TECHNIQUES FOR MEASUREMENT AND VERIFICATION OF GASTRIC CATHETER PLACEMENT IN NEWBORNS: INTEGRATIVE REVIEW

TÉCNICAS PARA MEDIR Y VERIFICAR LA POSICIÓN DEL CATÉTER GÁSTRICO EN RECIÉN NACIDOS: UNA REVISIÓN INTEGRAL

ABSTRACT

Objective:  To analyze scientific evidence related to techniques for measuring and verifying placement of a gastric catheter in newborns.

Method:  Integrative literature review, conducted in June 2023 using the Cochrane Library, LILACS, PubMed/MEDLINE®, CINAHL, EMBASE and Scopus databases.

Results:  118 articles were identified and nine were included, with five focusing on measurement techniques and four on placement verification methods. Weight-based formula and the NEMU technique improve the rate of correct placement, while methods such as pH verification and ultrasound offer safe and non-invasive approaches.

Conclusion:  Weight-based formulas and the NEMU technique have been shown to be effective in inserting gastric catheters, while pH assessment and ultrasound offer safety in confirming position. Further research is needed to improve these techniques, ensuring safety and clinical efficacy in the neonatal population.

DESCRIPTORS:
Newborn; Gastric catheterization; Neonatal Intensive Care; Nursing Care; Feeding Methods

RESUMO

Objetivo:  analisar as evidências científicas relacionadas às técnicas de mensuração e de verificação do posicionamento do cateter gástrico em recém-nascidos.

Método:  revisão integrativa da literatura, realizada em junho de 2023 nas bases de dados Biblioteca Cochrane, LILACS, PubMed/MEDLINE®, CINAHL, EMBASE e Scopus.

Resultados:  identificaram-se 118 artigos e foram incluídos nove, onde cinco investigaram as técnicas de mensuração e quatro abordaram os métodos de verificação do posicionamento. Fórmulas baseadas no peso e a técnica NEMU melhoram a taxa de posicionamento correto, enquanto métodos como a verificação do pH e a ultrassonografia oferecem abordagens seguras e não invasivas.

Conclusão:  fórmulas baseadas no peso e a técnica NEMU mostram-se eficazes na inserção de cateteres gástricos, enquanto a verificação do pH e a ultrassonografia oferecem segurança na confirmação do posicionamento. São necessárias investigações adicionais para aprimorar essas técnicas, assegurando a segurança e a eficácia clínica na população neonatal.

DESCRITORES:
Recém-nascido; Intubação gastrointestinal; Terapia Intensiva Neonatal; Cuidados de enfermagem; Métodos de alimentação

RESUMEN

Objetivo:  Analizar la evidencia científica relacionada con las técnicas de medición y verificación de la colocación de catéteres gástricos en recién nacidos.

Método:  Revisión bibliográfica integradora realizada en junio de 2023 en las bases de datos Cochrane Library, LILACS, PubMed/MEDLINE®, CINAHL, EMBASE y Scopus.

Resultados:  Se identificaron 118 artículos, de los cuales se incluyeron nueve. Cinco investigaron técnicas de medición y cuatro abordaron métodos de verificación de la colocación. Las fórmulas basadas en el peso y la técnica NEMU mejoran la tasa de colocación correcta, mientras que métodos como la monitorización del pH y la ecografía ofrecen enfoques seguros y no invasivos.

Conclusión:  Las fórmulas basadas en el peso y la técnica NEMU son eficaces para la inserción de catéteres gástricos, mientras que la monitorización del pH y la ecografía ofrecen una confirmación segura de la colocación. Se necesita más investigación para mejorar estas técnicas, garantizando la seguridad y la eficacia clínica en la población neonatal.

DESCRIPTORES:
Recién Nacido; Intubación Gastrointestinal; Cuidado Intensivo Neonatal; Atención de Enfermería; Métodos de Alimentación

INTRODUCTION

Recent technological advances have contributed significantly to the survival of clinically unstable newborn babies (NBs)¹. Clinical issues include the challenges faced in feeding neonates due to the immaturity of the digestive system. To meet this need, gastric catheterization is used. Although it is a common practice in neonatal environments, it is not without risks and involves a series of clinical decisions that can directly impact the safety of neonates during their hospital stay^2-3.

