Position confirmation of adult nasogastric feeding tubes with pH assessment

People who, for various reasons, are unable to swallow food may have problems with nutritional intake and may thus need to be supplied with nutrients through a nasogastric tube, which is a soft plastic tube that goes into the nose and down into the stomach. The position of the tube needs to be checked before each tube feeding to ensure that the opening opens into the stomach. There are different methods to check the position of the probe, the easiest of which is to blow air into the probe and use a stethoscope to listen for a rumbling sound from the stomach (“blurp test”). Other ways to perform a position check are by measuring the pH value of the fluid coming out of the probe or by doing an X-ray examination.

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: Report no: ut202409 Registration no: SBU 2023/1322

Question

What systematic reviews have been published regarding pH assessment for position confirmation compared to blurp test for nasogastric tube feeding?

Method

A systematic literature search was performed using the following databases: Medline (Ovid) and Scopus.
Two authors independently assessed the abstracts of all identified studies.

Identified literature

No relevant studies were identified.

Search strategies

Medline via OvidSP 20 February 2024

Title: Feeding tube placement
/ = Term from the MeSH controlled vocabulary; .sh = Term from the MeSH controlled vocabulary; exp= Term from MeSH including terms found below this term in the MeSH hierarchy; .ti,ab = Title or abstract; .tw = Title or abstract; .kf = Keywords; .kw = Keywords, exact; .bt = Book title. NLM Bookshelf; .pt = Publication type; .ja = Journal abbreviation; .af = All fields; adjn = Adjacent. Proximity operator retrieving adjacent words, adj3 retrieves records with search terms within two terms from each other. * or $ = Truncation “ “ = Citation Marks; searches for an exact phrase

*Cochrane Highly Sensitive Search Strategy for identifying randomized trials in MEDLINE: sensitivity- and precision-maximizing version (2008 revision); Ovid format. The Cochrane Collaboration; 2008. Available from: https://training.cochrane.org/handbook/current/chapter-04-technical-supplement-searching-and-selecting-studies#section-3-6-1. with modifications: the following terms are added: clinical trial, phase iii.pt. ; randomised.ab. ; ("Phase 3" or "phase3" or "phase III" or P3 or "PIII").ti,ab,kw.
Search terms Items found
Population:
1. exp Enteral Nutrition/ or exp Intubation, Gastrointestinal/ or (feeding* adj3 (enteral or force or gastric or tube* or nasogastric)).ab,ti,kf,bt. or (nasogastric tube* or Enteral tube* or Enteral Nutrition or naso-enteric tube*).ab,ti,kf,bt. 45 344
Intervention:
2. exp Auscultation/ or ((Measure* or test* or marker*) adj3 (pepsin or trypsin or carbon dioxide or biochemical)).ab,ti,kf,bt. or (auscultat* or verif* or confirm* or air bolus or water bubbling or blurp* or Placement or Placing or Safety or Misplac* or locat* or reassess* or aspirat* or capnography or ph or dislogd* or displac* or fixation or migration or position* or gastric residual or accuracy).ab,ti,kf,bt. 5 719 619
Study types: systematic reviews and meta-analysis / randomized controlled trials*
3.; ((Systematic Review/ or Meta-Analysis/ or Cochrane Database Syst Rev.ja. or ((systematic adj4 review) or "meta analys*" or metaanalys*).ti,bt,ab.) not (editorial/ or letter/ or case reports/)) 470 896
Combined sets:
4. 1 AND 2 11 351
5. 3 AND 4 502
Final result
6. 5 502

Scopus via scopus.com 20 February 2024

Title: Feeding tube placement

Title: Feeding tube placement
TITLE-ABS-KEY = Title, abstract or keywords (including indexed keywords and author keywords) ALL = All fields W/n = Within. Proximity operator retrieving terms within n words from each other; PRE/n = Precedes by. Proximity operator, the first term in the search must precede the second by n words; LIMIT-TO (X) = Includes only results of specified type, e.g., publication type or time range; DOCTYPE = Publication type; “re” = review; “le” = letter;  “ed” = editorial; “ch” = book chapter; “cp” = conference proceedings; * = Truncation; “ “ = Citation Marks; searches for an exact phrase
Search terms Items found
Population:
1. TITLE-ABS-KEY ( ( feeding* W/3 ( enteral OR force OR gastric* OR tube* OR nasogastric* OR "naso-enteric*" OR nasoenteric* OR "naso enteric*" ) ) OR "nasogastric tube*" OR "enteral tube*" OR "enteral nutrition" OR "naso-enteric tube" OR "nasoenteric tube" OR "naso enteric tube" ) 52 561
Intervention:
2. TITLE-ABS-KEY ( auscultat* OR verif* OR confirm* OR "air bolus" OR "water bubbling" OR blurp* OR placement OR placing OR safety OR misplac* OR location OR reassess* OR aspirat* OR capnography OR ph OR dislogd* OR displac* OR fixation OR migration OR position* OR "gastric residual" OR accuracy ) 16 037 671
3. TITLE-ABS-KEY ( ( measure* OR test* OR marker*) W/3 ( pepsin OR trypsin OR "carbon dioxide" OR biochemical ) ) 86 903
Study types: systematic reviews and meta-analysis / randomized controlled trials
4. TITLE-ABS-KEY ( ( systematic W/2 review ) OR "meta analy*" OR metaanaly* ) AND (EXCLUDE (DOCTYPE, “le”) OR EXCLUDE (DOCTYPE, “ed”) OR EXCLUDE (DOCTYPE, “ch”) OR EXCLUDE (DOCTYPE, “cp”)) 691 612
Combined sets:
5. 2 OR 3 16 098 667
6. 1 AND 5 15 157
7. 4 AND 6 743
Final result
8. 7 743
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