So, I'm curious. (I'm not really sure where to post this!)
In class we are taught to check placement by residual pH.
The hospitals in our area still have policies saying to inject air and listen. Despite that there is evidenced based practice saying it's not an effective way to check placement. Other hospitals in the state have realized that and changed policies EIGHT years ago.
So my question is, is this really just my area that still does it that way?
Okay. I read my post and what was I thinking? I had a TIA while writing it! I wrote that with no sleep at 2:00 in the morning. Residual 70 on g tube. The ng tubel for the placement they taught us to put 10-20 ml of air then withdrawal 10 to check ph. Since I am a student I do not know what LTC or hospitals rules are on that. At the clinical sites we did air and no PH testing. Probably expense? Whenever I did pull out residual was always under 50 and good bowel sounds too.
So what about when there are continuous feeds through an NGT? Checking pH then is just checking the pH of the formula that's infusing which could have come from the lungs or wherever else just as easily...[/quote']
Wouldn't you flush them just like you do the g tubes so they don't clog? I am sure maybe there are orders to do that when changing the bags? I don't know but that is a good question.
So what about when there are continuous feeds through an NGT? Checking pH then is just checking the pH of the formula that's infusing, which could have come from the lungs or wherever else just as easily...
Thank you! That reference has radiographic verification as the "gold standard"
It says no such thing.
Conclusion and recommendations about initial gastric tube (GT) placement bedside verification methods in the emergency department:
Auscultation as a single verification method is unreliable in determining GT placement (Not recommended).
There is insufficient evidence to support the use of carbon dioxide detection methods as a single GT placement bedside verification method (Level C: Weak).
There is insufficient evidence to support the use of transillumination and magnetic detection methods along with equipment and laboratory setting limitations (Level C: Weak).
There is sufficient evidence to support pH testing of GT aspirates as a component of a multiple method bedside verification approach (Level B: Moderate).
X-ray is the gold standard for when the tube is just placed. But the tube can become dislodged and you should check placement in another way before flushing or giving meds or tube feelings. The secondary way of checking placement is what I am questioning.
No, x-ray is not the 'gold standard" for NG tube placement confirmation (although I suppose CT scan would do, but in an age of trying for cost containment ...) . The only way to confirm actual gastric placement at bedside is to check the pH of aspirate. It is quite possible to insert a Salem sump tube through a fistula in the esophagus and have it end up overlying the stomach, which will look like it's IN the stomach on flat plate. Even a lateral view can be ambiguous. Acid pH is not. This is why those references say what they say. Did you even read them?
So what about when there are continuous feeds through an NGT? Checking pH then is just checking the pH of the formula that's infusing, which could have come from the lungs or wherever else just as easily...
There is always some acid in the stomach, so if you draw back enough that it doesn't look like straight TF (i.e., you have actually aspirated from the stomach and not just the tube) the pH would not match the pH of the formula right out of the can.
It says no such thing. Conclusion and recommendations about initial gastric tube (GT) placement bedside verification methods in the emergency department: [*]Auscultation as a single verification method is unreliable in determining GT placement (Not recommended). [*]There is insufficient evidence to support the use of carbon dioxide detection methods as a single GT placement bedside verification method (Level C: Weak). [*]There is insufficient evidence to support the use of transillumination and magnetic detection methods along with equipment and laboratory setting limitations (Level C: Weak). [*]There is sufficient evidence to support pH testing of GT aspirates as a component of a multiple method bedside verification approach (Level B: Moderate).
You posted two references, so yes the first one does say it is the gold standard and the second reference has a disclaimer at the bottom.
No, x-ray is not the 'gold standard" for NG tube placement confirmation (although I suppose CT scan would do, but in an age of trying for cost containment ...) . The only way to confirm actual gastric placement at bedside is to check the pH of aspirate. It is quite possible to insert a Salem sump tube through a fistula in the esophagus and have it end up overlying the stomach, which will look like it's IN the stomach on flat plate. Even a lateral view can be ambiguous. Acid pH is not. This is why those references say what they say. Did you even read them?
Okay... we seem to have some confusion here. What I meant was that typically X-rays are taken after the tube is placed and before any flushing or anything else is done. It tests placement initially but obviously would be ridiculous to do every time to check placement. I wasn't referring to checking placement at the bedside with the x-ray.
I was just explaining to the poster that I was originally asking about bedside placement which is why X-rays wouldn't be a feasible answer here.
Checking for placement depends somewhat on when you are doing the checking. Right after placement? Hours or days later but before a meal or medication ? Be sure you know the differences.
No, x-ray is not the 'gold standard" for NG tube placement confirmation (although I suppose CT scan would do, but in an age of trying for cost containment ...) . The only way to confirm actual gastric placement at bedside is to check the pH of aspirate. It is quite possible to insert a Salem sump tube through a fistula in the esophagus and have it end up overlying the stomach, which will look like it's IN the stomach on flat plate. Even a lateral view can be ambiguous. Acid pH is not. This is why those references say what they say. Did you even read them?
Actually the first link I pulled up said that radiological evidence was the good standard for NG tube placement in pediatrics from the site you provided. However, it also admit that it would contribute to rising costs so it recommended it in high risk. So asking them if they have even read the reference you provided isn't fair.
Mainergal2000
206 Posts
Okay. I read my post and what was I thinking? I had a TIA while writing it! I wrote that with no sleep at 2:00 in the morning. Residual 70 on g tube. The ng tubel for the placement they taught us to put 10-20 ml of air then withdrawal 10 to check ph. Since I am a student I do not know what LTC or hospitals rules are on that. At the clinical sites we did air and no PH testing. Probably expense? Whenever I did pull out residual was always under 50 and good bowel sounds too.