The effectiveness of the diazo reaction in the determination of tip-end position after blind insertion of the nasoenteric tube by ICU nurses: A prospective comparative study.
Chun Song, Qing Liu, Lu Zhang and 5 others
PMID 42521394WHAT IT FOUND
For ICU patients with blindly placed nasoenteric tubes, a bedside diazo test on aspirated fluid agreed with X-ray position in 92.3% of cases.
It was the best bedside method tested, but X-ray still confirms final position.
Key findings
01The diazo reaction was the best bedside method tested, with 92.3% agreement with X-ray, 95.5% sensitivity, and 80.2% specificity.
02The pH test detected 97.3% of intestinal placements but correctly excluded only 48.4% of non-intestinal placements.
03The diazo reaction can be wrong when bile refluxes into the stomach or when biliary obstruction lowers intestinal bilirubin.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Single-centre ICU study using consecutive convenience sampling, so results may not apply to other ICUs or wards. The authors did not collect detailed baseline comorbidities or medications such as prokinetic agents, which could affect test performance. The diazo reaction needs a bilirubin reagent kit, so it may not be available everywhere. False positives can occur with duodenogastric reflux, and false negatives can occur with biliary obstruction. Only 427 of 438 enrolled patients completed all six tests. The authors described the sample as relatively small.
Declared interests
This work was supported by the Shandong Province Medical Staff Science and Technology Innovation Program. The authors declare no known competing financial interests.
The easy way to misread this
Do not treat a red diazo reaction as final proof that the tube is in the intestine. X-ray remains the reference standard, and bile reflux can make a stomach aspirate turn red, while biliary obstruction can make an intestinal aspirate stay pale.