Clinical decisions related to gastric catheterization are particularly important, given the nature and fundamental role of the gastric catheter (GC) in the management of NBs^3-4. The GC is a flexible tubular device made of resistant, non-toxic material, with orifices located at its distal end, which can be inserted orally or nasally^3,5. It is indicated for various purposes, such as nutritional support, drug administration, gastric decompression, post-surgical rest, monitoring bleeding, and gastric aspiration⁶.

Correct insertion and continuous monitoring of the GC are essential to avoid serious complications that can arise due to improper placement⁶. These complications include bronchial aspiration, pneumothorax, atelectasis and respiratory problems, especially when the distal end of the catheter is close to the gastroesophageal junction^3,7.

Nutritional problems such as malabsorption and low weight gain can occur when the catheter is located close to or beyond the pylorus^2,7. The incidence of incorrect catheter placement errors described in the literature ranged from 47.5% to 59%, and showed a high risk of complications in these patients^4,7-8.

To ensure the correct insertion of the GC and minimize the risk of complications, it is crucial to use precise measurement techniques. Among the approaches described in the literature, the Nose, Earlobe, Xiphoid (NEX) technique and the Nose, Earlobe, Mid-Umbilicus (NEMU) technique are the most noteworthy^7,9-10. Formulas based on the child's weight or height, such as Age Related, Height Based (ARHB), are used to estimate the appropriate length of the catheter, helping to prevent placement errors and their possible complications^7,10.

The technique of gastric catheterization in nursing practice uses different tests to confirm the precise location of the catheter, given the need for it to feed neonates. This procedure is the sole responsibility of the nurse and is performed several times during the neonate's hospital stay¹¹. In neonatology services and in the literature, techniques with variations on the placement of the catheter are identified, and there is no consensus on the best method for this procedure^3,6-12.

Given the importance of this subject, it is essential to establish consistent standards for this procedure in neonatal units to ensure the implementation of best practices and patient safety. The aim of this study was to analyze the scientific evidence related to techniques for measuring and verifying placement of the gastric catheter in newborns.

METHOD

This is an integrative review, a methodology that enables the synthesis of knowledge by integrating both experimental and non-experimental studies. This method offers a comprehensive understanding of the phenomenon or problem under analysis, enables critical discussions of the findings and promotes their application in Evidence-Based Practice¹³.

This review was conducted in six stages to ensure the robustness and relevance of the findings. The stages were: formulating the research question; selecting the sample by searching the literature for primary studies; extracting data from selected studies; evaluating included studies; interpreting results; and, finally, presenting findings of the review. This methodological approach provides critical discussions of the findings and their application in Evidence-Based Practice¹⁴.

To develop the guiding question, the PICo strategy¹⁵ was adopted, considering: “P” (population) - newborns; ‘I’ (intervention) - techniques for measuring and verifying position of the GC; and ‘Co’ (context) - gastric catheterization. Based on the strategy adopted, the following guiding question was formulated: “What are the techniques for measuring and verifying placement of the GC in newborns”?

An advanced search was conducted in June 2023, via the CAPES portal, in the following databases: COCHRANE Library, Latin American and Caribbean Health Sciences Literature (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE and SCOPUS. The controlled descriptors were selected from the Health Sciences Descriptors (DeCS) and the Medical Subject Headings (MeSH). The search strategies were validated by a librarian and are detailed in Chart 1 below.

Chart 1 -
Search strategy. Uberaba, MG, Brazil, 2023.

Databases	Search strategies
COCHRANE	Infant, Newborn AND Intubation, Gastrointestinal
LILACS	((Recém-Nascido) OR (Infant, Newborn) OR (Recién Nacido)) AND ((Intubação Gastrointestinal) OR (Intubation, Gastrointestinal) OR (Intubación Gastrointestinal)) AND ((Terapia Intensiva Neonatal) OR (Intensive Care, Neonatal) OR (Cuidado Intensivo Neonatal))
MEDLINE/PubMed	((Infant, Newborn) AND (Intubation, Gastrointestinal)) AND (Intensive Care, Neonatal)
CINAHL	"Infant, Newborn" AND "Intubation, Gastrointestinal" AND "Intensive Care, Neonatal"
EMBASE	('newborn'/exp OR newborn) AND 'digestive tract intubation'/exp AND 'newborn intensive care'/exp
SCOPUS	(TITLE-ABS-KEY ("Infant, Newborn") AND TITLE-ABS-KEY ("Intubation, Gastrointestinal") AND TITLE-ABS-KEY ("Intensive Care, Neonatal"))

Primary studies that addressed the research question, covering the last ten years, published in Portuguese, English or Spanish, and available in their entirety were included. This time limit was established to ensure the inclusion of relevant evidence on the subject.

