Abstract
Purpose
To test the accuracy and potential time savings of capnography as compared with a two-step radiographic method in placing feeding tubes in critically ill patients.
Methods
One hundred feeding tube placements were studied in our tertiary care intensive care unit. All placements utilized a twostep radiographic method, but capnography was added to the procedure. The procedure was then completed or abandoned depending on radiographie interpretation.
Results
Radiography showed 11 feeding tubes projecting within the tracheobronchial tree. In all 11 of these placements, the capnography unit displayed a normal capnogram. Radiography revealed 86 tube placements in the midesophageal region. In all 86 of these placements, capnography displayed a “purging warning”. In three placements, radiography indicated that the tube was coiled in the oropharynx. In these cases, the capnograph displayed one “no purging/no capnogram” result, and two “purging” warnings. If using capnography alone, an average of 72.5 min would be required to complete a feeding tube placement (which includes time for requisite “pre-feed radiograph”). The two-step radiological approach took an average of 169.4 min, a difference of 96.9 min (P < 0.0001) between the two methods.
Conclusions
Capnography accurately identified all intratracheal feeding tube placements in this study. This study also shows that the use of capnography would significantly shorten the time needed for tube placement compared with a two-step radiologie method. Capnography should be considered for routine use when placing feeding tubes since it adds little time to the procedure and may improve patient safety.
Résumé
Objectif
Tester l’exactitude et le gain de temps potentiel associés à la capnographle comparée à la radiographie en deux étapes utilisées lors de la mise en place d’une sonde d’alimentation chez les patients gravement malades.
Méthode
Nous avons étudié 100 mises en place de sonde d’alimentation à notre unité de soins intensifs de centre tertiaire. La radiographie en deux temps, et la capnographie, ont été utilisées dans tous les cas. L’intervention a été complétée ou abandonnée selon l’interprétation radiographique.
Résultats
La radiographie a montré 11 sondes insérées dans la trachée. Dans ces 11 cas, la capnographie a affiché un capnogramme normal. La radiographie a révélé 86 mises en place au milieu de l’œsophage. Dans ces 86 cas, la capnographie a affiché un avertissement de “purge”. Dans trois cas, la radiographie a indiqué que la sonde était enroulée dans l’oropharynx. La capnographie a alors affiché une “absence de purge/absence de capnogramme” et deux avertissements de “purge”. L’utilisation d’une sonde d’alimentation, avec la capnographie seule, exige en moyenne 72,5 min incluant le temps requis pour “un radiogramme préalimentation”). La technique utilisant la radiographie en deux temps demande en moyenne 169,4 min. Il y a donc une différence de 96,9 min (P < 0,0001) entre les deux méthodes.
Conclusion
La capnographie a permis de vérifier avec précision la position de toutes les sondes d’alimentation de la présente étude. L’usage de la capnographie, comparée à la radiographie en deux temps, a aussi réduit sensiblement le temps nécessaire à la mise en place de la sonde. La capnographie devrait faire partie de la mise en place courante des sondes, puisqu’elle prolonge de peu l’intervention et peut améliorer la sécurité du patient.
Article PDF
Similar content being viewed by others
References
Boyes RJ, Kruse JA Nasogastric and nasoenteric intubation. Crit Care Clin 1992; 8: 865–78.
Raff MH, Cho S, Dale R A technique for positioning nasoenteral feeding tubes. JPEN J Parenter Enterai Nutr 1987; 11:210–3.
Gharib AM, Stern EJ, Sherbin VL, Rohrmann CA Nasogastric and feeding tubes. The importance of proper placement. Postgrad Med 1996; 99: 174–6.
Wendell GD, Lenchner GS, Promisloff RA Pneumothorax complicating small-bore feeding tube placement. Arch Intern Med 1991; 151: 599–602.
Roubenoff R, Ravich WJ. Pneumothorax due to nasogastric feeding tubes. Report of four cases, review of the literature, and recommendations for prevention. Arch Intern Med 1989; 149: 184–8.
Swiech K, Lancaster DR, Sheehan R. Use of a pressure gauge to differentiate gastric from pulmonary placement of nasoenteral feeding tubes. Appl Nurs Res 1994; 7: 183–9.
McWey RE, Curry NS, Schabel SI, Reines HD. Complications of nasoenteric feeding tubes. Am J Surg 1988; 155: 253–7.
Metheny N. Minimizing respiratory complications of nasoenteric tube feedings: state of the science. Heart Lung 1993; 22: 213–23.
Woodall BH, Winfield DF, Bisset IIIGS. Inadvertent tracheobronchial placement of feeding tubes. Radiology 1987; 165: 727–9.
Carey TS, Holcombe BJ. Endotracheal intubation as a risk factor for complications of nasoenteric tube insertion. Crit Care Med 1991; 19: 427–9.
Metheny N, Dettenmeier P, Hampton K, Wiersema L, Williams P. Detection of inadvertent respiratory placement of small-bore feeding tubes: a report of 10 cases. Heart Lung 1990; 19: 631–8.
Metheny N Measures to test placement of nasogastric and nasointestinal feeding tubes: a review. Nurs Res 1988; 37: 324–9.
Harris MR, Huseby JS. Pulmonary complications from nasoenteral feeding tube insertion in an intensive care unit: incidence and prevention. Crit Care Med 1989; 17: 917–9.
Dorsch JA, Dorsch SE. Gas monitoring.In: Dorsch JA, Dorsch SE (Eds). Understanding Anesthesia Equipment, 4th ed. Baltimore: Williams & Wilkins, 1999: 679–753.
Asai T, Stacey M. Confirmation of feeding tube position; how about capnography? (Letter). Anaesthesia 1994; 49: 451.
Mercurio P, Levine P. Determining NG-tube position (Letter). Respir Care 1985; 30: 999.
D’Souza CR, Kilam SA, D’Souza U, Janzen EP, Sipos RA. Pulmonary complications of feeding tubes: a new technique of insertion and monitoring malposition. Can JSurg 1994; 37: 404–8.
Author information
Authors and Affiliations
Corresponding author
Additional information
Supported in part by a grant from the Kingston General Hospital Research Fund. Dr. Heyland is a career scientist with the Ontario Ministry of Health.
Rights and permissions
About this article
Cite this article
Kindopp, A.S., Drover, J.W. & Heyland, D.K. Capnography confirms correct feeding tube placement in intensive care unit patients. Can J Anesth 48, 705–710 (2001). https://doi.org/10.1007/BF03016209
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF03016209