Litmus tests for verification of feeding tube location in infants: evaluation of their clinical use

Nyqvist, Kerstin Hedberg; Sorell, Annette; Ewald, Uwe

doi:10.1111/j.1365-2702.2004.01074.x

Cited by 22 publications

(11 citation statements)

References 23 publications

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“…1 Testing the pH of feeding tube aspirates is frequently recommended 2,3 but infrequently used. 4 Probable reasons for the lack of use are concerns that an infant's developmental age and the frequent use of feedings and gastric acid inhibitors interfere with the effectiveness of pH testing. 5,6 However, the extent to which these factors actually influence the efficacy of this method in infants is unknown because little research has been focused on these patients.…”

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confidence: 99%

The pH of Feeding Tube Aspirates From Critically Ill Infants

Meert

Caverly

Kelm

et al. 2015

American Journal of Critical Care

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Background The extent to which gastric acid inhibitors and feedings affect gastric pH in infants is unclear. Objectives To compare pH values of gastric aspirates from infants according to use or no use of gastric acid inhibitors and feedings. Methods Colorimetric pH tests were used to measure the pH of aspirates from feeding tubes in 54 critically ill infants; 29 of the gastric aspirates were from infants who did not receive acid inhibitors or feedings, 13 were from infants who received acid inhibitors but no feedings, 3 were from infants who received feedings but no acid inhibitors, and 5 were from infants who received both acid inhibitors and feedings. The remaining 4 feeding tubes were in nongastric sites. Results Individual pH readings of 5.5 or less were found in 97% of the gastric aspirates from infants with no recent feedings or acid inhibitors, 77% of the gastric aspirates from infants who received acid inhibitors, and 67% of the gastric aspirates from infants with recent feedings. Among 2 esophageal aspirates and 2 duodenal aspirates, 1 of each type had a pH less than 5.5. A pH cut point of 5.5 or less did not rule out esophageal or duodenal placement. Conclusions The pH of gastric aspirates from critically ill infants is often 5.5 or less, regardless of the use of acid inhibitors, feedings, or both. Most likely a cut point of 5.5 or less would rule out respiratory placement because tracheal pH is typically 6.0 or higher.

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mentioning

confidence: 99%

The pH of Feeding Tube Aspirates From Critically Ill Infants

Meert

Caverly

Kelm

et al. 2015

American Journal of Critical Care

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“…[12][13][14][15][16] In our pediatric ICU, to confirm gastric placement the nursing staff rely on gastric pH and subsequent radiograph. In a previous study the gastric pH method was only 77% sensitive and 38% specific for proper placement.…”

Section: Discussionmentioning

confidence: 99%

Electrocardiographic Guidance for the Placement of Gastric Feeding Tubes: A Pediatric Case Series

et al. 2011

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“…This procedure is of nurses' responsibility and frequently repeated during hospitalization. (5) Among the methods for verification of tube placement found in the literature, the following stand out: ultrasound; measurement of gastric hydrogen ion concentration (pH) by aspiration, bilirubin, pepsin and trypsin; assessment of gastric aspirate characteristics; observation of blistering by placing the proximal end of the probe immersed in water; measuring the level of carbon dioxide at the proximal end of the probe; auscultation of bubbling sound in the epigastrium or upper left quadrant of the abdomen as air is introduced; and thoracoabdominal radiography. (7) The thoracoabdominal radiography is considered gold standard for the verification of tube placement.…”

Section: Introductionmentioning

confidence: 99%

“…For this reason, authors affirm it is essential to verify the placement of all inserted tubes without the aid of direct visualization methods prior to feeding or medication administration. (6) In the aforementioned measurement methods, placement errors occur (4,5) thus, tests to confirm the precise localization of the tube are extremely important given the need of its use for feeding preterm infants. This procedure is of nurses' responsibility and frequently repeated during hospitalization.…”

Section: Introductionmentioning

confidence: 99%

“…(4) In care practice, enteral tube placement techniques use several measurements to estimate the length of the tube to be introduced into the newborn (NB), namely the measurement from the tip of the nose to the ear lobe and until the xiphoid (NEX); from the tip of the nose to the ear lobe and from this point to the midline between the xiphoid and the umbilicus (NEMU); and from the tip of the nose to the ear lobe and from this to the umbilicus (NEU). (4,5) There are also measurements based on formulas that consider weight or height classified by the child's age. (3) In a review of cases of inadvertent insertion of nasogastric tubes into the respiratory tract of children, the presence of serious injuries and even death was evident.…”

Section: Introductionmentioning

confidence: 99%

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Posicionamento de sonda enteral em neonatos segundo técnica modificada de mensuração

et al. 2017

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Objective: To evaluate the effectiveness of the enteral tube measurement using the modified nose -ear -xiphoid (NEX) technique by disregarding the tube distal orifices for placement in newborns' neonatal gastric cavity. Methods: A prospective study conducted in a neonatal unit of a teaching hospital in the city of São Paulo, based on the radiographic analysis of 60 radiographs of 28 newborns using enteral tubes measured by the modified technique, and who had thoracoabdominal radiography. Results: The correct placement index according to analysis by position was 68.3% and 71.7%, according to evaluators 1 and 2, respectively. In the analysis by vertebrae, 95% of tubes were properly placed in the gastric cavity. There was a statistically significant association between height and location of the enteral tube according to evaluator 2. Conclusion: The evaluated measurement technique presents a risk for inadequate enteral tube placement in newborns, and its application in clinical practice should not be encouraged. ResumoObjetivo: Avaliar a efetividade da mensuração de sonda enteral pela técnica modificada, nariz -orelha -apêndice xifoide, com desconto dos orifícios distais da sonda, para posicionamento na câmara gástrica de neonatos. Métodos: Estudo prospectivo, desenvolvido em unidade neonatal de um hospital de ensino do município de São Paulo, a partir da análise radiográfica de 60 radiografias de 28 neonatos em uso de sonda enteral mensurada pela técnica modificada, submetidos à radiografia toracoabdominal. Resultados: O índice de posicionamento correto, de acordo com a análise por posições, foi de 68,3% e 71,7%, segundo os avaliadores 1 e 2, respectivamente, enquanto na análise por vértebras, 95% das sondas estavam adequadamente locadas na câmara gástrica. Ocorreu associação estatisticamente significante entre estatura e localização da sonda enteral, segundo o avaliador 2. Conclusão: A técnica de mensuração avaliada apresenta risco para posicionamento inadequado da sonda enteral utilizada em neonatos, devendo ser desencorajada sua aplicação na prática clínica.

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Litmus tests for verification of feeding tube location in infants: evaluation of their clinical use

Abstract: Application of pH indicator paper is recommended as a complementary method for assessment of aspirates from feeding tubes.

Cited by 22 publications

References 23 publications

The pH of Feeding Tube Aspirates From Critically Ill Infants

The pH of Feeding Tube Aspirates From Critically Ill Infants

Electrocardiographic Guidance for the Placement of Gastric Feeding Tubes: A Pediatric Case Series

Posicionamento de sonda enteral em neonatos segundo técnica modificada de mensuração

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