Articles of review, duplicate studies, reflections, commentaries, abstracts from annals, theses, dissertations, opinion articles, course completion papers, letters to the editor, reports, official documents from national and international programs, book chapters and e-books were excluded.

The selection of the studies was initially based on a reading of the titles and abstracts by two independent reviewers from the Rayyan Qatar Computing Research Institute (Rayyan QCRI)¹⁶. Any discrepancies in the evaluations were forwarded to a third reviewer. This reviewer was responsible for deciding whether to include or exclude the studies, based on the previously established criteria.

The selected studies were then read in their entirety and critically assessed to determine the final sample. The information was extracted using a validated instrument¹⁷, which covered the following variables: article identification (authors, year of publication, language, country of origin), level of evidence, objective, methodological characteristics (design), result and conclusion¹⁸.

The studies were selected according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)¹⁹ guidelines, as shown in Figure 1.

Figure 1 -
Flowchart of the steps for selecting a sample of articles for the integrative review. Uberaba (MG), Brazil, 2023.

RESULTS

Nine studies were identified to compose the final sample of this study. Five of them investigated measurement techniques for GC insertion in NBs, with publications dating from 2016 to 2023. The other four studies investigated methods for verifying the placement of GC in NBs, with publication dates from 2017 to 2019. The studies included in the sample originated in Brazil (four studies), United States (three studies), Australia (one study), and Japan (one study).

Chart 2 shows the studies related to measurement techniques for insertion of the GC in NBs and presents the study identification, level of evidence, objective, design, result, and conclusion.

Chart 3 presents the studies related to methods for confirming the placement of the GC in NBs and includes the identification of the study, level of evidence, objective, design, result, and conclusion.

Chart 2 -
Synthesis of studies related to measurement techniques for gastric catheter insertion in newborns. Uberaba, MG, Brazil, 2023.

Author, year, language, country of origin	Level of evidence	Objective and design	Results and conclusion
Nguyen et al. 201620 English Australia	6	- To review the rates of correct GC placement, confirmed by radiography, after application of the weight-based formula. - Prospective, cross-sectional study - Sample: 107 NBs	The inclusion of a formula based on the weight of the newborn, as a complement to traditional morphological techniques for inserting the GC in neonates, showed a significant improvement in the rates of correct placement of the device.
Kato et al. 202021 English Japan	6	- To determine an estimated formula based on the weight of the newborn to estimate the length of the nasogastric catheter in low-birth-weight NBs. - Prospective, cross-sectional study - Sample: 152 NBs.	The formula based on the weight of the newborn to estimate the length of the nasogastric catheter proved to be superior to the approach based on height, especially when associated with the NEMU technique. This combination resulted in greater precision in the catheter insertion procedure.
Dias et al. 202012 English Brazil	2	-To verify whether there is a difference in the proportion of correctly positioned nasogastric catheters when using the NEMU method and the weight-based equation for measuring catheter insertion length. - Single-blind randomized controlled trial - Sample: 162 NBs.	Radiographic analysis showed that 75 nasogastric catheters (91.5%) inserted using the weight-based method and 54 (67.5%) inserted using the NEMU technique were properly positioned in the stomach.
Benefield; Salas. 202222 English United States	6	- To determine whether the combination of the NEMU method with a method based on birth weight is effective in reducing incorrect placement of orogastric catheters in extremely low birth weight babies. - Descriptive - Sample: 129 NBs.	NBs who had their orogastric catheters inserted using a combination of both methods (NEMU and birthweight-based method) were less likely to have the catheter positioned incorrectly. The weight-based equation alone was able to correctly predict the length of catheter insertion in 57 out of 89 NBs (64%).
Manzo et al. 202323 English Brazil	2	- To compare three methods (NEMU method, weight-based method and the ARHB method) for establishing insertion length of the GC in NB. - Triple-blind randomized clinical trial - Sample: 179 NBs.	The weight-based equation showed the highest percentage of properly positioned catheters (36.6%), followed by the ARHB method with 32.4%, and the NEMU method with 31.0%.

