Implications: Until further research can be done, pH testing using the cutoffs suggested above to predict stomach placement and obtaining an abdominal radiograph in all children in which either no aspirate is obtained or the pH is > 5 in fasting children or > 6 in fed children is recommended.
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