Methods to Confirm Feeding Tube Placement: Application of Research in Practice

Headnote

Numerous published studies have demonstrated that conventional methods for documenting proper position of orally or nasally placed feeding tubes in adults are inaccurate. The few available studies done in children indicate similar inadequacies. Auscultation after insufflation of air over the stomach and other less common practices used to verify proper tube position have been shown to be ineffective in predicting correct tube position. Checking pH of aspirate has been recommended as a better method to confirm feeding tube position at the bedside. Careful review of the literature and appropriate application of research findings can lead to change in time-honored nursing practices. Although change is often difficult, a coordinated effort by nurses across organizational lines may facilitate the process.

Ensuring that feeding tubes are in the correct location is a common nursing function. Pediatric nurses are also often responsible for teaching parents and other caregivers how to perform this function. Even after proper initial placement, feeding tubes can migrate out of position. Improper positioning of feeding tubes increases the risk of complications. Numerous studies have shown that conventional methods to verify placement of orally or nasally placed enteric tubes can be inaccurate. Despite this evidence, the nursing profession has been slow to implement appropriate changes in clinical practice. Health care providers, in general, often are reluctant to abandon traditional, time-honored practices in favor of procedures based on clinical research.

In June 2000, the Pediatric Nursing Council of Northeast Florida (PNC), a multi-institutional group of pediatric nurses, undertook the challenge of informing nursing practice regarding methods of verifying enteric tube placement. Successful implementation of changes in nursing practice begins with careful evaluation and analysis of research. Appropriate recommendations are then compiled and disseminated. With sufficient support, these recommendations can be successfully integrated into nursing practice.

Relevant Literature

A survey of pertinent literature was needed to build a research base for recommendations. The literature was examined in three areas: misplacement of feeding tubes, methods to verify placement, and limitations and future directions.

Misplacement of feeding tubes. Feeding tubes are improperly positioned if the feeding ports are located in the respiratory tract or esophagus, past the pylorus for tubes intended for gastric feedings, or in the stomach for feedings intended to be given into the intestine. Although it...