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Accuracy of the combined method (auscultation and pH measurement) and ultrasonography for confirmation of gastric tube placement: a study protocol for a prospective study
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  • Published on:
    Reponse to Torsy T, Eriksson M, Verhaeghe S, and Beeckman D’s comment on Rigobello MCG, Elias Junior J, Bonacim CAG, et al. upcoming prospective study
    • Fernanda RE Gimenes, RN, Ph.D, Associate Professor University of São Paulo at Ribierão Preto College of Nursing

    Dear editors

    We thank Torsy and colleagues to publish their comments on our upcoming prospective study aimed to assess the diagnostic accuracy of a combined method (auscultation and pH measurement) and ultrasonography versus an X-ray method to confirm the correct placement of the nasogastric tube (NGT), on 7 October 2020. Based on a decision analytical modelling approach proposed by Ni et al.(2017), Torsy and colleagues argue that the pH test with 5 is the safest cut-off for the verification of nasogastric feeding tube placement. However, Ni and colleagues concluded that is important to understand the local clinical environment so that appropriate choice of pH cut-offs can be made to maximize safety and to minimize the use of chest X-rays. In addition, in a recent review of 14 international guidelines to distinguish between gastric and pulmonary placement of NGT, Metheny and colleagues (2019) found considerable disagreement about the ‘best’ pH cut-point to distinguish between gastric and respiratory aspirates and that geographical location has a strong influence on recommendations for use of the pH method. In Brazil there is no national safety guideline recommending a pH cut-point. Thus, we will reconsider the set pH cut-off value to 5 to differentiate between gastric and oesophageal NGT placement in our study.
    In their comments, Torsy and colleagues affirm that the NEX (Nose-Earlobe-Xiphoid appendix) method to calculate the NGT insertion length is not the mos...

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    Conflict of Interest:
    None declared.
  • Published on:
    Comment on Rigobello MCG, Elias Junior J, Bonacim CAG, et al. Accuracy of the combined method (auscultation and pH measurement) and ultrasonography for confirmation of gastric tube placement: a study protocol for a prospective study.
    • Tim Torsy, RN, MSc, PhD candidate Odisee University College, Brussels, Belgium; Ghent University, Ghent, Belgium
    • Other Contributors:
      • Mats Eriksson, RN, MSc, PhD
      • Sofie Verhaeghe, RN, MSc, PhD
      • Dimitri Beeckman, RN, MSc, PhD

    Dear editors

    We thank Rigobello and colleagues to publish their protocol of an upcoming prospective study to assess the diagnostic accuracy of a combined method (auscultation and pH measurement) and ultrasonography versus an X-ray method to confirm a correct placement of the gastric tube (Rigobello et al., 2020). The authors emphasize the importance of verifying a correct tube placement to reduce adverse events and patient safety risks. We confirm the need for such study. However, the pH cut-off value to differentiate between gastric and oesophageal NG tube placement and the NEX method to calculate the NG tube insertion length are to be discussed.

    Applying a 5.5 pH cut-off to confirm the correct placement of the nasogastric (NG) tube in the stomach is debatable. Based on a decision analytical modelling approach, Ni et al. (2017) concluded a pH of ≤ 5 as an adequate cut- off value to indicate correct positioning of the NG tube tip in the stomach and therefore a non-pulmonary placement. Ni et al. (2017) concluded that the pH test with a 5.5 pH cut-off point has low sensitivity (81.0%) in detecting oesophageal placements (Ni et al., 2017). Therefore, a 5.0 pH cut-off has been adopted by several guidelines (American Society for Parenteral and Enteral Nutrition [ASPEN], 2017; American Association of Critical-Care Nurses [AACN], 2016) to confirm a non-pulmonary NG tube placement (Boullata et al., 2017; Metheny, 2016).

    Rigobello et al. (2020) describe that th...

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    Conflict of Interest:
    None declared.