title: Blind insertion of feeding tubes in intensive care units: a national survey.
abstract: BACKGROUND
  Although most critically ill patients experience at least 1 blind insertion of a feeding tube during their stay in an intensive care unit, little is known about the types of health care personnel who perform these insertions or about methods used to determine proper positioning of the tubes.
  
  
  OBJECTIVE
  To describe results from a national survey of critical care nurses about feeding tube practices in their adult intensive care units. The questions asked included who performs blind insertions of feeding tubes and what methods are used to determine if the tubes are properly positioned.
  
  
  METHODS
  Data were collected from members of the American Association of Critical-Care Nurses via pencil-and-paper and online surveys. Results from both forms were combined for data analysis and were compared with practice recommendations of national-level organizations.
  
  
  RESULTS
  A total of 2298 responses were obtained. Physicians perform more blind insertions of styleted feeding tubes than do nurses; in contrast, nurses place more nonstyleted tubes. Radiographic confirmation of correct position is mandated more often for blindly inserted styleted tubes (92.3%) than for nonstyleted tubes (57.5%). The 3 most commonly used bedside methods to determine tube location are auscultation for air injected via the tube, appearance of feeding tube aspirate, and observation for indications of respiratory distress.
  
  
  CONCLUSIONS
  Recommendations from multiple national-level organizations to obtain radiographic confirmation that each blindly inserted feeding tube is correctly positioned before the first use of the tube are not adequately implemented. Auscultation is widely used despite recommendations to the contrary.
authors.affiliation: Saint Louis University, 3525 Caroline Mall, St. Louis, MO 63104, USA. methenna@slu.edu
authors.forename: Norma A
authors.initials: NA
authors.lastname: Metheny
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Stewart
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Mills
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D001314:Auscultation / Q000706:statistics & numerical data; D019296:Capnography / Q000706:statistics & numerical data; D004750:Enteral Nutrition; D005766:Gastrointestinal Contents / Q000737:chemistry; D041981:Gastrointestinal Tract / Q000000981:diagnostic imaging; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007362:Intensive Care Units; D007441:Intubation, Gastrointestinal / Q000379:methods*; D057184:Practice Patterns, Nurses' / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011859:Radiography; D012128:Respiratory Distress Syndrome / Q000175:diagnosis; D011795:Surveys and Questionnaires