Frequently Asked Questions


General Questions


  • Why would we use RightSpotpH® indicators?
Why would we use RightSpotpH® indicators?

The RightBio Metrics products are the only FDA cleared/CLIA waived pH indicators for confirming gastric acidity for tubes ending in the stomach. pH paper and strips are not FDA cleared or CLIA waived. Additionally, RightBio Metrics devices are fully enclosed systems that protect from gastric acid exposure and do not require calibration.


  • What is the difference between RightSpotpH® SmallBore and RightSpotpH® indicators?
What is the difference between RightSpotpH® SmallBore and RightSpotpH® indicators?

RightSpotpH® SmallBore indicators fit small bore tubes (primarily feeding) that are 10Fr or less in diameter. RightSpotpH® fits large bore tubes (primarily suction) that are >10Fr in diameter. The pH scale ranges from 4.5-7 in .05 increments.


  • Do I need a special NG/OG tube for your product?
Do I need a special NG/OG tube for your product?

No, our products are designed to work with all manufacture brands and size NG/OG feeding tubes. If you use Vygon Nutrisafe 2 or EnFit compatible tubes, please let us know. We can work with you to get the appropriate adapters.


  • Are your products ENFit compatible?
Are your products ENFit compatible?

Currently, you can use an adapter. We have plans in place to make our products ENFit compatible. Having said that, most US hospitals have not adopted ENFit yet, so we are working with multiple companies to ensure our products meet whichever NG/OG tube they use in their hospital.


  • Can we re-use the pH indicators and/or the syringe?
Can we re-use the pH indicators and/or the syringe?

No, the pH indicators and the syringe used to withdraw aspirate cannot be reused. Once aspirate is obtained, please remove the pH indicator with the syringe attached and dispose of according to your hospitals policy.


  • What if we cannot obtain aspirate?
What if we cannot obtain aspirate?

An important first step to obtaining aspirate is to push a small amount of air into the NG/OG tube prior to attempting to get aspirate.  For infants 0.5-2cc, for pediatric patients 5-10cc and for adults 10cc or more. Please use your clinical judgement.

If you are still not able to obtain aspirate, lay the patient on their left side for 10 minutes, push air into the NG/OG tube again as directed and re-attempt.  In most cases if the NG/OG tube is in the stomach, aspirate will be obtained. If not, follow your hospitals protocol for further instruction. For additional information on obtaining aspirate please note the following studies:

  • NHS Resource Set Initial Placement for Nasogastric and Orogastric Tubes, July 2016
  • The Journal of Neonatology/Perinatology-Neonatal Intensive Care Journal, Fall 2015, p. 64, Dr. Gregory Martin

  • Do we need to calibrate or do quality controls on the RightSpotpH® indicators?
Do we need to calibrate or do quality controls on the RightSpotpH® indicators?

You do NOT need to calibrate or do quality controls on the RightSpotpH® indicators. Unlike pH paper or strips, our pH indicators are protected from light, air and humidity which are the three environmental factors that make un-protected pH strips/paper inaccurate


  • How much aspirate is needed?
How much aspirate is needed?

Only enough to change the color of the pH indicator. Once you see the color change, stop pulling aspirate. For the RightSpotpH® SmallBore it is ~.02cc and for the RightSpotpH® it is ~0.5cc.


  • Can these pH indicators be used on patients that have acid reflux and/or hiatal hernias?
Can these pH indicators be used on patients that have acid reflux and/or hiatal hernias?

In reflux or after vomiting the amount of residual gastric juice in the esophagus or oropharynx is not enough to fill the tube and indicator. Substantial amounts of aspirate that are in the oropharynx should be suctioned away immediately. Smaller amounts of gastric fluid due to acid reflux do not remain in the esophagus as the fluid is pushed into the stomach via peristalsis. For a hiatal hernia to be large enough to have the feeding tube or NG tube curl up is very rare. Reflux and Hiatal Hernias should not affect the RightSpotpH® indicators readings, however always follow your hospital protocol for final determination.


  • Are you able to use these products on patients that are on gastric acid suppressing medications?
Are you able to use these products on patients that are on gastric acid suppressing medications?

Yes. Published studies in the United States and United Kingdom demonstrate that despite patients being on medications designed to suppress gastric acid, the majority are still well below a pH of 5.


  • How often do you recommend checking pH?
How often do you recommend checking pH?

Some hospital check pH prior to each feed/medication delivery. Others check pH at shift change. While others only check at initial placement and suspected misplacement. Please follow your hospitals protocol for final determination. There are multiple published cases of tubes confirmed in the stomach and then later migrating into the lungs. Frequent checks can save lives.


  • Can you use this product when there is blood in the aspirate?
Can you use this product when there is blood in the aspirate?

