INTESTINAL PLACEMENT OF PH-SENSING NASOINTESTINAL FEEDING TUBES

Intestinal access for enteral nutrition can be achieved by spontaneous intestinal nasogastric tube passage or by endoscopic, fluoroscopic, o r surgical placement methods. Each of these methods has limitations th at may compromise clinical utility. pH-sensing nasointestinal feeding tubes allow active placement with minimal equipment and expertise; how ever, this method requires an acidic gastric pH. We sought to determin e whether antiulcer regimens used at our institution would preclude in testinal pH-sensing tube placement. Twenty-five patients had 25 (81%) successful intestinal placements in 31 attempts. Observed pH values an d calculated pH changes were compared within and between successful an d unsuccessful groups by using a Student's t test. Initial, lowest, an d final pH values did not differ significantly between groups. The pH change initial-into-lowest (4.7 +/- 0.18 vs 3.6 +/- 0.59, p < .03) and lowest-to-final (5.0 +/- 0.18 vs 3.0 +/- 0.47, p < .0001) differed si gnificantly between groups, whereas the pH change initial-to-final did not. Cost analysis of endoscopic ($782), fluoroscopic ($341 to $382), spontaneous ($167 to $212), and pH-sensing ($162) methods revealed 3% to 79% savings when the pH-sensing placement method was used. We conc lude that the antiulcer therapies used in our patient population did n ot preclude intestinal pH-sensing tube placement. If the pH changes fr om initial-to-lowest and lowest-to-final were greater than 4, successf ul intestinal placement occurred in 91% of attempts. Finally, the meth od was cost-effective at our institution.