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 receive a standard feeding tube or a feeding tube that uses a pH sensor to facilitate postpyloric placement and compared placement speed and accuracy, 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 kidneys, ureter, and bladder was taken at 1, 6, and 48 hours after placement in both groups. Separate cost-benefit analyses were done by using retrospective chart review of costs for a separate 20-patient standard feeding 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 sensor feeding tube patients and 45% of the standard feeding tube patients (the difference was not significant). At 48 hours, 93% of the pH sensor feeding tubes reached the duodenum vs 67% of the standard feeding tubes (P < .08). Thirty percent of the pH sensor patients had an initial gastric pH greater than or equal to 4, negating pH sensor benefit in tube placement. In the remaining 70% of the patients, placement with the pH sensor had a 100% specificity compared with the x-ray of the kidneys, ureter, and bladder. Displacement was easily detected with routine pH monitoring in three of the pH sensor feeding tube patients and corrected. It was detected in two standard feeding tube patients, one of whom aspirated. Cost-benefit analysis incorporating the above showed a cost savings of $81.00 per patient for the pH sensor feeding tube, more than the cost of the tube. Thus, pH sensor feeding tubes may obviate the need for confirmatory x-rays in patients without hypochlorhydria, resulting in potential significant savings.