It depends. If the aspirate has digested, coagulated blood that looks like coffee grounds, YES. If the aspirate is bright red, NO.


  • If I just fed a patient and need to check tube placement, can I still use your pH indicator?
If I just fed a patient and need to check tube placement, can I still use your pH indicator?

After a bolus feed, we recommend waiting 60 minutes before taking a pH reading. Always remember to clear the line with air immediately after a feeding and then again prior to taking a pH reading. If you don’t clear the line with air the next time you take a pH reading you will be pulling the feeding solution and/or medication into the pH indicator, not the true gastric content.


  • Some of our patients are on continuous feeds, can we still use pH to confirm gastric placement of the NG/OG tube.
Some of our patients are on continuous feeds, can we still use pH to confirm gastric placement of the NG/OG tube.

Yes, however the recommendation is to stop the continuous feed, clear the line with air and wait 5-60 minutes (depending on your hospitals protocol) then take the pH reading. The waiting period allows the gastric content to acidify.


  • If the patient is intubated or on a breathing machine, why would I need to confirm NG tube gastric placement?
If the patient is intubated or on a breathing machine, why would I need to confirm NG tube gastric placement?

Tubes can still be mis-placed into the lung and cause extensive damage. There are documented cases of the tube placed around the cuff on the endotracheal tube therefore it is important to confirm proper placement.


  • How are the RightSpotpH® indicators different than Gastrocult?
How are the RightSpotpH® indicators different than Gastrocult?

Gastrocult is FDA cleared for determining if there is blood in the aspirate; it does not distinguish between 5-7pH, exposes the healthcare work to aspirate and readings need to be completed by lab within two minutes of obtaining aspirate. Gastrocult is NOT FDA cleared to use to assist in placing tubes.


  • How are the RightSpotpH® indicators different than CO2 Now?
How are the RightSpotpH® indicators different than CO2 Now?

CO2 Now only indicates if the NG/OG tube is in the lungs, it does not confirm gastric placement.


  • How are the RightSpotpH® indicators different than Cortrack?
How are the RightSpotpH® indicators different than Cortrack?

Cortrack uses imaging and requires a highly skilled user to determine NG/OG tube placement. It has not been shown to be effective determining whether these tubes are in the lungs however can be used to determine gastric vs. post-pyloric placement. Cortrack requires a unique NG tube which costs $65-$80/each and a capital equipment purchase of $15,000 for the monitor. Our products can be used by any trained healthcare professional or caretaker and are much less expensive and do not require any capital equipment.


  • How are the RightSpotpH® indicators different than IRIS?
How are the RightSpotpH® indicators different than IRIS?

The IRIS system is like endoscopy and requires a highly skilled user. It is not indicated for pediatric patients. Published studies state that it is 60% accurate in determining NG/OG tube placement upon initial insertion and over time degrades to 30% accuracy.


  • Why are the RightSpotpH® indicators more effective at confirming NG tube placement than auscultation (air bolus)?
Why are the RightSpotpH® indicators more effective at confirming NG tube placement than auscultation (air bolus)?

US and U.K. patient safety alerts and studies have called for the immediate discontinuation of auscultation because of the high rates of misplacement associated with it. Publishes studies such as Children’s Hospital of Philadelphia (CHOP) 2015 article state that misplacement ranges 21-56%. There is NO clinical evidence to support auscultation yet there is a large body of evidence recommending and supporting the use of pH.

US Alerts

  • Child health patient safety organization (CHPSO) 2012 Alert
  • Children’s Hospital Association (CHA) 2012
  • American Association of Critical Care Nurses (AACN) 2016 Alert

EU Alerts

  • National Patient Safety Association (NPSA) 2011 Alert
  • National Patient Safety Association (NPSA)2016 Alert

ENA (Emergency Nurses Association) Clinical Practice Guidelines 2015


  • Can we use the RightSpotpH® indicators pH indicators to determine post-pyloric placement?
Can we use the RightSpotpH® indicators pH indicators to determine post-pyloric placement?

No. These pH indicators are FDA cleared/CLIA waived for gastric confirmation.


  • Can these pH indicators be reused?
Can these pH indicators be reused?

No. They are single-use only. The syringe may not be reused either. After obtaining aspirate sufficient to change the pH indicator color, please remove the pH indicator attached to the syringe and dispose of according to your hospitals policy.


  • We have never had a misplaced NG/OG tube so why would we want to purchase your product?
We have never had a misplaced NG/OG tube so why would we want to purchase your product?

Though you personally may not have experienced a misplaced NG/OG tube, published studies report that 21-56% of tubes are not in the stomach. Statistics indicate that it is only a matter of time.


