The purpose of this scholarly project was to develop a Best Evidence Statement (BESt) for the confirmation of nasogastric or orogastric tube placement in hospitalized children. The nose-ear-xiphoid (NEX) method of measurement and auscultatory method of tube verification is commonly used but is unreliable and has resulted in misplaced tubes as well as poor patient outcomes. Radiography is considered the gold standard however the risks outweigh the benefits due to excessive radiation exposure, increases in healthcare costs and delay in delivery of care. Methods which utilize bedside testing and proper tube measurement have been shown to be effective in nasogastric tube (NGT) or orogastric tube (OGT) verification. Gastric pH has been shown to be an accurate method of bedside testing with a pH of < 5 confirming placement in the stomach. In addition, age-related height-based (ARHB) methods have been shown to be an accurate method of predicting tube length. The Iowa Model of Evidence-Based Practice to Promote Quality Care was used to guide development of evidenced-based care recommendations that were published as a BESt statement at Cincinnati Children’s Hospital Medical Center and through The Agency for Healthcare Research and Quality’s (AHRQ) National Guideline Clearinghouse (NGC). The BESt recommendations include tube length prediction using ARHB methods and pH testing of gastric aspirate.
Sievers, S. A. (2012). Development of a Best Evidence Statement (Best) for Confirmation of Nasogastric (NGT) or Orogastric Tube (OGT) Placement. Wright State University, Dayton, OH.