Effectiveness of the auscultatory and pH methods in predicting feeding tube placement.

AIMS AND
OBJECTIVES: This study was designed to determine the effectiveness of the auscultatory and pH methods in predicting feeding tube location in critically ill patients.
BACKGROUND: There is confusion about how nurses should asses feeding tubes location at the bedside. The most common method for determining tube location is the auscultatory method. It is known that auscultation is an unreliable method and additional data relating to bedside methods are needed to assist nurses in making a decision regarding tube location.
DESIGN: A methodological study.
METHODS: The sample consisted of 44 new insertions of feeding tubes. Data from a total of 44 auscultations relating to tube position and gastrointestinal aspirates for pH were obtained from 32 critically ill adult patients ranging in age from 38-87 years. Results from the auscultatory and pH tests were compared with the location of the tube as determined by radiography. A total of 44 feeding tube applications were investigated using the auscultatory and pH methods and concurrently with X-rays to determine the feeding tube position. Nurses used the auscultatory method to predict tube position, a concurrent researcher aspirated fluid from the feeding tube, and samples were tested for pH within five minutes of radiographs taken to determine tube location. pH was measured with a test strip.
RESULTS: Mean pH level in the gastrointestinal aspirates was 4.23 (SD 1.20). Approximately 89% of the pH strip readings from gastrointestinal fluid were between 0-5. A pH of <5 successfully identified 90.4% of the 44 feeding tube cases.
CONCLUSION: The pH method is effective in determining the feeding tube position, but the auscultatory method is not effective in determining the feeding tube position. RELEVANCE TO CLINICAL PRACTICE: Simple bedside assessment of gastrointestinal aspirate pH is useful for predicting feeding tube position.