• GC gastric catheter; NBs: newborns; NEMU: Nose, Earlobe, Mid-Umbilicus; ARHB: Age Related, Height Based

Chart 3 -
Synthesis of studies related to methods for confirming gastric catheter placement in newborns. Uberaba, MG, Brazil, 2023.

Author, year, language, country of origin	Level of evidence	Objective and design	Results and conclusion
Metheny et al. 201724 English United States	6	- To compare sensitivity, specificity and negative and positive predictive values of four pH cut-off points in gastric differentiation and tracheal aspirates. - Descriptive study - Sample: 212 NBs and children	The pH test is considered the first viable option for immediate verification of GC placement in the stomach, and it is recommended that the pH strip reading be ≤ 5.0 to ensure adequate sensitivity. However, validation of subjective results of the colorimetric pH test with a pH meter was not possible due to the low volumes of waste aspirated.
Dias et al. 201925 English Brazil	6	-To evaluate diagnostic accuracy of ultrasound to verify position of the GC in NBs. - Descriptive study - Sample: 159 NBs.	Ultrasound showed high sensitivity in identifying correct placement of the GC in NBs, but assessing its specificity requires further studies with larger samples.
Atalay et al. 201926 English United States	6	-To investigate the feasibility of bedside ultrasound to verify correct placement of orogastric and nasogastric catheters in the NICU. - Descriptive study - Sample: 51 NBs.	Bedside ultrasound showed a sensitivity of 92.2% in correctly identifying the placement of the GC. In four neonates (7.8%), position of the catheter could not be determined using ultrasound. These results indicated that ultrasound is a promising diagnostic method for verifying the location of the GC in neonates, potentially eliminating the need for Xrays, although more studies are needed to confirm its effectiveness.
Dias et al. 20199 Portuguese Brazil	5	- To confirm the accuracy of pH test in determining the position of the GC in NBs. - Cross-sectional, double-blind diagnostic test study - Sample of 162 NBs.	The pH test using reagent strips showed high sensitivity in identifying proper placement of the gastric tube, with rates of 96.25% in patients undergoing treatment with gastric secretion inhibitors and 98.7% in patients without this treatment. These findings indicate that the pH test is a safe and effective technique to complement assessment of GC position, regardless of the use of medication to reduce gastric secretion.

• GC: gastric catheter, pH, NBs: newborns, NEMU: Nose, Earlobe, Mid-Umbilicus, ARHB: Age Related, Height Based

DISCUSSION

Evidence on the accuracy of techniques for measuring and verifying the placement of the GC demonstrated significant variations in the findings of the studies.^9,12,20-26. The utilization of formulas based on the weight of NBs demonstrated an improvement in the rate of correct placement of the catheter compared to traditional methods, such as NEX and NEMU measurements^12,20-23.

Studies have shown that the NEX technique, which measures the distance from the tip of the nose to the earlobe and from the earlobe to the xiphoid process to determine the length of the GC, is not recommended due to the high risk of improper placement, such as the tip of the catheter remaining above the gastroesophageal junction. This method has a considerable error rate, which can result in serious clinical complications^3,7,20-21.

In contrast, the NEMU method, which measures the distance from the nose to the earlobe and then from the earlobe to the midline between the xiphoid appendix and the umbilical scar, is recommended as a safer alternative for checking the length of the GC insertion. Although NEMU does not guarantee absolute accuracy, it offers greater consistency compared to the NEX method, making it preferable in clinical practice^20,26-27.

The weight-based formula, which calculates the length of the GC based on the weight of the NB, has proven to be a valuable method for optimizing catheter placement²³. This method is expressed in two formulas: one for oral catheter insertion (3x[weight in kg]+12) and the other for nasal catheter insertion (3x[weight in kg]+13)²⁸. Combining this formula with the NEMU method results in a significant improvement in the proportion of correctly positioned gastric catheters^21-22.

