Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates
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An abdominal radiograph is considered the "gold standard" for determining the position of flexible small-bore nasogastric/orogastric tubes. However, placement must be checked frequently while a tube is in place, and the summative radiation risk of multiple radiographs, as well as their expense, make the development of adequate bedside placement-locating methods imperative. Several methods of detecting tube placement have been investigated in adults, including: aspirating gastric contents and measuring the pH, bilirubin, pepsin, and trypsin levels; examining the visual characteristics of aspirate; placing the proximal end of the tube under water and observing for bubbles in synchrony with expirations; measuring the carbon dioxide level at the proximal end of the nasogastric/orogastric tube; auscultation for a gurgling sound over the epigastrium or left upper quadrant of the abdomen; and measuring the length from the nose/mouth to the proximal end of the tube. ⋯ Research on gastric tube placement in children is relatively new because children are challenging to study in that they are considered a vulnerable population. This review of the literature includes results of both adult and pediatric studies. Tube placement error rates varied from 1.9% to 89.5% in adults and between 20.9% and 43.5% in children.
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Providing nutrition to patients is a vitally important aspect of care. Enterally feeding even critically ill patients remains the method of choice for most prescribers; however, the decision to provide nutrition via the enteral route comes with the added concern of bronchopulmonary aspiration as a complication. The majority of the literature and research on enteral feeding is out of date and focuses primarily on ways to identify aspiration, rather then preventing it. ⋯ These recommendations are synthesized in this article in an effort to improve the quality and safety of administration of enteral nutrition to critically ill patients. However, this compiled information is limited to the current resources. More research should be done to decrease the risk of aspiration in this delicate population.