Evidence-based Practice in the Management of Gastric Tube Placement in Children

Evidence-based Practice in the Management of Gastric Tube Placement in Children: A Multicenter Quality Improvement Project

This multi-center quality improvement project aims to enhance gastric tube placement practices for children by systematically reviewing the latest evidence. The project team will identify gaps between current practices and best evidence, analyze barriers to implementing evidence-based guidelines, and develop strategies to facilitate their integration into clinical settings. The focus will also be on improving the knowledge and skills of pediatric nurses through targeted education and support. Ultimately, this initiative seeks to ensure the safety and effectiveness of gastric tube placement in the pediatric population, leading to better patient outcomes and higher standards of care.

Enteral nutrition is the preferred method of nutritional support for children with gastrointestinal function, encompassing both oral and tube feeding approaches. Tube feeding involves delivering liquid food, water, and medications directly into the gastrointestinal tract through a feeding tube, making it a primary method of enteral nutrition. Compared to parenteral nutrition, enteral nutrition is more aligned with the body's physiological needs, helping to maintain the intestinal mucosal barrier, protect organ function, and regulate immune responses while being easier to initiate, cost-effective, and associated with a lower risk of infection.

In 2009, the American Society for Parenteral and Enteral Nutrition (ASPEN) published guidelines for enteral nutrition practices, which were updated in 2017. ASPEN also launched the Verification of Enteral Tube Location Project (NOVEL) in 2019, providing clear protocols for the placement of nasogastric tubes in children. Additionally, the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition issued a position statement on nasoenteric feeding for children in 2019.

In China, pediatric clinical nutrition has developed more slowly, but pediatric tube feeding has received growing attention in recent years. The Chinese Society of Parenteral and Enteral Nutrition published clinical application guidelines for pediatric enteral and parenteral nutrition support in 2010, followed by neonatal nutrition support guidelines in 2013. However, there have been no recent updates or standardized procedures for pediatric tube feeding.

This study aims to synthesize the latest evidence on pediatric gastric tube placement and update healthcare professionals' knowledge in pediatric medical institutions, which also seeks to standardize tube placement techniques and apply best practices in clinical settings to enhance the safety and quality of care for children.

Nurse Inclusion and Exclusion Criteria:

Inclusion:

• Nurses who hold a valid and legal nursing license.
• Nurses who have at least 1 year of clinical nursing experience in pediatric care.

Exclusion:

• Nurses who are on leave or not on duty.
• Nurses working in departments such as the operating room or intravenous compounding center, where nasogastric tube placement is not routinely performed.
• Nurses who are in training or on internships.

Pediatric Patient Inclusion and Exclusion Criteria:

Inclusion:

• Hospitalized children Aged 0-18 years.
• Scheduled for nasogastric tube placement.
• Parents or legal guardians have signed the informed consent form, agreeing to the child's participation in the study.

Exclusion:

• Presence of severe complications or unstable medical conditions.
• Nasogastric tube is intended for gastrointestinal decompression, drainage, or venting.