The ARHB method uses the patient's height, adjusted for age, to determine the appropriate GC insertion depth²⁹. The formulas used are: [1.95 + 0.372 x (height in cm)] for nasogastric catheter insertion, and [1.95 + 0.372 x (height in cm) - 1 cm] for orogastric catheter insertion³⁰. The ARHB and NEMU techniques are validated and recommended in clinical practice for measuring GC insertion length^8,23.

The correct insertion and accurate verification of the position of the GC in NBs is essential to ensure the safety of the neonate during the procedures. In addition, assessment techniques that avoid radiation exposure are important and should be employed to achieve this accuracy, as routine radiographic confirmation is neither practical nor feasible. Therefore, adoption of non-radiological clinical methods is recommended to ensure the effectiveness and safety of the procedure^10,12,32.

With regard to the accuracy and safety of alternative methods to radiological examination for verifying catheter placement, auscultation of the epigastric region has proven to be inadequate^5,32. The use of this method is not recommended, as the presence of air bubbles can be detected in the epigastric region, even when the tip of the catheter is incorrectly positioned in the respiratory tract or esophagus. This limitation compromises the reliability of auscultation as a verification method, highlighting the need for more robust techniques to guarantee the correct location of the GC^5,24.

The presence of secretions, color assessment, and appearance of the contents aspirated from the gastric catheter can help to confirm position. However, the specificity of this method is not fully guaranteed, as endotracheal and bronchial secretions can resemble gastric secretions, which can result in incorrect interpretations^5,24,31.

Accuracy in determining catheter position can be achieved by simultaneous use of two or more methods at the bedside, which is recommended. Combining different approaches can provide a more reliable assessment and minimize the risk of errors in GC placement^31-32.

Currently, consensus among experts is that checking pH using reagent strips, performed at the bedside, is the safest and most recommended method for confirming the correct placement of the GC^9,24,31.

Values ≤ 5.5 on the pH test indicate adequate gastric placement, while > 5.5 require additional confirmation by radiological examination^9,24,31. The combination of assessing the color of the aspirated gastric contents with the pH test offers an integrated and effective approach, promoting safety and accuracy in GC placement^9,24,33

Abdominal ultrasonography has proven to be a useful and promising method for verifying GC placement, showing high sensitivity compared to traditional radiological methods^25-28,32. This method is advantageous because it is simple, fast, and does not expose the patient to radiation, which is particularly relevant for the neonatal population²⁶.

The limitations of this study include the possible omission of references from databases not included in this review and the scarcity of specific research on NBs in the literature.

CONCLUSION

The use of weight-based formulas combined with the NEMU technique demonstrates efficacy in CG insertion, while pH verification and ultrasound offer safe and non-invasive methods for verifying placement. Although these methods have considerable advantages, the scarcity of specific research highlights the need for further investigation to validate and refine these techniques, thus ensuring safety and clinical efficacy for the neonatal population.

ACKNOWLEDGMENT

To the Graduate Program in Health Care, UFTM.

