1. COST CONSCIOUSNESS PROJECT- IMAGING CONFIRMATION OF LARGE-BORE NG TUBE PLACEMENT WILL FISHER DSR2

2. CURRENT GUIDELINES Sited most by the literature: American Association of Critical Care Nurses stated in 2010: Obtain radiographic confirmation of correct placement of any blindly inserted tube prior to its initial use for feedings or medication administration.

3. EVIDENCE FOR GUIDELINES Enhancing patient safety during feeding-tube insertion: a review of more than 2,000 insertions- a 2004 review article in the Journal of Parenteral and Enteral Nutrition Of all small-bore nasogastric feeding-tube placements, 1.3%- 2.4% resulted in 50 documented cases of feeding-tube malpositions during 4 years. Over half of the 50 patients were mechanically ventilated, and only 2 had a normal mental status.

4. MEANWHILE IN OTHER PARTS OF THE MEDICAL WORLD… In Pediatric Patients- imaging is reserved for “high risk patients” In the UK patients are not routinely imaged to verify NG tube placement

5. JUST THE FACTS 11 patients seen in both ICU and Medical wards settings with NG tubes- avoiding post pyloric feedings All had NG tube placement confirmed with xray and subsequently verified by a radiologist 2 out of the 11 patients required advancing of the NG tube- both of which were intubated patients in the Unit

6. ANALYSIS Price of a chest xray: 50-1200 USD Comparing apples to oranges, or apples to much, much smaller apples An Xray will not prevent damage caused by malpositioning of a tube, but would prevent the administration of tube feeds into the lungs- always a good thing.

7. CONCLUSIONS A delay in patient care from having a radiologist read the film Perhaps the prior guidelines have been overly applied Consider the case for administration of the NG- Is the patient high risk ie changes in mental status or mechanically ventilated? More research is needed on this topic