Clinical Practice Guideline: Gastric Tube Placement Verification

Killian, Marylou; Slivinski, Andie; Bradford, Judith Young; Horigan, Annie; Barnason, Susan; Foley, Andi; Johnson, Mindi; Kaiser, Janet; MacPherson-Dias, Robin; Stapleton, Stephen J.; Valdez, Anna Maria; Vanhoy, Mary Alice; Zaleski, Mary Ellen; Gillespie, Gordon Lee; Proehl, Jean A.; Bishop‐Royse, Jessica; Wolf, Lisa; Delao, Altair M.; Gates, Leslie

doi:10.1016/j.jen.2019.03.011

Cited by 11 publications

(7 citation statements)

References 24 publications

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“…In the clinical practice guidelines, there are factors stated that restrict the use of pH measurement and colorimetric capnometry for confirming NGT localization; there is insufficient evidence concerning these methods in general (Boullata et al, 2017; Killian et al, 2018; Metheny et al, 2019). In this current study, according to the findings from the colorimetric capnometry measurement results, all NGT placements were determined to be in the stomach.…”

Section: Discussionmentioning

confidence: 99%

The effectiveness of auscultatory, colorimetric capnometry and pH measurement methods to confirm placement of nasogastric tubes: A methodological study

TAŞKIRAN

Sarı

2022

Int J of Nursing Practice

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Aim: To determine the effectiveness of auscultatory, colorimetric capnometry and pH measurement methods for confirmation of correct nasogastric tube placement in critically ill patients.Background: Incorrect nasogastric tube placement causes serious complications.Design: This was a methodological and comparative study. Methods:The study sample consisted of 88 new insertions of nasogastric feeding tubes between April 2018-2019. Results from the 'auscultatory', 'pH' and 'colorimetric capnometry' methods were compared with the location of the nasogastric tube as determined through radiography. Descriptive statistics, Eta analysis and the Cohen kappa compliance test as well as sensitivity and specificity were conducted.Results: There was a weak agreement (26.3%) between the auscultation and radiological evaluation for confirming nasogastric tube placement. The pH measurement and colorimetric capnometry methods were not correlated with radiological evaluation. Stomach pH increased as patient age increased and use of the colorimetric capnometry method failed to confirm the oesophageal and duodenal location. The specificity of the auscultation was low, and both the specificity and sensitivity pH methods were low. Conclusion:It was determined that auscultation, measuring pH and colorimetric capnometry were unreliable methods for confirming placement of nasogastric tubes.It is recommended to confirm initial placement of the nasogastric tube with radiography and to develop effective and reliable non-radiological measurement methods that can be performed at the bedside.

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Section: Discussionmentioning

confidence: 99%

The effectiveness of auscultatory, colorimetric capnometry and pH measurement methods to confirm placement of nasogastric tubes: A methodological study

TAŞKIRAN

Sarı

2022

Int J of Nursing Practice

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“…Besides, 40 ml warm water was fed through NG tube, and the patient had no adverse reactions such as choking, signs of respiratory distress, etc. Nevertheless, the bedside radiography was not carried out immediately because of its de ciency, such as delayed enteral feeding administration and the risk of radiation exposure to patients [24][25][26]. Unfortunately, this patient encountered malposition of the NG tube.…”

Section: Discussionmentioning

confidence: 99%

Malposition of a Nasogastric Feeding Tube Into the Right Pleural Cavity of a Nasopharyngeal Carcinoma Patient After Radiotherapy and Chemotherapy: A Case Report

Zhang

Zhu

Liu

et al. 2021

Preprint

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Background: Nasogastric feeding tube plays an important role in nutrition intake, drug administration, and stomach emptying for patients with severe dysphagia. However, inserting nasogastric tubes is not absolutely harmless. Inadvertent malposition into the trachea or the pleural cavity could result in severe pulmonary complications. Case presentation: We present a case of a 67-year-old patient with a history of nasopharyngeal carcinoma and after the treatment of radiotherapy and chemotherapy. Nasogastric tubes have to be placed for enteral nutrition and avoiding aspiration owing to his severe dysphagia. Unfortunately, he experienced a malposition of nasogastric tube into the right pleura cavity after blind replacement by nurse, whereas the nurses and physicians did not recognize this fault, even the bedside chest radiography (X-ray) was performed twice after intubation. A week later, his condition deteriorated so rapidly that he had to undergo tracheotomy, and the tube was finally found in his trachea.Conclusions: The Nasopharyngeal carcinoma patients after radiotherapy and chemotherapy should be fully evaluated before the nasogastric tube placement whether the blind insertion is suitable or not. Meanwhile, we should not feed immediately unless we have a radiograph to verify the right position of NG tube. Furthermore, careful monitoring of both typical and untypical symptoms of malposition is essential during tube feeding.

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“…X-ray confirmation is considered the reference standard for nasogastric tube insertion. [2][3][4] When used to verify G tube placement, water-soluble contrast is typically used to aid visualization. The instillation of 300 ml of air instead of contrast to enhance x-ray visualization has been suggested and noted to enhance visualization of the stomach, decrease cost, and eliminate risk associated with x-ray verification using contrast media.…”

Section: Means To Verify Placementmentioning

confidence: 99%

“…X‐ray confirmation is considered the reference standard for nasogastric tube insertion 2–4 . When used to verify G tube placement, water‐soluble contrast is typically used to aid visualization.…”

Section: Background (Available Knowledge)mentioning

confidence: 99%

“…Additionally, providers in various EDs or clinic settings sometimes strug-gle with how to reliably verify tube placement post-G tube replacement. Although there are national guidelines for placement verification post-nasogastric tube insertion, [2][3][4] evidence-based guidance regarding means to verify placement after G tube replacement is sorely lacking. This assessment is critical for patient safety prior to tube use as a misplaced tube may lead to dire patient consequences.…”

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confidence: 99%

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Assessment of the effect of colored beverage on gastric returns after gastric tube replacement to enhance placement verification

2021

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Background: Verification of appropriate placement of newly replaced gastrostomy tubes is essential prior to use to avoid potentially serious adverse events.Problem: A lack of standardized guidance regarding effective and practical means to verify placement exists. Aspiration or drainage of gastric-like contents is one mean suggested to help determine placement, yet when returns are minimal, this becomes challenging. Materials, Method, Intervention:Oral ingestion or the instillation of a colored beverage prior to tube replacement was used in a midwestern healthcare clinical setting to enhance returns in both volume and color via the newly replaced gastrostomy tube. A retrospective review of this practice was conducted, which included 176 gastric tube replacements over 4 years.Results: A significant increase in volume of returns via the newly replaced tube was noted (P < .001) and a strong correlation of color to the ingested or consumed beverage was found with 95% of returns reflecting color tinting of the beverage or in many cases, strong color change to that of the beverage color. Conclusion:Presented is a simple, cost-effective method that has shown to be clinically useful in assessing placement of newly replaced gastrostomy tubes that may be useful in other practices and settings.

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Clinical Practice Guideline: Gastric Tube Placement Verification

Cited by 11 publications

References 24 publications

The effectiveness of auscultatory, colorimetric capnometry and pH measurement methods to confirm placement of nasogastric tubes: A methodological study

The effectiveness of auscultatory, colorimetric capnometry and pH measurement methods to confirm placement of nasogastric tubes: A methodological study

Malposition of a Nasogastric Feeding Tube Into the Right Pleural Cavity of a Nasopharyngeal Carcinoma Patient After Radiotherapy and Chemotherapy: A Case Report

Assessment of the effect of colored beverage on gastric returns after gastric tube replacement to enhance placement verification

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