  • After the indicator changes color how long do we have to read it?
After the indicator changes color how long do we have to read it?

The Instructions-for-Use state that the indicator should be read within two minutes of the color change.


  • Can your product be used in the homecare setting?
Can your product be used in the homecare setting?

Yes, our pH products are ideal for the homecare setting where caretakers are not trained or capable of using other methods to confirm gastric NG/OG tube placement and may not provide the appropriate environmental controls for working with pH strips or paper.


  • Could we use RightSpotpH® indicators in place of x-ray for initial placement of NG/OG tubes?
Could we use RightSpotpH® indicators in place of x-ray for initial placement of NG/OG tubes?

The United Kingdom uses pH first line and only confirms NG/OG tube placement with x-ray if results are non-conclusive. There are many US hospitals adopting similar protocols such as CHOP (Children’s Hospital of Philadelphia). Please follow your hospital protocol for final determination.


  • Is the use of the RightSpotpH® indicators reimbursable?
Is the use of the RightSpotpH® indicators reimbursable?

The cost is reimbursable in the E.D. It also may be reimbursable in-patient, depending on how your hospital bills for Point of Care Tests. If your hospital gets reimbursed for bedside blood glucose they should be able to be reimbursed for our product. The CPT Code is 83986QW and the reimbursement ranges from $4.80 -$7.00, depending on the payer.


NICU


  • Do neonates stomachs produce acid?
Do neonates stomachs produce acid?

Yes. Published studies in the United States and United Kingdom state that neonates’ stomachs produce acid.

  • The Journal of Neonatology/Perinatology-Neonatal Intensive Care Journal, Fall 2015, p. 64, Dr. Gregory Martin
  • NHS National Patient Safety Association, Reducing the harm caused by misplaced gastric feeding tubes in babies under the care of neonatal units, 2005

  • Is it possible to obtain aspirate from a neonate?
Is it possible to obtain aspirate from a neonate?

Yes. Published studies in the US and U.K. state that it is possible to obtain aspirate from neonates. See studies referenced above.


  • Are there any studies that support use of pH to confirm NG/OG tube placement in the neonatal population?
Are there any studies that support use of pH to confirm NG/OG tube placement in the neonatal population?

Yes. See studies referenced above.


  • Will the RightSpotpH® SmallBore fit 4Fr-6Fr NG/OG tubes?
Will the RightSpotpH® SmallBore fit 4Fr-6Fr NG/OG tubes?

Yes. The RightSpotpH® SmallBore will accommodate tubes 10Fr or smaller.


  • Are there any accounts using your product in the US?
Are there any accounts using your product in the US?

Yes. Please ask your local sales representative for a list of NICU’s currently using the RightSpotpH® SmallBore.


Emergency Department


  • We primarily use Salem Sumps, will your product fit the larger tubes?
We primarily use Salem Sumps, will your product fit the larger tubes?

Yes. The RightSpotpH® will fit large bore tubes >10Fr.


  • Most of our patients eventually go for x-ray so why would we need to check placement with pH?
Most of our patients eventually go for x-ray so why would we need to check placement with pH?

Yes, true, however lung tissue is fragile and easily damaged. Putting lung tissue to suction can cause issues such as pneumonitis to an already critically ill patient which leads to poor clinical outcomes and increased length of stay. Do you want tissue placed to suction or feeding for possibly hours? Additionally, if the patient is not scheduled for x-ray do you want to expose them unnecessarily for an NG/OG tube confirmation and wait the additional time to for the x-ray to be read? Our pH indicators will give you an immediate response and this time savings could improve your patient’s overall time spent in the ED.


  • If we are only administering suction, why would it matter if the NG/OG tube is in the lungs? Eventually it will be detected by x-ray?
If we are only administering suction, why would it matter if the NG/OG tube is in the lungs? Eventually it will be detected by x-ray?

Please see answer referenced above.


  • What are the recommendations for confirming NG/OG tube placement in the E.D.?
What are the recommendations for confirming NG/OG tube placement in the E.D.?

The ENA Clinical Practice Guidelines 2015 do not recommend auscultation for confirming tube placement. Their recommendation is to use x-ray, followed by pH. If the patient is not scheduled for x-ray do you want to expose them unnecessarily for an NG/OG tube confirmation and wait the additional time to for the x-ray to be read. Our pH indicators will give you an immediate response and this time savings could improve your patient’s overall time spent in the ED.


  • Is the use of the RightSpotpH® indicators reimbursable when used in the E.D.?
Is the use of the RightSpotpH® indicators reimbursable when used in the E.D.?

Yes. Our CPT Code is 83986QW and the reimbursement ranges from $4.80 -$7.00, depending on the payer.

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