Use of pH Testing to Confirm Feeding Tube Placement: A Quality Improvement Project

Abstract

BACKGROUND: Chest radiography confirms initial nasogastric tube placement but is impractical for repeated verification during feeding and medication administration. LOCAL PROBLEM: Nasogastric tube placement verification practices on the neuroscience unit delayed feedings and medication administration due to radiograph interpretation and physician order wait times. The aim of this quality improvement project was to assess feasibility, usability, and adoption of gastric aspirate pH testing and tube length measurement for ongoing nasogastric tube placement verification after initial chest radiography confirmation. METHODS: The Stevens Star Model of Knowledge Transformation guided this project and involved assessing relevance and feasibility of the practice change, developing an action plan, implementing the intervention, and evaluating the results. The quality improvement intervention was to use gastric aspirate pH testing along with distal tube length measurement at the nostril exit site, rather than gastric auscultation, for ongoing nasogastric tube placement verification. RESULTS: With 100% staff compliance with workflow and process measures, the project was feasible and usable. A total of 141 gastric aspirate samples were tested over 6 months. Gastric placement was confirmed (pH ≤5.5) in 131 samples. Ten of the 141 samples had a pH of greater than 5.5, indicating placement not confirmed. Postimplementation surveys indicated that staff nurses accepted the practice change. CONCLUSION: Gastric aspirate pH testing along with tube length measurement is feasible and effective for ongoing nasogastric tube placement verification in patients with stroke and other neurological conditions. The next step is to incorporate suggested process improvements into the next practice change cycle.