MEASURES TO TEST FEEDING TUBE PLACEMENT

为了防止严重的肺部并发症，护士必须确认正确的 初始插入时和定期插入时的饲管位置 然后 为此目的重复X射线是不切实际的，因为 费用、辐射风险和非急症护理患者无法获得 设置. 以前的研究表明，床边pH值测试是一种 预测管位置的有前途的方法;然而，异常值的实例 读数发生得足够频繁以致需要额外的确证数据。 本研究的最终目的是促进床边酶的开发 与pH测试结合使用的测试，以确认正确的管位置， 从而以成本有效的方式增加患者安全性。 之前 床旁酶试验可以开发，有必要确定（1） 饲管吸出物中胃蛋白酶和胰蛋白酶的通常水平（通过实验室 分析）和（2）的存在和浓度的程度， 这些酶可以预测饲管的位置。 这项基础工作将 在拟议的研究中完成。 如果结果显示 床旁酶试验的可取性和可行性，商业来源 将寻求开发测试，并进行临床测试 FDA要求用于诊断、生产和销售。 这项研究将在五家医院进行，为期三年， 将寻求400名受试者的样本量（200名使用鼻胃管 和200个鼻肠管）。 变量包括年龄， 存在或不存在H2受体拮抗剂。 数据将在 每例受试者两个阶段：放置饲管后立即，以及 在开始喂食之后再次进行。 在初始放置（和 在X光检查后五分钟内），将吸出液体并进行检测， 博士 酶（胃蛋白酶和胰蛋白酶）的实验室分析将 执行。 将pH值和酶检测结果与实际试管进行比较 位置，由X射线确定。 研究的第二阶段还将 包括比较pH和酶测量值（在 喂食已经停止）与放射学结果。 假设胃吸出物将具有低pH值， 含有胃蛋白酶，肠道吸出物将具有高pH值， 含有胰蛋白酶。 此外，预计意外呼吸 由于液体中存在胃蛋白酶或胰蛋白酶， 从试管中吸出。

To prevent serious pulmonary complications, nurses must confirm correct feeding tube location upon initial insertion and at regular intervals thereafter. Repeated x-rays for this purpose are impractical because of expense, radiation risk, and inaccessibility to patients in non-acute care settings. Previous studies have indicated that bedside pH testing is a promising method for predicting tube position; yet, instances of outlier readings occur frequently enough to require additional corroborative data. This study's ultimate aim is to facilitate development of bedside enzyme tests to use in conjunction with pH tests to confirm proper tube position, thereby increasing patient safety in a cost-effective manner. Before bedside enzyme tests can be developed, it is necessary to determine (1) the usual levels of pepsin and trypsin in feeding tube aspirates (by laboratory analyses) and (2) the extent to which the presence and concentration of these enzymes can predict feeding tube location. This basic work will be accomplished in the proposed study. Should the results demonstrate desirability and feasibility of bedside enzyme tests, a commercial source will be sought to develop the tests, and carry them to the clinical testing required by the FDA for a diagnostic, and production and marketing. The study will be conducted at five hospitals over a three year period, and a sample size of 400 subjects will be sought (200 with nasogastric tubes and 200 with nasointestinal tubes). Variables will include age, and presence or absence of H2 receptor antagonists. Data will be collected in two phases for each subject: immediately after feeding tube placement, and again after feedings have been initiated. Following initial placement (and within five minutes after an x-ray), fluid will be aspirated and tested for pH. The, laboratory analyses for enzymes (pepsin and trypsin) will be performed. Results of pH and enzyme tests will be compared to actual tube position, as determine by x-ray. The second phase of the study will also involve comparison of pH and enzyme measurements (at least one hour after feedings have ceased) with radiologic results. It is hypothesized that gastric aspirates will have low pH values and contain pepsin, and that intestinal aspirates will have high pHs and contain trypsin. Further, it is expected that inadvertent respiratory placement can be ruled out by the presence of pepsin or trypsin in fluid aspirated from the tube.