ERT
Auscultation of an air bolus is not considered a reliable or safe method for verifying feeding tube position.
Perform hand hygiene before patient contact.Verify the correct patient using two identifiers per organization policy.Observe the external portion of the tube for movement of the length mark away from the mouth or naris.Perform hand hygiene and don gloves.Determine the appropriate time to verify tube placement.For intermittently tube-fed patients, test placement immediately before each feeding and before administering medications.Wait at least 30 minutes after medication administration by tube or mouth.
Obtaining Gastric Aspirate
Draw 20 to 30 ml of air into a 60-ml syringe, and then attach syringe to proximal end of feeding tube.Flush tube with 20 to 30 ml of air before attempting to aspirate fluid. In some cases, more than one air bolus is necessary.Draw back on syringe slowly, and obtain a small amount of gastric aspirate.Observe appearance of aspirate.If after repeated attempts, fluid cannot be aspirated from a tube that a radiograph confirmed was in the desired position, assume the tube remains correctly placed if:There are no risk factors for tube dislocation.Tube has remained in original taped position.Patient is not experiencing respiratory distress.
Testing pH of Gastric Aspirate
If the patient is receiving continuous tube feeding, test pH of the aspirate during a period when the tube feeding has been turned off.Gently mix aspirate in syringe. Expel a few drops into a clean medicine cup.Dip the pH strip into the aspirate or apply a few drops of aspirate to the strip.Compare the strip color with the color on the chart provided by the manufacturer.Gastric fluid from a fasting patient usually has a pH of 5 or less.Fluid aspirated from a tube in the small intestine of a fasting patient usually has a pH greater than 6.Pleural fluid has a pH of 7 or higher.Respiratory secretions generally have a pH greater than 6.
Completing the Procedure
Irrigate tube to maintain patency.Verify that color, pH, and appearance of aspirate are consistent with the initial tube placement according to x-ray results.Obtain a repeat x-ray confirmation if bedside verification methods leave any doubt about tube location.Assess, treat, and reassess pain according to organization standard.Discard supplies, remove gloves, and perform hand hygiene.