Capnometry and Air Insufflation for Assessing Initial Placement of Gastric Tubes

Elpern, Ellen H.; Killeen, Kathryn; Talla, Erlinda; Perez, Gabriel; Gurka, David P.

doi:10.4037/ajcc2007.16.6.544

Cited by 45 publications

(19 citation statements)

References 13 publications

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“…Some techniques to reduce the risk for pulmonary placement include listening for air exchange at the end of the tube after 25 cm tube length has been inserted, 22 carbon dioxide calorimetry, [33][34][35][36] and tube placement check by radiograph. 37 Fluoroscopic and endoscopic guidance for feeding tube placement have been utilized, and placement is verified during tube placement.…”

Section: Nasally Placed Feeding Tubes: Placementmentioning

confidence: 99%

Enteral Access Devices: Types, Function, Care, and Challenges

Lord

2018

Nut in Clin Prac

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Enteral access feeding devices are placed in patients who have a functional and accessible gastrointestinal (GI) tract but are not able to consume or absorb enough nutrients to sustain adequate nutrition and hydration. For many individuals, enteral nutrition support is a lifesaving modality to prevent or treat a depleted nutrient state that can lead to tissue breakdown, compromised immune function, and poor wound healing. Psychological well-being is also affected with malnutrition and dehydration, triggering feelings of apathy, depression, fatigue, and loss of morale, negatively impacting a patient's ability for self-care. A variety of existing devices can be placed through the nares, mouth, stomach or small intestine to provide liquid nutrition, fluids, and medications directly to the GI tract. If indicated, some of the larger-bore devices may be used for gastric decompression and drainage. These enteral access devices need to be cared for properly to avert patient discomfort, mechanical device-related complications, and interruptions in the delivery of needed nutrients, hydration, and medications. Clinicians who seek knowledge about enteral access devices and actively participate in the selection and care of these devices will be an invaluable resource to any healthcare team. This article will review the types, care, proper positioning, and replacement schedules of the various enteral access devices, along with the prevention and troubleshooting of potential problems.

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Section: Nasally Placed Feeding Tubes: Placementmentioning

confidence: 99%

Enteral Access Devices: Types, Function, Care, and Challenges

Lord

2018

Nut in Clin Prac

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“…However, these tests can result in false positive results in 16% of cases when compared with X-rays. 18 They are also unable to positively confirm misplacement of the NGT in the mouth, nasopharynx or oesophagus. 19 …”

Section: Introductionmentioning

confidence: 98%

Study to determine the likely accuracy of pH testing to confirm nasogastric tube placement

Rowat

Graham

Dennis

2018

BMJ Open Gastroenterol

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ObjectiveTo establish the likely accuracy of pH testing to identify gastric aspirates at different pH cut-offs to confirm nasogastric tube placement.MethodsThis prospective observational study included a convenience sample of adult patients who had two (one fresh and one frozen) gastric and oesophageal samples taken during gastroscopy or two bronchial and saliva samples taken during bronchoscopy. The degree of observer agreement for the pH of fresh and frozen samples was indicted by kappa (k) statistics. The sensitivities and specificities at pH ≤5.5 and the area under the receiver operating characteristics (ROC) curve at different pH cut-offs were calculated to identify gastric and non-gastric aspirates.ResultsNinety-seven patients had a gastroscopy, 106 a bronchoscopy. There was complete agreement between observers in 57/92 (62%) of the paired fresh and frozen gastric samples (k=0.496, 95% CI 0.364 to 0.627). The sensitivity of a pH ≤5.5 to correctly identify gastric samples was 68% (95% CI 57 to 77) and the specificity was 79% (95% CI 74 to 84). The overall accuracy to correctly classify samples was between 76% and 77%, regardless of whether patients were taking antacids or not. The area under the ROC curve at different pH cut-offs was 0.74.ConclusionThe diagnostic accuracy of pH ≤5.5 to differentiate gastric from non-gastric samples was low, regardless of whether patients were taking antacids or not. Due to the limited accuracy of the pH sticks and the operators’ ability to differentiate colorimetric results, there is an urgent need to identify more accurate and safer methods to confirm correct placement of nasogastric tubes.

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“…Measuring pH of gastric aspirate is another reliable indicator for tube placement. However, studies have confirmed that radiography is superior to other technique despite the risk of radiation exposure, but if not available, pH method can be applied (10,38,(46)(47)(48)(49)(50).…”

Section: Discussionmentioning

confidence: 99%

Nurses' Knowledge and Responsibility toward Nutritional Assessment for Patients in Intensive Care Units

Kalaldeh

Shahein

2014

JHSCI

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Introduction: Nutritional assessment is a prerequisite for nutritional delivery. Patients in intensive care suffer from under-nutrition and nutritional failure due to poor assessment. Nursing ability to early detect nutritional failure is the key for minimizing imparities in practice and attaining nutritional goals. Aim of this article is to examine the ability of Jordanian ICU nurses to assess the nutritional status of critically ill patients, considering biophysical and biochemical measures.Methods: This cross sectional study recruited nurses from different health sectors in Jordan. ICU nurses from the governmental sector (two hospitals) and private sectors (two hospitals) were surveyed using a self-administered questionnaire. Nurses' knowledge and responsibility towards nutritional assessment were examined.Results: A total of 220 nurses from both sectors have completed the questionnaire. Nurses were consistent in regard to knowledge, responsibility, and documentation of nutritional assessment. Nurses in the governmental hospitals inappropriately perceived the application of aspiration reduction measures. However, they scored higher in applying physical examination and anthropometric assessment. Although both nurses claimed higher use of biochemical measurements, biophysical measurements were less frequently used. Older nurses with longer clinical experience exhibited better adherence to biophysical measurement than younger nurses.Conclusion: Nursing nutritional assessment is still suboptimal to attain nutritional goals. Assessment of body weight, history of nutrition intake, severity of illness, and function of gastrointestinal tract should be considered over measuring albumin and pre-albumin levels. A well-defined evidence-based protocol as well as a multidisciplinary nutritional team for nutritional assessment is the best to minimize episodes of under-nutrition.

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Capnometry and Air Insufflation for Assessing Initial Placement of Gastric Tubes

Cited by 45 publications

References 13 publications

Enteral Access Devices: Types, Function, Care, and Challenges

Enteral Access Devices: Types, Function, Care, and Challenges

Study to determine the likely accuracy of pH testing to confirm nasogastric tube placement

Nurses' Knowledge and Responsibility toward Nutritional Assessment for Patients in Intensive Care Units

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