MEASURES TO TEST FEEDING TUBE PLACEMENT

确定相对简单、安全、廉价的措施 用于测试小口径鼻胃和鼻肠的放置 饲养管是本研究的最终目的。目前使用的 这些广泛使用的管子放置的测试方法(其他 比射线照相)在很大程度上无效。这是一个重要的 问题是因为护士要负责测试 每次间歇喂食前的喂食管，至少一次 对接受持续管内喂养的患者进行换班。它不是 由于增加了辐射风险和费用， 经常做X光检查以确定管子的位置。不幸的是， 未发现放置不当的喂养管容易导致 肺部吸入物的发病率和死亡率增加。 通常使用的听诊方法的变体将是 为预测管子位置而进行的测试，以及pH 测量从管子中抽出的液体。该标准 对这些措施的有效性进行测试的标准是 放射检查(KUB)。研究将在#年进行。 三个急性护理机构；样本量为120(试点测试 将分10个科目进行)。在试图区分 新插入的胃部和呼吸部之间的位置 管，研究人员将从管中抽出液体，并测试其 PH值在插入后30分钟内。然后，在适当的时候 两种方法(pH测试和听诊)的次数、性能 对于声音变化)将在120个 受试者在进食前和进食后各一次。 通过管子。 据推测，护士可以预测在什么时候喂奶 管子末端通过充气进入胃肠道(GI) 通过导管，同时听诊六个腹部部位 使用多谱勒时声音质量和强度的变化 听诊器。(听诊的确切数量和地点将为 在试运行测试期间进行了改进。)此外，还假设 护士可以通过以下方法预测小口径管在胃肠道的终点 测试从管内抽出的液体的pH值(抽出的液体 从胃中排出的液体会有酸性的酸碱度，而液体则会被吸入 从小肠中排出的细菌会有碱性的pH值)。最后，它是 假设护士可以区分胃和胃 经呼吸放置最初插入的喂养管 通过注射器检查从导管中抽出的液体的酸碱度 (胃吸出物会有酸性的pH值，而肺 分泌物可能是微碱性的)。

The identification of relatively simple, safe, inexpensive measures for testing placement of small-bore nasogastric and nasointestinal feeding tubes is the ultimate aim of this study. Presently used measures for testing placement of these widely used tubes (other than radiography) are largely ineffective. This is an important problem since nurses are responsible for testing placement of feeding tubes prior to each intermittent feeding and at least once a shift for patients receiving continuous tube feedings. It is not feasible, because of increased radiation risk and expense, to obtain x-rays to verify tube placement this often. Unfortunately, failure to detect an improperly placed feeding tube predisposes to pulmonary aspiration with increased morbidity and mortality. A variation of the commonly used auscultatory method will be tested for the purpose of predicting tube position, as will pH measurement of fluid aspirated from the tubes. The criterion against which the efficacy of the measures will be tested is radiographic examination (KUB). The study will be conducted in three acute care facilities; the sample size is 120 (pilot testing will be done in 10 subjects). In an attempt to differentiate between gastric and respiratory placement of the newly inserted tube, the researchers will aspirate fluid from the tube and test its pH within thirty minutes after insertion. Then, at the appropriate times, performance of both methods (pH testing and auscultation for sound variations) will be done twice in each of the 120 subjects once before and once after feedings are introduced through the tubes. It is hypothesized that nurses can predict at which point a feeding tube ends in the gastrointestinal (GI) tract by insufflating air through the tube while auscultating six abdominal sites for variation in sound quality and intensity with a doppler stethoscope. (The exact number and sites for auscultation will be refined during the pilot testing.) Also, it is hypothesized that the nurse can predict where small-bore tubes end in the GI tract by testing the pH of fluid aspirated from the tubes (fluid aspirated from the stomach will have an acidic pH, while fluid aspirated from the small intestine will have an alkalinic pH). Finally, it is hypothesized that nurses can differentiate between gastric and respiratory placement of initially inserted feeding tubes by checking the pH of fluid aspirated from the tubes via syringe (gastric aspirate would have an acidic pH while pulmonary secretions would likely be slightly alkaline).