A review of guidelines to distinguish between gastric and pulmonary placement of nasogastric tubes

• Published in: Heart & lung Vol. 48; no. 3; pp. 226 - 235
• Main Authors: Metheny, Norma A., Krieger, Mary M., Healey, Frances, Meert, Kathleen L.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2019
• Subjects: enteral nutrition; Enteral Nutrition - adverse effects; Enteral Nutrition - methods; Enteral Nutrition - standards; gastrointestinal; Humans; intubation; Intubation, Gastrointestinal - adverse effects; Intubation, Gastrointestinal - standards; Medical Errors - prevention & control; nasogastric tubes; practice guidelines; Practice Guidelines as Topic; Respiratory Distress Syndrome, Adult - etiology; Respiratory Distress Syndrome, Adult - prevention & control; Trachea; tube placement determination; enteral nutrition; gastrointestinal; tube placement determination; intubation; nasogastric tubes; practice guidelines
• ISSN: 0147-9563; 1527-3288; 1527-3288
• DOI: 10.1016/j.hrtlng.2019.01.003

The purpose of this review was to (1) identify areas of agreement and disagreement in guidelines/recommendations to distinguish between gastric and pulmonary placement of nasogastric tube and (2) summarize factors that affect choices made by clinicians regarding which method(s) to use in specific situations. Systematic searches were conducted in the PubMed, Scopus, and CINAHL Plus databases using a combination of keywords and data-specific subject headings. Searches were limited to guidelines/recommendations from national level specialty groups and governmental sources published in the English language between January 1, 2015 and September 20, 2018. Fourteen guidelines that described methods to distinguish between gastric and pulmonary placement of nasogastric tubes were identified from a variety of geographic locations. Tube placement testing methods included in the review were: radiography, respiratory distress, aspirate appearance, aspirate pH, auscultation, carbon dioxide detection and enteral access devices. All fourteen guidelines agreed that radiography is the most accurate testing method. Of the nonradiographic methods, pH testing was most favored; least favored was auscultation.