title: Hold that x-ray: aspirate pH and auscultation prove enteral tube placement.
abstract: We report here a prospective study evaluating an alternative to the roentgenographic confirmation of "fine-bore" nasoenteral feeding tubes. Of 78 nasoenteral intubations in 46 patients using a Dobbhoff (Biosearch Medical Products) weighted enteral feeding tube, gastric aspirates were evaluated in 28. Auscultation was performed in all 78. Data was collected at initial placement prior to x-ray confirmation. Observers used color-coded pH paper to analyze gastric aspirate (pH < or = 4) and/or auscultation of the epigastrium to determine feeding tube position prior to x-rays. Auscultation alone was ineffective as a confirmatory test with only 6.3% specificity (p = 0.31). Aspiration to ascertain tube position was very accurate when pH < or = 4.0 (p = 0.0005) and when it was performed. A pH value of > 4 was not very helpful in predicting malposition (37%) especially when pH altering medications were used. Aspiration of contents was successful in 85% of patients. We conclude that when the pH of the nasogastric tube aspirate is < 4.0, x-ray films are not needed to prove the accuracy of tube placement. In other situations, a film is indicated since auscultation is inaccurate.
authors.affiliation: Department of Internal Medicine, Genesys Regional Medical Center, Flint, Michigan, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Neumann
authors.forename: C T
authors.initials: CT
authors.lastname: Meyer
authors.forename: J L
authors.initials: JL
authors.lastname: Dutton
authors.forename: R
authors.initials: R
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001314:Auscultation; D004750:Enteral Nutrition; D005069:Evaluation Studies as Topic; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007441:Intubation, Gastrointestinal; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity