To prevent serious pulmonary complications, nurses must confirm correct feeding tube location upon initial insertion and at regular intervals thereafter. Repeated x-rays for this purpose are impractical because of expense, radiation risk, and inaccessibility to patients in non-acute care settings. Previous studies have indicated that bedside pH testing is a promising method for predicting tube position; yet, instances of outlier readings occur frequently enough to require additional corroborative data. This study's ultimate aim is to facilitate development of bedside enzyme tests to use in conjunction with pH tests to confirm proper tube position, thereby increasing patient safety in a cost-effective manner. Before bedside enzyme tests can be developed, it is necessary to determine (1) the usual levels of pepsin and trypsin in feeding tube aspirates (by laboratory analyses) and (2) the extent to which the presence and concentration of these enzymes can predict feeding tube location. This basic work will be accomplished in the proposed study. Should the results demonstrate desirability and feasibility of bedside enzyme tests, a commercial source will be sought to develop the tests, and carry them to the clinical testing required by the FDA for a diagnostic, and production and marketing. The study will be conducted at five hospitals over a three year period, and a sample size of 400 subjects will be sought (200 with nasogastric tubes and 200 with nasointestinal tubes). Variables will include age, and presence or absence of H2 receptor antagonists. Data will be collected in two phases for each subject: immediately after feeding tube placement, and again after feedings have been initiated. Following initial placement (and within five minutes after an x-ray), fluid will be aspirated and tested for pH. The, laboratory analyses for enzymes (pepsin and trypsin) will be performed. Results of pH and enzyme tests will be compared to actual tube position, as determine by x-ray. The second phase of the study will also involve comparison of pH and enzyme measurements (at least one hour after feedings have ceased) with radiologic results. It is hypothesized that gastric aspirates will have low pH values and contain pepsin, and that intestinal aspirates will have high pHs and contain trypsin. Further, it is expected that inadvertent respiratory placement can be ruled out by the presence of pepsin or trypsin in fluid aspirated from the tube.

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Research Project (R01)
Project #
5R01NR001669-04
Application #
3391592
Study Section
Nursing Research Study Section (NURS)
Project Start
1987-08-15
Project End
1994-07-31
Budget Start
1992-08-01
Budget End
1993-07-31
Support Year
4
Fiscal Year
1992
Total Cost
Indirect Cost
Name
Saint Louis University
Department
Type
Other Domestic Higher Education
DUNS #
City
Saint Louis
State
MO
Country
United States
Zip Code
63103
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Metheny, N A; Smith, L; Stewart, B J (2000) Development of a reliable and valid bedside test for bilirubin and its utility for improving prediction of feeding tube location. Nurs Res 49:302-9
Metheny, N A; Stewart, B J; Smith, L et al. (1999) pH and concentration of bilirubin in feeding tube aspirates as predictors of tube placement. Nurs Res 48:189-97
Metheny, N A; Stewart, B J; Smith, L et al. (1997) pH and concentrations of pepsin and trypsin in feeding tube aspirates as predictors of tube placement. JPEN J Parenter Enteral Nutr 21:279-85
Metheny, N A; Clouse, R E; Clark, J M et al. (1994) pH testing of feeding-tube aspirates to determine placement. Nutr Clin Pract 9:185-90
Metheny, N; Reed, L; Berglund, B et al. (1994) Visual characteristics of aspirates from feeding tubes as a method for predicting tube location. Nurs Res 43:282-7
Metheny, N; McSweeney, M; Wehrle, M A et al. (1990) Effectiveness of the auscultatory method in predicting feeding tube location. Nurs Res 39:262-7
Metheny, N; Dettenmeier, P; Hampton, K et al. (1990) Detection of inadvertent respiratory placement of small-bore feeding tubes: a report of 10 cases. Heart Lung 19:631-8
Metheny, N; Williams, P; Wiersema, L et al. (1989) Effectiveness of pH measurements in predicting feeding tube placement. Nurs Res 38:280-5