Selecting pH cut-offs for the safe verification of nasogastric feeding tube placement: a decision analytical modelling approach

2.50
Hdl Handle:
http://hdl.handle.net/11287/620545
Title:
Selecting pH cut-offs for the safe verification of nasogastric feeding tube placement: a decision analytical modelling approach
Authors:
Ni, M. Z.; Huddy, J. R.; Priest, O. H.; Olsen, Sisse; Phillips, L. D.; Bossuyt, P. M. M.; Hanna, G. B.
Abstract:
Objectives The existing British National Patient Safety Agency (NPSA) safety guideline recommends testing the pH of nasogastric (NG) tube aspirates. Feeding is considered safe if a pH of 5.5 or lower has been observed; otherwise chest X-rays are recommended. Our previous research found that at 5.5, the pH test lacks sensitivity towards oesophageal placements, a major risk identified by feeding experts. The aim of this research is to use a decision analytic modelling approach to systematically assess the safety of the pH test under cut-offs 1–9. Materials and methods We mapped out the care pathway according to the existing safety guideline where the pH test is used as a first-line test, followed by chest x-rays. Decision outcomes were scored on a 0–100 scale in terms of safety. Sensitivities and specificities of the pH test at each cut-off were extracted from our previous research. Aggregating outcome scores and probabilities resulted in weighted scores which enabled an analysis of the relative safety of the checking procedure under various pH cut-offs. Results The pH test was the safest under cut-off 5 when there was ≥30% of NG tube misplacements. Under cut-off 5, respiratory feeding was excluded; oesophageal feeding was kept to a minimum to balance the need of chest X-rays for patients with a pH higher than 5. Routine chest X-rays were less safe than the pH test while to feed all without safety checks was the most risky. Discussion The safety of the current checking procedure is sensitive to the choice of pH cut-offs, the impact of feeding delays, the accuracy of the pH in the oesophagus, as well as the extent of tube misplacements. Conclusions The pH test with 5 as the cut-off was the safest overall. It is important to understand the local clinical environment so that appropriate choice of pH cut-offs can be made to maximise safety and to minimise the use of chest X-rays.
Citation:
Selecting pH cut-offs for the safe verification of nasogastric feeding tube placement: a decision analytical modelling approach 2017, 7 (11):e018128 BMJ Open
Publisher:
BMJ
Journal:
BMJ Open
Issue Date:
4-Nov-2017
URI:
http://hdl.handle.net/11287/620545
DOI:
10.1136/bmjopen-2017-018128
Additional Links:
http://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2017-018128
Note:
This article is freely available via Open Access. Click on the Additional Link above to access the full-text via the publisher's site.
Type:
Journal Article
Language:
en
ISSN:
2044-6055; 2044-6055
Appears in Collections:
Breast Surgery; 2017 RD&E publications

Full metadata record

DC FieldValue Language
dc.contributor.authorNi, M. Z.en
dc.contributor.authorHuddy, J. R.en
dc.contributor.authorPriest, O. H.en
dc.contributor.authorOlsen, Sisseen
dc.contributor.authorPhillips, L. D.en
dc.contributor.authorBossuyt, P. M. M.en
dc.contributor.authorHanna, G. B.en
dc.date.accessioned2017-11-22T12:41:09Z-
dc.date.available2017-11-22T12:41:09Z-
dc.date.issued2017-11-04-
dc.identifier.citationSelecting pH cut-offs for the safe verification of nasogastric feeding tube placement: a decision analytical modelling approach 2017, 7 (11):e018128 BMJ Openen
dc.identifier.issn2044-6055-
dc.identifier.issn2044-6055-
dc.identifier.doi10.1136/bmjopen-2017-018128-
dc.identifier.urihttp://hdl.handle.net/11287/620545-
dc.description.abstractObjectives The existing British National Patient Safety Agency (NPSA) safety guideline recommends testing the pH of nasogastric (NG) tube aspirates. Feeding is considered safe if a pH of 5.5 or lower has been observed; otherwise chest X-rays are recommended. Our previous research found that at 5.5, the pH test lacks sensitivity towards oesophageal placements, a major risk identified by feeding experts. The aim of this research is to use a decision analytic modelling approach to systematically assess the safety of the pH test under cut-offs 1–9. Materials and methods We mapped out the care pathway according to the existing safety guideline where the pH test is used as a first-line test, followed by chest x-rays. Decision outcomes were scored on a 0–100 scale in terms of safety. Sensitivities and specificities of the pH test at each cut-off were extracted from our previous research. Aggregating outcome scores and probabilities resulted in weighted scores which enabled an analysis of the relative safety of the checking procedure under various pH cut-offs. Results The pH test was the safest under cut-off 5 when there was ≥30% of NG tube misplacements. Under cut-off 5, respiratory feeding was excluded; oesophageal feeding was kept to a minimum to balance the need of chest X-rays for patients with a pH higher than 5. Routine chest X-rays were less safe than the pH test while to feed all without safety checks was the most risky. Discussion The safety of the current checking procedure is sensitive to the choice of pH cut-offs, the impact of feeding delays, the accuracy of the pH in the oesophagus, as well as the extent of tube misplacements. Conclusions The pH test with 5 as the cut-off was the safest overall. It is important to understand the local clinical environment so that appropriate choice of pH cut-offs can be made to maximise safety and to minimise the use of chest X-rays.en
dc.language.isoenen
dc.publisherBMJen
dc.relation.urlhttp://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2017-018128en
dc.rightsArchived with thanks to BMJ Open. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/ licenses/by-nc/4.0/en
dc.subjectWessex Classification Subject Headings::Surgeryen
dc.titleSelecting pH cut-offs for the safe verification of nasogastric feeding tube placement: a decision analytical modelling approachen
dc.typeJournal Articleen
dc.identifier.journalBMJ Openen
dc.description.noteThis article is freely available via Open Access. Click on the Additional Link above to access the full-text via the publisher's site.en
dc.type.versionPublisheden
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