REFERENCES

• 1. Corvaglia L, Fantini MP, Aceti A, Gibertoni D, Rucci P, Baronciani D, et al. Predictors of full enteral feeding achievement in very low birth weight infants. PLoS One [Internet]. 2014 [cited 2025 Sep 30];9(3):e92235. Available from: https://doi.org/10.1371/journal.pone.0092235
  » https://doi.org/10.1371/journal.pone.0092235
• 2. Cooley Kim V. DNP, NNP-BC, CCNS, C-ONQS; Denning, Patricia W. MD. A nurse-driven protocol for neonatal enteral access device placement confirmation. Adv Neonatal Care [Internet]. 2024 [cited 2025 Sep 30];24(4):324-32. Available from: https://doi.org/10.1097/ANC.0000000000001186
  » https://doi.org/10.1097/ANC.0000000000001186
• 3. Nascimento J, Santos IMM, Silva LJ. Care given to newborns fed by gastric tube: concepts and practices. Texto Contexto Enferm [Internet]. 2019 [cited 2025 Sep 30];28:e20170242. Available from: https://doi.org/10.1590/1980-265X-TCE-2017-0242
  » https://doi.org/10.1590/1980-265X-TCE-2017-0242
• 4. Wallace T, Steward D. Gastric tube use and care in the NICU. Newborn Infant Nurs Rev [Internet]. 2014 [cited 2025 Sep 30];14(3):103-8. Available from: https://doi.org/10.1053/j.nainr.2014.06.011
  » https://doi.org/10.1053/j.nainr.2014.06.011
• 5. Dos Santos LCA, Ribeiro WA, Fassarella BPA, Neves KC. Care of newborns fed by gastric probe. Rev Pró-Uni [Internet]. 2021 [cited 2025 Sep 30];12(2):27-31. Available from: https://doi.org/10.21727/rpu.v12i2.3041
  » https://doi.org/10.21727/rpu.v12i2.3041
• 6. Souza CF de, Araújo CMT de, Barreto AKCP Length of gastric tube insertion in newborn: nurse’s practices. Rev Enferm UERJ [Internet]. 2022 [cited 2025 Sep 30];30(1):e69484. Available from: https://doi.org/10.12957/reuerj.2022.69484
  » https://doi.org/10.12957/reuerj.2022.69484
• 7. Dias FSB, Emidio SCD, Lopes MHBM, Shimo AKK, Beck ARM, Carmona EV. Procedures for measuring and verifying gastric tube placement in newborns: an integrative review. Rev Lat Am Enfermagem [Internet]. 2017 [cited 2025 Sep 30];10;25:e2908. Available from: https://doi.org/10.1590/1518-8345.1841.2908
  » https://doi.org/10.1590/1518-8345.1841.2908
• 8. da Silva PNJ, Baptista SCPD, Carvalheira APP, Russo NC, Bocchi SCM. Técnicas de mensuração para sondagem gástrica em recém-nascidos: revisão integrativa. Braz J Health Rev [Internet]. 2023 [cited 2025 Sep 30];6(4):18150-65. Available from: https://ojs.brazilianjournals.com.br/ojs/index.php/BJHR/article/view/62317
  » https://ojs.brazilianjournals.com.br/ojs/index.php/BJHR/article/view/62317
• 9. Dias FSB, Almeida BP, Alvares BR, Jales RM, Caldas JPS, Carmona EV. Use of pH reagent strips to verify gastric tube placement in newborns. Rev Lat Am Enfermagem [Internet]. 2019 [cited 2025 Sep 30];27:e3227. Available from: https://doi.org/10.1590/1518- 8345.3150.3227
  » https://doi.org/10.1590/1518- 8345.3150.3227
• 10. André RR, Mendes CQS, Avelar AFM, Balieiro MMFG. Enteral tube placement in newborns according to the modified measurement technique. Acta Paul Enferm [Internet]. 2017 [cited 2025 Sep 30];30(6):590-7. Available from: https://doi.org/10.1590/1982- 0194201700083
  » https://doi.org/10.1590/1982- 0194201700083
• 11. Conselho Federal de Enfermagem (BR). Resolução COFEN nº 619/2019. Normatiza a atuação da Equipe de Enfermagem na Sondagem Oro/nasogástrica e Nasoentérica [Internet]. 2019 [cited 2025 Sep 30]. Available from: https://www.cofen.gov.br/resolucaocofen-no-619-2019/
  » https://www.cofen.gov.br/resolucaocofen-no-619-2019/
• 12. Dias FSB, Jales RM, Alvares BR, Caldas JPS, Carmona EV. Randomized clinical trial comparing two methods of measuring insertion length of nasogastric tubes in newborns. J Parenter Enteral Nutr [Internet]. 2020 [cited 2025 Sep 30];44(5):912-919. Available from: https://doi.org/10.1002/jpen.1786
