Nutrition and Dietetics, University College London Hospital, London, UK.
School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, Queensland, Australia.
J Clin Nurs. 2024 Aug;33(9):3624-3633. doi: 10.1111/jocn.17188. Epub 2024 May 19.
To measure the reliability of pH testing to confirm ongoing nasogastric tube (NGT) position and to document associated complications.
Confirming NGT position is essential, as use of an incorrectly positioned tube can cause harm. Substantial evidence examines initial confirmation of NGT position, yet limited evidence exists considers NGT displacement which is identified via ongoing NGT position tests. In the NHS, pH testing is recommended to confirm ongoing NGT position; however, there may be an association with excess X-rays and missed enteral nutrition and/or medications.
Prospective observational study using STROBE checklist.
Data collected from medical records of 136 patients with NGTs in a London NHS Trust included pH tests, test results and complications related to ongoing pH tests which failed to confirm the tube was positioned in the stomach, that is, X-rays, and disruptions to enteral nutrition and medication. Cohen's Kappa determined pH test reliability.
Of 1381 pH tests conducted to confirm NGT position, five (0.3%) correctly identified an NGT displacement, and one (0.07%) failed to identify displacement before use. The reliability of ongoing pH tests using Cohen's Kappa was minimal (0.29). Ongoing pH tests that failed to confirm a correctly positioned NGT led to 31 (22.8%) patients having X-rays, 24 (17.6%) missing >10% of prescribed enteral nutrition and 25 (18.4%) missing a critical medication.
Ongoing NGT position testing using pH tests did not prevent the use of a displaced tube, and more than one-fifth of patients required X-rays to confirm a correctly position NGT, contributing to missed medications and enteral nutrition.
Caution should be used when confirming ongoing NGT position with a pH test. Future guidelines should balance the risk of using a displaced tube with potential delays to nutrition and/or medication. More research is needed to explore alternative methods of ongoing NGT position testing.
测量 pH 值测试以确认持续鼻胃管（NGT）位置的可靠性，并记录相关并发症。
确认 NGT 位置至关重要，因为使用位置不正确的管子会造成伤害。大量证据检查了 NGT 位置的初始确认，但有限的证据表明存在通过持续 NGT 位置测试确定的 NGT 移位。在国民保健制度中，推荐使用 pH 值测试来确认持续 NGT 位置；然而，可能与过多的 X 射线和错过肠内营养和/或药物有关。
使用 STROBE 清单进行前瞻性观察研究。
从伦敦国民保健制度信托基金中 136 名 NGT 患者的病历中收集数据，包括 pH 值测试、测试结果以及与未能确认管子位于胃部的持续 pH 值测试相关的并发症，即 X 射线以及对肠内营养和药物的干扰。柯恩氏 Kappa 确定了 pH 值测试的可靠性。
在 1381 次用于确认 NGT 位置的 pH 值测试中，有五（0.3%）次正确识别出 NGT 移位，一次（0.07%）未能在使用前识别出移位。使用柯恩氏 Kappa 的持续 pH 值测试的可靠性微不足道（0.29）。未能确认正确定位的 NGT 的持续 pH 值测试导致 31 名（22.8%）患者进行 X 射线检查，24 名（17.6%）错过 >10%的规定肠内营养，25 名（18.4%）错过关键药物。
使用 pH 值测试的持续 NGT 位置测试并不能防止使用移位管，超过五分之一的患者需要 X 射线来确认正确定位的 NGT，这导致错过药物和肠内营养。
在使用 pH 值测试确认持续 NGT 位置时应谨慎。未来的指南应权衡使用移位管的风险与营养和/或药物可能出现的延迟。需要更多的研究来探索持续 NGT 位置测试的替代方法。
