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Summary
Background
Malpositioned feeding tubes carry the risk of serious complications. However, common bedside methods of differentiating tracheal from gastric feeding tube placement are neither accurate nor practical. Therefore, we conducted an animal study to verify feeding tube placement by syringe aspiration test.
Methods
A total of 26 pigs were anesthetized and intubated with tracheal tubes in the trachea and the esophagus. The animals were divided into two groups. The animals in the mechanical ventilation group were paralysed and received mechanical ventilation. The animals in the spontaneous breathing group maintained spontaneous breathing. The feeding tubes were then inserted through the tracheal tubes, into the trachea and esophagus, so that the anterior openings of the feeding tubes were located in the trachea and esophagus. A feeding syringe was then attached and 30 ml of air was aspirated into the syringe. The ability to aspirate air without resistance was defined as a positive syringe aspiration test. If there was resistance as air was aspirated, it was defined as a negative syringe aspiration test. In the next step, 20 esophageal ventilations were given to create a distended stomach in the experimental animals, and the syringe aspiration test was repeated in the same manner described above.
Results
The syringe aspiration test was positive for feeding tubes placed in the trachea and was negative for feeding tubes located in the esophagus in both the mechanical ventilation group and the spontaneous breathing group.
Conclusion
The syringe aspiration test is an effective method of differentiating tracheal from esophageal feeding tube placement.
Keywords
complications
feeding tube
placement verification
syringe aspiration
tube insertion
Cited by (0)
Copyright © 2012 Published by Elsevier B.V.
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Terms in this set (5)
A nurse has just inserted a nasogastric tube in a client. Which method is most reliable for verifying the correct placement of the tube?
Radiographic confirmation of position
Radiographic (x-ray) examination is the only reliable method to determine accurate tube placement. In the absence of an x-ray, pH testing is predicative of correct placement. Although visualization of aspirated contents can help confirm correct placement of the tube, this method is not as reliable as an x-ray.
After inserting a nasogastric tube, what should the nurse do to ensure that the tube is properly placed in the client?
Test the pH of aspirated content.
Current research demonstrates that the use of pH is predictive of correct placement of a nasogastric tube. The pH of gastric contents is acidic (less than 5.5). If the client is taking an acid-inhibiting agent, the range may be 4.0 to 6.0. The pH of intestinal fluid is 7.0 or higher, indicating the tube is beyond the stomach. The pH of respiratory fluid is 6.0 or higher. An x-ray can also be used to check placement of the tube, as well as aspirating the gastric contents and checking them for color and consistency. A feeling of fullness will not confirm tube placement. An ultrasound is not used for confirmation of tube placement.
A nurse has just received a client's laboratory results and is reviewing them. Which finding should the nurse recognize as an indication of malnutrition or malabsorption?
Serum albumin 2.8 g/dL (28 g/L)
Normal serum albumin is 3.3 to 5 g/dL (33 to 50 g/L). Decreased albumin indicates malnutrition or malabsorption. Decreased Hgb indicates anemia. Increased creatinine indicates dehydration. Increased Hct indicates dehydration.
A client has had a nasogastric tube inserted in preparation for tube feedings. When developing the client's plan of care, the nurse would anticipate checking the placement of the tube at which time?
Before administering a medication through the tube
The nurse would verify correct placement of the nasogastric tube after the initial insertion, before beginning a feeding or instilling medications or liquids, and at 4-hour intervals during continuous feedings. This ensures that the tip of the tube is situated in the stomach or intestine, preventing inadvertent administration of substances into the wrong place. A misplaced feeding tube in the lungs or pulmonary tissue places the client at risk for aspiration.
A nurse aspirates a small amount of fluid from a client's nasogastric tube. The nurse determines that the tube is in the intestines based on the aspirate being which color?
Straw-colored
Gastric fluid can be green with particles, off-white, or brown if old blood is present. Intestinal aspirate tends to look clear or straw-colored to a deep golden yellow color. Also, intestinal aspirate may be greenish brown if stained with bile. Respiratory or tracheobronchial fluid is usually off-white to tan and may be tinged with mucus.
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