pH and concentration of bilirubin in feeding tube aspirates as predictors of tube placement.
BACKGROUND
Currently available bedside methods for determining feeding tube placement often provide inconclusive results. Therefore, additional data are needed to assist nurses in making decisions regarding tube location.


OBJECTIVE
To describe the usual concentration of bilirubin in aspirates from newly inserted feeding tubes and to determine the extent to which these measures can contribute to pH alone in correctly predicting feeding tube location.


METHODS
Gastrointestinal samples for concurrent pH and bilirubin testing were obtained from adult, acutely ill patients with newly inserted small-bore feeding tubes (nasogastric, n = 209; nasointestinal, n = 228) within 5 minutes of radiographs taken to determine tube location. Respiratory samples were tested (tracheobronchial, n = 126; pleural, n = 24). pH was measured with a pH meter, and bilirubin content was assayed spectrophotometrically. Results from the pH and bilirubin tests were compared with tube location as determined by radiography.


RESULTS
Mean pH levels in the lung (7.73) and intestine (7.35) were significantly higher than the mean pH level in the stomach (3.90; p < .001 for each comparison). Mean bilirubin levels in the lung (.08 mg/dl) and stomach (1.28 mg/dl) were significantly lower than the mean bilirubin level in the intestine (12.73 mg/dl; p < .001 for each). By visually inspecting distribution overlap and mean differences by tube site, results were dichotomized so that a combination of pH and bilirubin values could be used to develop a predictive algorithm. A pH of >5 and a bilirubin value of <5 mg/dl correctly identified all respiratory cases, whereas a pH >5 coupled with a bilirubin level of > or =5 mg/dl correctly identified three fourths of the intestinal cases. A pH of < or =5 coupled with a bilirubin value of <5 correctly identified more than two thirds of the gastric cases.


CONCLUSIONS
Preliminary laboratory-based data indicate that appropriate use of the proposed algorithm could significantly reduce the number of x-rays needed to exclude respiratory placement and to distinguish between gastric and intestinal placement.
Saint Louis University School of Nursing, MO 63104-1099, USA. methenna@slu.edu
N A
NA
Metheny
B J
BJ
Stewart
L
L
Smith
H
H
Yan
M
M
Diebold
R E
RE
Clouse
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001663:Bilirubin / Q000378:metabolism*; D004750:Enteral Nutrition / Q000451:nursing*; D005260:Female; D005750:Gastric Juice / Q000378:metabolism*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007419:Intestinal Secretions / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009729:Nursing / Q000379:methods; D011237:Predictive Value of Tests
D001663:Bilirubin