transpyloric placement

We use the "snap" sign as one indicator for assessing placement, but it's not always a good one. If the tube is coiled in the stomach, you'll get a snap. If it's kinked, you'll get a snap. We listen along the right costal margin at the mid axillary line for gurgles when the tube is insufflated as well as over the epigastrium; they help confirm placement when we have a snap, but we don't remove the stylet until the abdominal xray confirms that the tube crosses the midline. I'll see if I can find a copy of our P&P.

Our facility uses the same as janfrn's. Snap back can be very deceptive. For us, no use of transpylorics until placement confirmed with abdominal xray.

Same here as JanFRN as well - seems to be the best way to go...

What is a snap test for transpyloric tubes?

I agree-We use the snap test but do not rely on it. We do not remove the wire or use the tube until it is confirmed by x-ray.

Once you think you're where you should be, you attempt to aspirate the tube. If the plunger is sucked back to the end of the syringe quite dramatically, that's a positive snap. There's usually no air in the pylorus and the space is like a vacuum.

Thanks for clarifying. We have a neat little bedside u/s machine and the tubes are placed by our CNS under direct visualization and are cleared right after placement to use. This is new within the last 6 mos. for us and since the tubes do occassionally migrate back into the stomach, maybe we should do this periodically? A lot of the kids get daily or qod CXRs and if they are small enough, the tube can be visualized but I'm wondering if we should be doing more.

Unfortunately the snap test isn't a foolproof method for ascertaining placement. If the tube is kinked or has coiled in the stomach you'll get a positive snap but still not be in the right place. All our kiddies have daily CXR that includes the upper abdomen so that the tube can be visualized at least once a day. We also document the length of the tube at the naris every shift. The ones that are well-secured don't migrate much.