Comparison of the RightSpot pH Indicator & RightLevel pH Detector With the Gold Standard of Radiographic Verification of Feeding Tube Placement & Gastrostomy Tube Replacement

Feeding tube placement is a common procedure that occurs in most ICU healthcare settings. In addition, replacement of G-tubes is a common practice in most ED settings throughout the US. Various practices have been used to confirm its placement, including the usage of litmus paper (acid versus base only), pH level indicators (precise measurement), auscultation, bubbling method, aspirate appearance, chest radiography (CXR) and gastrografin .

Review of data in numerous studies has revealed that many of these techniques may not provide fully accurate results, possibly leading to the potential for patient injuries, and even fatal complications. Auscultation, bubbling method, and aspirate appearance have been demonstrated to provide findings that can be misinterpreted and cause false assurance of correct placement. Several deaths and serious injuries have been attributed to the use of litmus paper in verification of feeding tube placement and subsequent utilization of the tube as well as G-tube replacement. Consequently, litmus paper is no longer considered to be a safe and effective confirmatory test for feeding tube placement or G-tube replacement.

Currently, the gold standard for verification of feeding tube placement is CXR or abdominal x-ray and G-tube replacement in an acute care setting is abdominal x-ray with gastrografin. This method is time-consuming, costly, and results in an increase in patient exposure to radiation. In addition for a patient who resides outside of the hospital setting at the time of needed G-tube replacement there is additional costs of transport to and from the ED. An alternative to CXR is measurement of gastric content pH level. This is a confirmed and valid tool for nasogastric/orogastric (NG/OG) verification and a recognized replacement of the litmus paper test.A pH level of 4.5 or less has been validated to indicate presence of gastric contents. A drawback to the use of typical pH indicators alone is that they require fluid aspirate to be placed manually onto the indicator surface. This increases the risk of exposure to bodily fluids for medical personnel. Thus, the ideal device to determine accurate feeding tube placement and G-tube replacement is one that will precisely measure the acid (pH) level of aspirate and significantly reduce the risk of bodily fluid exposure.

The RightSpot pH Indicator & RightLevel pH Detector are devices which purport to meet both of these criteria. Both can provide an accurate pH level. The pH paper is encased in a protective exterior that can be attached directly to a syringe, thus, decreasing the likelihood of accidental exposure.

This study will evaluate the use of this novel device to accurately verify feeding tube placement in an ICU care setting and G-tube replacement (of foley catheter) by measuring the pH and comparing this with gastrografin radiographic confirmation.