The identification of relatively simple, safe, inexpensive measures for testing placement of small-bore nasogastric and nasointestinal feeding tubes is the ultimate aim of this study. Presently used measures for testing placement of these widely used tubes (other than radiography) are largely ineffective. This is an important problem since nurses are responsible for testing placement of feeding tubes prior to each intermittent feeding and at least once a shift for patients receiving continuous tube feedings. It is not feasible, because of increased radiation risk and expense, to obtain x-rays to verify tube placement this often. Unfortunately, failure to detect an improperly placed feeding tube predisposes to pulmonary aspiration with increased morbidity and mortality. A variation of the commonly used auscultatory method will be tested for the purpose of predicting tube position, as will pH measurement of fluid aspirated from the tubes. The criterion against which the efficacy of the measures will be tested is radiographic examination (KUB). The study will be conducted in three acute care facilities; the sample size is 120 (pilot testing will be done in 10 subjects). In an attempt to differentiate between gastric and respiratory placement of the newly inserted tube, the researchers will aspirate fluid from the tube and test its pH within thirty minutes after insertion. Then, at the appropriate times, performance of both methods (pH testing and auscultation for sound variations) will be done twice in each of the 120 subjects once before and once after feedings are introduced through the tubes. It is hypothesized that nurses can predict at which point a feeding tube ends in the gastrointestinal (GI) tract by insufflating air through the tube while auscultating six abdominal sites for variation in sound quality and intensity with a doppler stethoscope. (The exact number and sites for auscultation will be refined during the pilot testing.) Also, it is hypothesized that the nurse can predict where small-bore tubes end in the GI tract by testing the pH of fluid aspirated from the tubes (fluid aspirated from the stomach will have an acidic pH, while fluid aspirated from the small intestine will have an alkalinic pH). Finally, it is hypothesized that nurses can differentiate between gastric and respiratory placement of initially inserted feeding tubes by checking the pH of fluid aspirated from the tubes via syringe (gastric aspirate would have an acidic pH while pulmonary secretions would likely be slightly alkaline).

Agency
National Institute of Health (NIH)
Institute
National Institute of Nursing Research (NINR)
Type
Research Project (R01)
Project #
5R01NR001669-02
Application #
3391591
Study Section
Nursing Research Study Section (NURS)
Project Start
1987-08-15
Project End
1989-07-31
Budget Start
1988-08-15
Budget End
1989-07-31
Support Year
2
Fiscal Year
1988
Total Cost
Indirect Cost
Name
Saint Louis University
Department
Type
Schools of Nursing
DUNS #
City
Saint Louis
State
MO
Country
United States
Zip Code
63103
Metheny, N A; Titler, M G (2001) Assessing placement of feeding tubes. Am J Nurs 101:36-45; quiz 45-6
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; 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 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; 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