美国住院新生儿和儿科患者临时肠内装置的使用

　　临时肠道装置（EAD）如鼻胃管（NG）、口胃管（OG）、幽门后置管（PP）常用于新生儿和儿科患者以提供营养、液体和用药。虽然这些临时EAD在儿科医疗中很常见，但是尚不清楚这些装置的使用频率、哪种住院患者的使用频率最高、已知体重或年龄选择哪种尺寸的管、每个医院如何定位的政策。为此，美国堪萨斯城慈善儿童医院、密西西比大学、匹兹堡儿童医院、达拉斯儿童医学中心、辛辛那提儿童医院、威斯康星儿童医院、宾夕法尼亚大学、宾夕法尼亚儿童医院开展了一项多中心1天现况调查的研究。

　　该研究对新生儿和儿科NG、OG、PP管的数量进行统计，同时还收集年龄、体重、病区、医院类型、当天住院患者总数、确定置管方法等附加资料。

　　结果发现，在63所参与医院全部新生儿和儿科8333例儿童中，有1991例临时EAD（24%）。其中1316例NG（66%）、414例OG（21%）、261例PP（17%）EAD。新生儿重症监护病房（NICU）的使用率最高（61%），其次是内外科病区（21%）和儿科重症监护病房（18%）。EAD放置成功的验证方法包括观察管内有抽吸物（n=21）、听诊（n=18）、长度测量（n=8）、pH（n=10）、X射线（n=6）。

　　因此，临时EAD使用常见于儿科医疗，置管成功的验证方法多种多样。

JPEN J Parenter Enteral Nutr. 2016;40(4):574-80.

Use of Temporary Enteral Access Devices in Hospitalized Neonatal and Pediatric Patients in the United States.

Lyman B, Kemper C, Northington L, Yaworski JA, Wilder K, Moore C, Duesing LA, Irving S.

Children's Mercy Hospital, Kansas City, Missouri; University of Mississippi Medical Center School of Nursing, Jackson, Mississippi; Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; Children's Medical Center of Dallas Neonatal Intensive Care Unit, Dallas, Texas; Cinncinnati Children's Hospital, Cincinnati, Ohio; Children's Hospital of Wisconsin, Milwaukee, Wisconsin; University of Pennsylvania School of Nursing and Children's Hospital of Pennsylvania, Philadelphia, Pennsylvania.

BACKGROUND: Temporary enteral access devices (EADs), such as nasogastric (NG), orogastric (OG), and postpyloric (PP), are used in pediatric and neonatal patients to administer nutrition, fluids, and medications. While the use of these temporary EADs is common in pediatric care, it is not known how often these devices are used, what inpatient locations have the highest usage, what size tube is used for a given weight or age of patient, and how placement is verified per hospital policy.

MATERIALS AND METHODS: This was a multicenter 1-day prevalence study. Participating hospitals counted the number of NG, OG, and PP tubes present in their pediatric and neonatal inpatient population. Additional data collected included age, weight and location of the patient, type of hospital, census for that day, and the method(s) used to verify initial tube placement.

RESULTS: Of the 63 participating hospitals, there was an overall prevalence of 1991 temporary EADs in a total pediatric and neonatal inpatient census of 8333 children (24% prevalence). There were 1316 NG (66%), 414 were OG (21%), and 261 PP (17%) EADs. The neonatal intensive care unit (NICU) had the highest prevalence (61%), followed by a medical/surgical unit (21%) and pediatric intensive care unit (18%). Verification of EAD placement was reported to be aspiration from the tube (n = 21), auscultation (n = 18), measurement (n = 8), pH (n = 10), and X-ray (n = 6).

CONCLUSION: The use of temporary EADs is common in pediatric care. There is wide variation in how placement of these tubes is verified.

PMID: 25567784

DOI: 10.1177/0148607114567712