Ensuring Proper Orogastric Tube Placement To Eliminate Gum Line

Notching: Quality Improvement

Katie Webb, RN
Bon Secours Memorial College of Nursing

Background Aim Statement Project Description

The recent addition of Bubble Continuous Positive 100% Prevention of long term feeding PDSA cycles were conducted by educating staff
Airway Pressure (CPAP) has prompted all feeding on securement position change, implications,
complications and oral malformation caused by
tubes to be placed as orogastric (OG) tubes (NANN, assessment, and evaluation of outcomes.
palatal orogastric tube pressure in preterm infant
2008).
for the duration of bubble CPAP Three cycles were conducted on “Tube Tuesdays”
The OG tube has historically been secured midline on (the day tubes are designated to be changed in
the lower lip. the NICU).
Evaluation of
Education compliance Use of
Consistent pressure of the OG tube on the gum line Staff were first educated about the change in
on and colorful signs huddle and through email. Staff were instructed on
has increased incidences of oral mucosa breakdown
assessment modifying placed next how to complete the oral mucosa exam and the
Breakdown of the mucosa and jaw structure leads to and proper placement to to feeding proper location of sercurement (side of lip and
• improper formation of the teeth securement lower corner tube supplies cheek).
• feeding and speech difficulties of mouth
• delayed development Following each cycle data was analyzed, barriers
• increased cost of care (Zaralkiewicz, Teegardin, & identified and changes were made accordingly.
Whitney, 2012) Cycle 1 Cycle 2 Cycle 3
References
120% Pre Results Zaratkiewicz, S., Teegardin, C., Whitney, J. D. (2012).
100% Impleme The education provided increased compliance to Retrospective review of the reduction of oral pressure
ntation ulcers: a change in practice. Critical Care Nurse 35(3).
95% on proper securement by the end of cycle 3.
80% Cycle 1 Doi:10.1097/CNQ.0b013e3182542de3.

100% of mucosa remained intact as a result of National Pressure Ulcer Advisory Panel. (2013). Best
60% the change. practices for prevention of medical device-related
Cycle 2 pressure ulcer injuries in pediatric population.
40% Proper tube securement was deferred when Retrieved from http://www.npuap.org/wp-
related to patient condition (craniofacial content/uploads/2013/04/Updated-BestPractices-
20% Cycle 3 anomalies). Pediatric2017.pdf

0% Continued work should be done when other Bon

National Association of Neonatal Nurses (NANN).
(2008). The nursing care of the infant receiving Bubble
Mucosa Assess. Proper Mucosa Intact Secours NICUs being using Bubble CPAP. CPAP therapy. Advances in Neonatal Care, 8(2). Doi:
Securement 10.1097/01.ANC.0000317257.53330.fc