transpyloric placement

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My picu currently uses transpyloric tubes and have been for while. We check placement via "snap" test, like many other facilities. I am looking for any protocols that incorporate this test or any other placement checks, besides xray.

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Specializes in NICU, PICU, PCVICU and peds oncology.

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.

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Specializes in Peds Critical Care, Dialysis, General.

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.

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Specializes in Pediatric Intensive Care, ER.

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

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What is a snap test for transpyloric tubes?

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Specializes in PICU.

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. :yeah:

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Specializes in NICU, PICU, PCVICU and peds oncology.
What is a snap test for transpyloric tubes?

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.

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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.

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Specializes in NICU, PICU, PCVICU and peds oncology.

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.

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Sorry, i didn't clarify good.

We only use snap test Q 2hrs to test for change in tube patency. We always confirm either with bedside u/s or xray. We just do q 2hr check to make sure the tube hasn't migrated or is getting clogged from formula or meds.

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Anoter test we also use is pH. The stomach is much more acidic than the duodenum. Of course this test can be obscured by certain medications or conditions and therefore is not definitive. This is also assuming you can aspirate contents.

Don

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