Initial and Ongoing Verification of Feeding Tube Placement in Adults (applies to blind insertions and placements with an electromagnetic device)

Abstract

Level A Meta-analysis of quantitative studies or metasynthesis of qualita tive studies with results that consis tently support a specifi c action, intervention, or treatment (including systematic review of randomized controlled trials) Level B Well-designed, controlled studies with results that consistently support a specifi c action, intervention, or treatment Level C Qualitative studies, descriptive or correlational studies, integrative reviews, systematic reviews, or randomized controlled trials with inconsistent results Level D Peer-reviewed professional and organizational standards with the support of clinical study recommendations Level E Multiple case reports, theory-based evidence from expert opinions, or peer-reviewed professional organizational standards without clinical studies to support recommendations Level M Manufacturer's recommendations only by AACN on April 4, 2019

Accuracy of the combined method (auscultation and pH measurement) and ultrasonography for confirmation of gastric tube placement: a study protocol for a prospective study

“…This method is, however, considered inconclusive and it is related to false positives, even when the tube is located in the oesophagus or in the trachea. 7 The most proficient professionals can have difficulty in recognising pulmonary intubation when inserting an NGT since the sound made by the insufflated air can be transmitted to the epigastrium, regardless of the tube being placed in the lungs, oesophagus, stomach, duodenum or jejunum. 8 Among the other non-radiographic methods used, the measurement of pH is the first line test and the most sensitive.…”

“…According to a recent review of international guidelines, 9 epigastric auscultation is the least desirable method, with pH measurement recommended by the UK National Patient Safety Agency (NPSA) 10 and American Association of Critical-Care Nurses. 7 The reference pH values are typically distinct in the lungs, stomach and bowel. The gastric pH is acid, with values varying from 1 to 5.5.…”

“…9 Values equal to or higher than 6 are indicators of gut or respiratory aspiration, with the latter being more alkaline. 7 Accordingly, values that are lower than 6 indicate gastric positioning and exclude the possible displacement of the tube to the lungs. 9 Nevertheless, the possibility of the distal end of the tube being in the oesophagus is not excluded.…”

A review of guidelines to distinguish between gastric and pulmonary placement of nasogastric tubes

“…1,2 Although small-bore tubes are most often associated with complications, large-bore tubes are not without risk. 3 Introducing fluids or medications into the respiratory tract or pleural space via a misplaced NG or orogastric tube is a Never Event in England. "Never Events are considered wholly preventable where guidance or safety recommendations that provide strong systemic protective barrier are available at a national level, and should have been implemented by all healthcare providers."…”

“…There are multiple guidelines/recommendations for determining NG tube placement. Most include two or more of the following methods: (1) radiography, (2) signs of respiratory distress, (3) aspirate appearance, (4) aspirate pH, (5) carbon dioxide detection, (6) auscultation, and (7) enteral access devices. Unfortunately, despite a similar evidentiary basis, there are often key differences in the guidelines/recommendations to distinguish between gastric and pulmonary placement.…”