MEASURES TO TEST FEEDING TUBE PLACEMENT

描述：（改编自申请人摘要）因为大约 在美国，每年有100万病人接受管饲， 经常被要求检查饲管的位置。准确 放置喂食管是确保婴儿获得充足营养的关键。 患者和避免严重的，如果不是灾难性的，肺 并发症（如通过无意中放置的管喂养 在呼吸道，或肺吸入在高风险 患者）。目前，放射线照相术是唯一一贯可靠的 用于确定管位置的方法。不幸的是，反复的X光检查 价格昂贵，并造成辐射风险;而且，它们不容易 非急症护理环境中的患者可获得。拟定研究 旨在确定在何种程度上，结果从一个组合 简单，便宜的测试可以在床边使用（结合 手持计算器，预先编程逻辑回归 方程）以准确地预测管位置。这些床边检查 包括：测量抽吸物的pH值;测试是否存在 胰蛋白酶、胃蛋白酶和胆红素的浓度;并检查 抽吸的外观。（腹部X光片将在 收集所有胃肠道样本，以作为“黄金 “标准”将与结果进行比较。床边检查 已进行初步测试，同时进行实验室化验， 分割样本（在腹部X射线检查时，以确定实际试管 初步调查结果表明，敏感性很高， 测试的特异性，无论是单独还是集体。在 拟议的三部分研究，将获得额外的235个样本 由研究者进行，以细化逻辑回归 方程需要（1）区分胃肠道和 呼吸道放置，和（2）胃和肠放置。在 研究的第二部分，20名护士将接受 使用床旁测试和计算器;在适当的评定者同意后 已经建立，他们将对300个胃样本进行测试， 肠道和呼吸道液体（由 研究者）并通过使用计算器预测管位置。在 在研究的最后一部分，同样的20名护士将使用 床边测试和计算器，以预测在200的时间管的位置 临床环境中的插管。在何种程度上这些 个人可以准确地预测喂养管的位置， 方法将被评估。研究的最终目的是提供 临床医生使用简单、便宜的床边测试（与 使用预编程计算器），可以显著增加 准确预测饲管位置的可能性，从而 减少对昂贵、不方便和潜在有害的X-射线的依赖， 射线预编程的计算器将作为决策支持 预测饲管放置的工具。

DESCRIPTION: (Adapted from applicants abstract) Because approximately one million patients are tube-fed annually in the United States, nurses are frequently challenged to check feeding tube placement. Accurate placement of feeding tubes is key to ensuring adequate nourishment of patients and avoiding serious, if not catastrophic, pulmonary complications (such as feeding through a tube inadvertently positioned in the respiratory tract, or pulmonary aspiration in high-risk patients). At present, radiography is the only consistently reliable method for determining tube location. Unfortunately, repeated x-rays are expensive and pose a radiation risk; also, they are not readily accessible to patients in non-acute care settings. The proposed study is designed to determine the extent to which results from a combination of simple, inexpensive tests can be used at the bedside (in conjunction with a handheld calculator preprogrammed with logistic regression equations) to accurately predict tube location. These bedside tests involve: measuring the aspirate's pH; testing for the presence and concentration of trypsin, pepsin, and bilirubin; and examining the aspirate's appearance. (Abdominal x-rays will be taken at the time of collection of all gastrointestinal samples to serve as the "gold standard" against which the results will be compared.) The bedside tests have undergone initial testing concurrently with laboratory assays on split samples (at the time of abdominal x-rays to determine actual tube position); preliminary findings indicate high levels of sensitivity and specificity of the tests, both individually and collectively. In the proposed three-segment study, an additional 235 samples will be obtained by the investigators to allow refinement of the logistic regression equations needed to (1) differentiate between gastrointestinal and respiratory placement, and (2) gastric and intestinal placement. In the second segment of the study, 20 staff nurses will be instructed on the use of the bedside tests and calculator; after suitable rater agreement has been established, they will perform tests on 300 samples of gastric, intestinal, and respiratory fluids (randomly provided by the investigators) and predict tube location by use of the calculator. In the final segment of the study, the same 20 staff nurses will use the bedside tests and calculator to predict tube location at the time of 200 tube insertions in clinical settings. The extent to which these individuals can accurately predict feeding tube location by the proposed methods will be evaluated. The ultimate goal of the study is to provide clinicians with simple, inexpensive bedside tests (used in conjunction with a preprogrammed calculator) that can significantly increase the probability of accurately predicting feeding tube location, thereby decreasing reliance on costly, inconvenient, and potentially harmful x- rays. The preprogrammed calculator will serve as a decision-support tool in predicting feeding tube placement.