Evidence-Based Practice Network

Show Me The Evidence

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Validating Enteral Tube Placement: An evidence approach
Meeting nutritional needs of hospitalized patients can be challenging. We know using the gut is superior to parenteral nutrition because it maintains intestinal function, has fewer complications, and is less costly (Cerra, 1997). If a patient is unable to swallow safely, enteral feeding is recommended. Enteral tube positioning has always been an area of discussion for nurses. Research has shown a malpositioned tube that has been used to deliver feedings or medication can result in aspiration, pneumothorax, and sepsis (Simons & Abdallah, 2012). Which method for verifying enteral tube placement is best according to the evidence?

The authors of the article published in the February issue of the American Journal of Nursing, "Bedside Assessment of Enteral Tube Placement: Aligning Practice with Evidence," critically appraised the research around the current methods being used to verify feeding tube placement. The authors found that the 5 most common methods used in practice are:
  • X-ray visualization of the tube
  • pH testing of aspirate
  • Visual assessment of aspirate
  • Visualization of external tube length
  • Auscultation of air insufflated through the feeding tube (Simons & Abdallah, 2012).
 The research clearly shows that the most reliable method of verifying enteral tube placement is an X-Ray (Simons & Abdallah, 2012). I encourage each of you to read this article and adopt the evidence of enteral tube placement verification in your institution. This evidence-based intervention will improve your patient outcomes and decrease your costs due to complications associated with improper placement of enteral feeding tubes.

Cerra, F, et al. 1997. Applied nutrition in ICU patients. A consensus statement of the American College of Chest Physicians. 111(3): 769-78.

Simons, S., Abdullah, L. 2012. Bedside assessment o f enteral tube placement: aligning practice with evidence. American Journal of Nursing, 112(2).

Submitted by:
Anne Dabrow Woods, MSN, RN, CRNP
Chief Nurse and Publisher
Wolters Kluwer Health Medical Research

Posted by Lisa Morris Bonsall on 2/10/2012 1:21:54 PM with 4 comments

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Louise Malbon-Reddix
Thank You for this article and the reminder, that we as nurses need to be committed to the accurate assessment of our patients in all ways. I am always amazed to note the things that we do asses but don't get credit for, as there is not a dedicated space to check it off in or write down the performance of it in our notes; i.e. the length. An intervention though would be made if we find a difference though.
2/27/2012 3:29:56 PM

Nothing much has changed though. Still the same as spelled out in Fundamentals in Nursing Books.
2/27/2012 11:53:23 PM

Lucia Ojewale
Its a beautiful work.Although patients do not access to routine x-ray on the wards. Whats your take on aspirating and discarding gastric content before feeding?
2/28/2012 4:45:19 AM

cecile Agbalokwu BSN-RN
XRAY verification is usually done post insertion .what do you recommend for old PEG -TUBES .We still use pH testing of aspirate for all peg tube here.
2/28/2012 10:18:10 AM

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