MEASURES TO TEST FEEDING TUBE PLACEMENT

为了预防严重的肺部并发症，护士必须确认正确 在初始插入时并以规则的间隔放置饲养管 之后。为此目的重复进行x光检查是不切实际的，因为 费用、辐射风险和非急性护理患者的可及性 设置。以前的研究表明，床边酸碱度测试是一种 预测管子位置的有希望的方法；然而，离群值的实例 读数出现的频率足够高，需要额外的确证数据。 这项研究的最终目的是促进床边酶的开发 与pH测试一起使用的测试，以确定正确的管子位置， 从而以具有成本效益的方式提高患者的安全性。在此之前 可以开发床边酶试验，有必要确定(1) 饲管抽吸物中胃酶和胰酶的正常水平(实验室 分析)和(2)以下因素的存在和集中程度 这些酶可以预测喂养管的位置。这项基本工作将是 在拟议的研究中完成。如果结果表明 商业来源--床边酶试验的可取性和可行性 将寻求开发测试，并将其带到临床测试 由FDA要求进行诊断、生产和销售。 这项研究将在五家医院进行，为期三年， 将寻找400名受试者的样本大小(200名有鼻胃管 200例使用鼻肠管)。变量将包括年龄，以及 是否有H2受体拮抗剂。数据将在以下位置收集 每个受试者分两个阶段：立即放置饲管，以及 在开始喂食之后，再次开始。在初始安置之后(和 在X光检查后的五分钟内)，将抽出液体并进行检测 PH值。酶(胃酶和胰酶)的实验室分析将是 已执行。酸碱度和酶检测结果将与实际试管进行比较 位置，由x射线确定。第二阶段的研究还将 包括比较pH值和酶的测量(至少在一小时后 喂食已停止)，有放射学结果。 据推测，胃抽吸物具有低pH值和 含有胃酶，而且肠道吸出物会有较高的PHS和 含有胰酶。此外，预计不经意的呼吸道 体液中有胃酶或胰酶可排除放置的可能性。 从管子里抽出来。

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.