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Indicators of postpyloric feeding tube placement in children
V Gharpure1, K L Meert, A P Sarnaik
1Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit 48201, USA.
Insights
Bedside tests like aspirate color, pH, and bilirubin can predict feeding tube placement in critically ill children. These simple assessments may reduce the need for X-rays, improving patient care.
Area of Science:
- Pediatric critical care medicine
- Gastroenterology
- Medical diagnostics
Background:
- Accurate postpyloric placement of nasoenteric feeding tubes is crucial for critically ill children.
- Radiography is the standard for confirming tube position but involves radiation exposure and delays.
- Exploring simpler, non-invasive methods for verifying feeding tube placement is essential.
Purpose of the Study:
- To evaluate the accuracy of five indicators in predicting postpyloric feeding tube placement in pediatric patients.
- Indicators assessed include aspirate color, pH, and concentrations of bilirubin, pepsin, and trypsin.
Main Methods:
- A prospective, observational study was conducted in a university teaching hospital.
- Gastrointestinal aspirates (n=96) were collected from 53 critically ill children.
- Aspirates were analyzed for color, pH, bilirubin, pepsin, and trypsin; results were compared with radiographic confirmation of tube position.
Main Results:
- Aspirate pH > or =6 showed high negative predictive value (94%) but lower positive predictive value (76%) for postpyloric placement.
- Bilirubin concentration > or =5 mg/dL demonstrated the highest positive predictive value (96%).
- Clear yellow aspirate color, low pepsin (< or =20 microg/mL), and high trypsin (> or =50 microg/mL) showed high overall efficiency (93-94%).
Conclusions:
- Bedside assessment of gastrointestinal aspirate color, pH, and bilirubin concentration effectively predicts feeding tube position.
- These bedside tests can potentially reduce the reliance on radiographic confirmation.
- Laboratory analysis of pepsin and trypsin also accurately predicts tube position, suggesting potential for developing new bedside diagnostic tests.
Objective:
To determine the validity of five indicators (color, pH, and concentrations of bilirubin, pepsin, and trypsin in aspirated gastrointestinal secretions) in predicting postpyloric placement of feeding tubes in critically ill children.
Design:
Prospective, observational study.
Setting:
University teaching hospital.
Patients:
A total of 96 gastrointestinal aspirates were obtained from 53 children requiring placement of a nasoenteric feeding tube.
Interventions:
Feeding tubes were aspirated by applying suction with a 20-mL syringe. Repeat aspirates from the same patient were obtained on different days. All aspirations were performed within 30 mins of obtaining a radiograph to assess tube position.
Measurements And Main Results:
Aspirates were inspected visually for color. pH and bilirubin concentrations were determined at the bedside by using reagent strips. Pepsin and trypsin concentrations were measured spectrophotometrically in a research laboratory. The sensitivity, specificity, predictive values, and efficiency for each indicator and their 95% confidence intervals were determined based on the position of the feeding tube on the radiograph. Aspirate pH > or =6 had the lowest positive predictive value (76%, range 67% to 85%) but high negative predictive value (94%, range 89% to 99%) for determining postpyloric positioning of the feeding tube. Bilirubin concentration > or =5 mg/dL (> or =86 micromol/L) had the highest positive predictive value (96%, range 91% to 100%) and lowest negative predictive value (88%, range 81% to 95%). Overall efficiency was best for the appearance of a clear yellow aspirate color (93%, range 88% to 98%), pepsin concentration < or =20 microg/mL (94%, range 89% to 99%), and trypsin concentration > or =50 microg/mL (94%, range 89% to 99%).
Conclusions:
Simple bedside assessment of gastrointestinal aspirate color, pH, and bilirubin concentration is useful for predicting feeding tube position. Use of these tests may reduce the number of radiographic studies needed to confirm postpyloric positioning. Laboratory-determined pepsin and trypsin concentrations predict tube position with a high degree of accuracy. Development of simple and inexpensive bedside tests for the detection of gastrointestinal enzymes may be useful.
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