Pediatric Feeding Tubes

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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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Alfred S., M.D. -

Can you comment on the use of pH paper to confirm proper location of a replaced tube to avoid x-rays in these patients.

Jason Woods -

This piece is really focused on through the skin gastric tubes, so the confirmation is different. In general in a developed tract, neither radiographic or pH confirmation is used. If the tube enters easily, is able to spin in the skin without resistance, and does not cause pain when a small amount of fluid is flushed into it, we consider this confirmation of appropriate placement. For tracts that are not well developed or experience trauma, typically the use of contrast is required and neither plain X-rays or pH paper is adequate.

For an NG tube, local protocols dictate what you can do at your institution and that is outside of the scope of this piece. The generally accepted cutoff for using pH paper to confirm gastric placement of NG is 5. There are many reasons why pH paper may not be adequate (misinterpretation, medications that change the pH of the gastric content, inability to obtain an aspirate) but these generally are not false confirmations. Many institutions allow the use of pH paper with pH less than or equal to 5 as confirmation of NG placement.

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