Indicators of Post-Pyloric Feeding Tube Placement

Nasojejunal feeding tubes are used to provide enteral nutrition to children at risk for pulmonary aspiration. Determination of tube position without x-ray would facilitate placement and

reduce radiation exposure. We determined the validity of 5 indicators (color, pH, and concentrations of bilirubin, pepsin and trypsin in aspirated gastrointestinal secretions) in predicting

post-pyloric placement of feeding tubes in critically ill children. Feeding tubes were aspirated within 30 minutes of obtaining an x-ray to assess tube position. Aspirates were visually

inspected for color. pH was measured using pHydrion Micro test paper (Micro Essential Laboratory, Brooklyn, NY). Bilirubin concentration was measured at the bedside using N-Multistix SG

reagent strips (Bayer Corporation, Elkhart, IN) with a modified color scale. This color scale was specifically developed for assessing bilirubin concentration in gastrointestinal secretions.

Pepsin and trypsin concentrations were determined spectrophotometrically in a research laboratory. Sensitivity, specificity and predictive values for each indicator, and their 95%

confidence intervals were determined. Seventy-eight aspirates were obtained from 41 children with median age 2.7 years (range 0.02-19.0 years). Forty-seven aspirates were obtained from

patients receiving H2 receptor blocking agents or antacids. Validity data for each indicator is shown in the table.

Conclusion: Simple bedside tests for pH and bilirubin can be used to objectively predict feeding tube position with a high degree of accuracy. Use of these tests can be expected to reduce

the number of x-ray studies needed to confirm the post-pyloric location of feeding tubes.

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