Advertisement

Pediatric Radiology

, Volume 47, Issue 10, pp 1302–1311 | Cite as

Nasoduodenal tube placement: Are two views necessary to confirm position?

  • Anh-Vu NgoEmail author
  • Stephen Done
  • Randolph Otto
  • Seth Friedman
  • A. Luana Stanescu
Original Article

Abstract

Background

Nasoduodenal tube (NDT) placement is typically performed at the bedside and two-view abdominal radiographs are usually used to confirm tube position. Anecdotally, in most instances the lateral view is unnecessary and utilizes more than twice the radiation than an anteroposterior (AP) view alone.

Objective

We hypothesize that NDT location can be determined using only the AP view, with the NDT position determined on two views utilized as the gold standard.

Materials and methods

A search was performed for all two- or three-view abdominal radiographs from September 2012 to September 2013 with the phrase “ND tube” in the reason field of the requisition. These studies were independently reviewed by two radiologists and scored for anatomical tube position in three different scenarios: AP view alone, the lateral view alone, and both views together, with the latter serving as the gold standard. The anatomical scores were subsequently grouped to reflect clinically significant scenarios. Comparative analysis was performed with the original and clinically grouped scores.

Results

A total of 102 patients and 306 separate two-view exams were evaluated. Of the 102 patients, 55 had at least two separate exams. Across raters, concordances of AP and lateral scores relative to the gold standard assessment were 88% and 73% for anatomical scores, and 91.5% and 86.4% for clinically grouped data. Trend differences for fewer errors were found with the AP compared to the lateral view. There were statistically significant group differences with a greater number of false-negative errors in the lateral data set. No clear differences were found when comparing AP and lateral ratings for false-positive errors. Upon review of the common errors, we determined a few imaging findings on AP radiographs that can help assess the need for an additional lateral view.

Conclusion

A single AP view is sufficient to determine the NDT position in most cases. Two views should be reserved for cases where the NDT position cannot be definitively assessed. Transitioning toward the single AP view to evaluate the NDT position could have immediate consequences for dose reduction.

Keywords

Dose reduction Gastrointestinal tract Neonates Radiography Nasoduodenal tube Feeding tube 

Notes

Acknowledgements

Special thanks to Andreea T. Stanescu for her contribution with Fig. 1.

Compliance with ethical standards

Conflicts of interest

None

References

  1. 1.
    Khalid I, Doshi P, DiGiovine B (2010) Early enteral nutrition and outcomes of critically ill patients treated with vasopressors and mechanical ventilation. Am J Crit Care 19:261–268CrossRefPubMedGoogle Scholar
  2. 2.
    Peter JV, Moran JL, Phillips-Hughes J (2005) A metaanalysis of treatment outcomes of early enteral versus early parenteral nutrition in hospitalized patients. Crit Care Med 33:213–220CrossRefPubMedGoogle Scholar
  3. 3.
    Sajid MS, Harper A, Hussain Q et al (2014) An integrated systematic review and meta-analysis of published randomized controlled trials evaluating nasogastric against postpyloris (nasoduodenal and nasojejunal) feeding in critically ill patients admitted in intensive care unit. Eur J Clin Nutr 68:424–432CrossRefPubMedGoogle Scholar
  4. 4.
    Van Caillie M, Powell GK (1975) Nasoduodenal versus nasogastric feeding in the very low birthweight infant. Pediatrics 56:1065–1072Google Scholar
  5. 5.
    Slagt C, Innes R, Bihari D et al (2004) A novel method for insertion of post-pyloric feeding tubes at the bedside without endoscopic or fluoroscopic assistance: a prospective study. Intensive Care Med 30:103–107CrossRefPubMedGoogle Scholar
  6. 6.
    Creel AM, Winkler MK (2007) Oral and nasal enteral tube placement errors and complications in a pediatric intensive care unit. Pediatr Crit Care Med 8:161–164CrossRefPubMedGoogle Scholar
  7. 7.
    Stock A, Gilbertson H, Babl FE (2008) Confirming nasogastric tube position in the emergency department: pH testing is reliable. Pediatr Emerg Care 24:805–809CrossRefPubMedGoogle Scholar
  8. 8.
    Strouse PJ (2004) Disorders of intestinal rotation and fixation (“malrotation”). Pediatr Radiol 34:837–851CrossRefPubMedGoogle Scholar
  9. 9.
    Dumitriu DI, Menten R, Clapuyt P (2016) Ultrasound of the duodenum in children. Pediatr Radiol. doi: 10.1007/s00247-016-3564-4 PubMedGoogle Scholar
  10. 10.
    Koplewitz BZ, Daneman A (1999) The lateral view: a useful adjunct in the diagnosis of malrotation. Pediatr Radiol 29:144–145CrossRefPubMedGoogle Scholar
  11. 11.
    Lampl B, Levin TL, Berdon WE et al (2009) Malrotation and midgut volvulus: a historical review and current controversies in diagnosis and management. Pediatr Radiol 39:359–366CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Department of RadiologySeattle Children’s HospitalSeattleUSA

Personalised recommendations