Abstract
Feeding immaturity is a common problem for premature infants. The use of nasogastric and orogastric feeding tubes (FT) allows for nutrition delivery for infants too premature or sick to orally feed. Placement errors occur in up to 59% of the time and have been associated with adverse sequelae. The use of standardized placement methods such as Nose-Ear-Mid-Umbilicus (NEMU) have improved FT placement accuracy. The purpose of this quality improvement project was to develop an evidence-based standardized measurement protocol, educate nursing staff, and retrospectively analyze radiographs to assess accuracy of the standard NEMU versus a weight-based algorithm (WBA) for placement of enteral FT in neonatal intensive care unit (NICU) infants. Program implementation included protocol development, nursing staff education, assessment of radiographs obtained for clinical purposes, and compliance audits. Pre- and post-implementation measures of nursing knowledge were obtained. Radiographs of infants with FT were analyzed to determine if a WBA would have predicted a more accurate placement versus the standard NEMU. Forty-eight nurses completed the educational program. Thirty-three and 16 RNs completed the pre- and post-educational program knowledge tests, with mean correct scores of 76 and 89 percent, respectively. Sixty radiographs were analyzed. Results indicated accurate placement with NEMU versus WBA method in 49 (82%) and 54 (90%) of the 60 radiographs, respectively. The NEMU method of FT placement, supported through education and protocol development, resulted in fewer placement errors than reported in the literature. However, a WBA method of placement may result in even fewer errors, if utilized.