Accuracy and costs of bedside methods for confirming nasoenteral feeding tube position: a diagnostic accuracy study

Aim: To analyze the accuracy and costs of bedside methods for confirming the position of a nasoenteral feeding tube newly inserted blindly by nurses.

Design: Diagnostic accuracy study of three clinical methods (ultrasound, epigastric auscultation, and pH measurement) compared to radiography. The direct costs of each method used to confirm the positioning of the nasoenteral tube were also measured.

Methods: Seventy-six adult patients underwent a total of 87 nasoenteral tube insertion procedures in hospital units located within the Northeast region of the State of São Paulo, Brazil. The clinical methods were conducted on all study participants in the specified sequence: ultrasound (as index test), followed by epigastric auscultation and pH measurement (also index tests).

Results: The outcomes regarding the confirmation of the accurate positioning of the nasoenteral tube are as follows: ultrasonography demonstrated sensitivity and specific of 79.0% and 66.7%, respectively. Epigastric auscultation exhibited a sensitivity of 81.3% and specificity of 83.3%. The pH measurement method displayed sensitivity and specificity of 89.3% and 100% respectively. Additionally, in terms of estimated direct costs, the pH measurement method incurred a higher cost (USD $8.31) compared to the other methods, with a difference of USD $6.68.

Conclusions: Based on these results, X-ray examination remains the primary method for confirming the placement of nasoenteral tubes recently inserted blindly at the bedside. However, when considering the costs of the evaluated methods, it is advisable to consider the variations in expenses between non-radiological methods and X-ray examinations.