  » https://doi.org/10.1002/jpen.1786
• 13. Souza MT de, Silva MD da, Carvalho R de. Integrative review: what is it? How to do it? Einstein [Internet]. 2010 [cited 2025 Sep 30];8(1):102-6. Available from: https://doi.org/10.1590/S1679-45082010RW1134
  » https://doi.org/10.1590/S1679-45082010RW1134
• 14. Mendes KDS, Silveira RC de CP, Galvão CM. Integrative literature review: a research method to incorporate evidence in health care and nursing. Texto Contexto Enferm [Internet]. 2008 [cited 2025 Sep 30];17(4):758-64. Available from: https://doi.org/10.1590/S0104-07072008000400018
  » https://doi.org/10.1590/S0104-07072008000400018
• 15. Joanna Briggs Institute. Joanna Briggs Institute Reviewers’ Manual: 2014 edition. Joanna Briggs Institute Adelaide; 2014 [cited 2025 Sep 30] Available from: http://joannabriggs.org/assets/docs/sumari/ReviewersManual-The-Systematic-Review-ofEconomic-Evaluation- Evidence-2014_v2.pdf
  » http://joannabriggs.org/assets/docs/sumari/ReviewersManual-The-Systematic-Review-ofEconomic-Evaluation- Evidence-2014_v2.pdf
• 16. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan - a web and mobile app for systematic reviews. Syst Rev [Internet]. 2016 [cited 2025 Sep 30];5(1):210. Available from: https://doi.org/10.1186/s13643-016-0384-4
  » https://doi.org/10.1186/s13643-016-0384-4
• 17. Ursi ES. Prevenção de lesões de pele no perioperatório: revisão integrativa da literatura [dissertação]. Ribeirão Preto, SP(BR): Escola de Enfermagem de Ribeirão Preto da USP; 2005 [cited 2025 Sep 30]. Available from: http://doi.org/10.11606/D.22.2005.tde18072005-095456
  » http://doi.org/10.11606/D.22.2005.tde18072005-095456
• 18. Galvão CM. Níveis de evidência [Editorial]. Acta Paul Enferm [Internet]. 2006 [cited 2025 Sep 30];19(2):5. Available from: http://www.scielo.br/pdf/ape/v19n2/ a01v19n2.pdf
  » http://www.scielo.br/pdf/ape/v19n2/ a01v19n2.pdf
• 19. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ [Internet]. 2021 [cited 2025 Sep 30];372(71). Available from: https://doi.org/10.1136/bmj.n71
  » https://doi.org/10.1136/bmj.n71
• 20. Nguyen S, Fang A, Saxton V, Holberton J. Accuracy of a weight-based formula for neonatal gastric tube insertion length. Adv Neonatal Care [Internet]. 2016 [cited 2025 Sep 30];16(2):158-61. Available from: http://doi.org/10.1097/anc.0000000000000261
  » http://doi.org/10.1097/anc.0000000000000261
• 21. Kato Y, Hirata K, Oshima Y, Wada K. Weight-Based Estimation of Insertion Length of the Nasogastric Tube in Extremely Low Birth-Weight Infants. Adv Neonatal Care [Internet]. 2020 [cited 2025 Sep 30];20(2):E31-E34. Available from: https://doi.org/10.1097/anc.0000000000000692
  » https://doi.org/10.1097/anc.0000000000000692
• 22. Benefield D, Salas AA. Orogastric Tube Insertion in Extremely Low Birth-Weight Infants. Adv Neonatal Care [Internet]. 2022 [cited 2025 Sep 30];22(6):E191-E195. Available from: https://doi.org/10.1097/anc.0000000000000944
  » https://doi.org/10.1097/anc.0000000000000944
• 23. Manzo BF, Marcatto JO, Ferreira B, Galvão Diniz C, Parker LA. Comparison of 3 Methods for Measuring Gastric Tube Length in Newborns: A Randomized Clinical Trial. Adv Neonatal Care [Internet]. 2023 [cited 2025 Sep 30];23(3):E79-E86. Available from: https://doi.org/10.1097/anc.0000000000001065
  » https://doi.org/10.1097/anc.0000000000001065
• 24. Metheny NA, Pawluszka A, Lulic M, Hinyard LJ, Meert KL. Testing Placement of Gastric Feeding Tubes in Infants. Crit Care [Internet]. 2017 [cited 2025 Sep 30];26(6):466-473. Available from: https://doi.org/10.4037/ajcc2017378
  » https://doi.org/10.4037/ajcc2017378
