A RANDOMIZED STUDY OF A PH SENSOR FEEDING TUBE VS A STANDARD FEEDING TUBE IN PATIENTS REQUIRING ENTERAL NUTRITION

Postpyloric feedings are a widely practiced form of enteral nutrition. We prospectively randomized two groups of hospital patients to receiv e a standard feeding tube or a feeding tube that uses a pH sensor to f acilitate postpyloric placement and compared placement speed and accur acy, displacement detection, and costs for the two groups. Thirty-nine patients were randomized, with 20 receiving a pH sensor feeding tube and 19 an identical non-pH sensor feeding tube. An x-ray of the kidney s, ureter, and bladder was taken at 1, 6, and 48 hours after placement in both groups. Separate cost-benefit analyses were done by using ret rospective chart review of costs for a separate 20-patient standard fe eding tube group and calculated costs for a 20-patient hypothetical pH sensor group. At 1 hour, the duodenum was reached in 53% of the pH se nsor feeding tube patients and 45% of the standard feeding tube patien ts (the difference was not significant). At 48 hours, 93% of the pH se nsor feeding tubes reached the duodenum vs 67% of the standard feeding tubes (P < .08). Thirty percent of the pH sensor patients had an init ial gastric pH greater than or equal to 4, negating pH sensor benefit in tube placement. In the remaining 70% of the patients, placement wit h the pH sensor had a 100% specificity compared with the x-ray of the kidneys, ureter, and bladder. Displacement was easily detected with ro utine pH monitoring in three of the pH sensor feeding tube patients an d corrected. It was detected in two standard feeding tube patients, on e of whom aspirated. Cost-benefit analysis incorporating the above sho wed a cost savings of $81.00 per patient for the pH sensor feeding tub e, more than the cost of the tube. Thus, pH sensor feeding tubes may o bviate the need for confirmatory x-rays in patients without hypochlorh ydria, resulting in potential significant savings.