• 25. Dias FSB, Alvares BR, Jales RM, Franco APV, Silva JEFD, Fabene SMS, Caldas JPS, Carmona EV. The Use of Ultrasonography for Verifying Gastric Tube Placement in Newborns. Adv Neonatal Care [Internet]. 2019 [cited 2025 Sep 30];19(3):219-225. Available from: https://doi.org/10.1097/anc.0000000000000553
  » https://doi.org/10.1097/anc.0000000000000553
• 26. Atalay YO, Polat AV, Ozkan EO, Tomak L, Aygun C, Tobias JD. Bedside ultrasonography for the confirmation of gastric tube placement in the neonate. Saudi J Anaesth [Internet]. 2019 [cited 2025 Sep 30];13(1):23-27. Available from: https://doi.org/10.4103/sja.SJA_413_18
  » https://doi.org/10.4103/sja.SJA_413_18
• 27. Lopes LS, Silva GD da, Alves AMA, Reis AT, Silva GRG da, Silvino ZR. Gastric tube insertion in preterm infants: prevalence analysis of measurement techniques. Rev Bras Enferm [Internet]. 2019 [cited 2025 Sep 30];27:e38515. Available from: http://doi.org/10.12957/reuerj.2019.38515
  » http://doi.org/10.12957/reuerj.2019.38515
• 28. Freeman D, Saxton V, Holberton J. A weight-based formula for the estimation of gastric tube insertion length in newborns. Adv Neonatal Care [Internet]. 2012 [cited 2025 Sep 30];12(3):179-82. Available from: https://doi.org/10.1097/anc.0b013e318256bb13
  » https://doi.org/10.1097/anc.0b013e318256bb13
• 29. Beckstrand J, Ellett MLC, McDaniel A. Predicting internal distance to the stomach for placement nasogastric and orogastric feeding tubes in children. J Adv Nurs [Internet]. 2007 [cited 2025 Sep 30];59(3):274-89. Available from: https://doi.org/10.1111/j.1365-2648.2007.04296.x
  » https://doi.org/10.1111/j.1365-2648.2007.04296.x
• 30. Ellett MLC, Cohen MD, Perkins SM, Smith CE, Lane KA, Austin JK. Predicting the Insertion Length for Gastric Tube Placement in Neonates. J Obstet Gynecol Neonatal Nurs [Internet]. 2011 [cited 2025 Sep 30];40(4):412-21. Available from: https://doi.org/10.1111/j.1552-6909.2011.01255.x
  » https://doi.org/10.1111/j.1552-6909.2011.01255.x
• 31. Parker LA, Withers JH, Talaga E. Comparison of Neonatal Nursing Practices for Determining Feeding Tube Insertion Length and Verifying Gastric Placement With Current Best Evidence. Adv Neonatal Care [Internet]. 2018 [cited 2025 Sep 30];18(4):307-317. Available from: https://doi.org/10.1097/anc.0000000000000526
  » https://doi.org/10.1097/anc.0000000000000526
• 32. Rodrigues da Silva H, Ferreira LP, Fernandes MTC, Dellanhese APF. Metodos alternativos de verificação do pisicionamento de sonda gástrica em crianças. Saud Coletiv [Internet]. 2020 [cited 2025 Sep 30];10(59):4326-4337. Available from: https://doi.org/10.36489/saudecoletiva.2020v10i59p4326-4337
  » https://doi.org/10.36489/saudecoletiva.2020v10i59p4326-4337
• 33. Kisting MA, Korcal L, Schutte DL. Lose the Whoosh: An Evidence-Based Project to Improve NG Tube Placement Verification in Infants and Children in the Hospital Setting. J Pediatr Nurs [Internet]. 2019 [cited 2025 Sep 30];46:1-5. Available from: https://doi.org/10.1016/j.pedn.2019.01.011
  » https://doi.org/10.1016/j.pedn.2019.01.011

NOTES

• ORIGIN OF THE ARTICLE
  Extracted from the dissertation - Construction and validation of a bundle on gastric catheterization in newborns, presented to the Graduate Program in Health Care, Federal University of Triângulo Mineiro, in 2024.
• FUNDING INFORMATION
  Without financial support.
• TRANSLATED BY
  Academic Editing for Nurses.
• DATA AVAILABILITY
  The entire data set supporting the results of this study was published in the article itself.

Edited by

• EDITORS
  Associated Editors: Leticia de Lima Trindade, Maria Lígia Bellaguarda. Editor-in-chief: Elisiane Lorenzini.

Data availability

The entire data set supporting the results of this study was published in the article itself.

Publication Dates

• Publication in this collection
  03 Nov 2025
• Date of issue
  2025

History

• Received
  05 Apr 2024
• Accepted
  23 Oct 2024