Abstract
Objective
To evaluate whether a simple aspiration test can be used to accurately confirm the correct placement of fine-bore feeding tubes in the oesophagus and prevent their inadvertent placement in the bronchial tree.
Design
We conducted an ethically approved, randomised, blinded trial to assess the accuracy of a simple aspiration test to differentiate between oesophageal and tracheal placement.
Setting
A tertiary referral cardiothoracic surgical unit.
Patients and participants
Twenty patients under-going elective cardiac surgery.
Intervention
Once anesthetised, a fine-bore feeding tube was inserted into the oesophagus or trachea and a researcher, blinded to the position, then performed the test. This involved attempted aspiration of ≥10 ml of air before and after insufflation of 10 ml of air and comparison with capnography, a test that has been shown to be highly sensitive and specific.
Measurements and results
With this small number of patients, the test accurately differentiated between ten oesophageal and ten tracheal placements.
Conclusions
A simple aspiration test could be a useful adjunct to prevent inadvertent bronchial placement of fine-bore feeding tubes. Careful attention must be paid to the technique to ensure that no false positives occur.
References
Lee AJ, Eve R, Bennett MJ (2006) Evaluation of a technique for blind placement of post-pyloric feeding tubes in intensive care: application in patients with gastric ileus. Intensive Care Med 32:553–556
Metheny NA, Meert KL, Clouse RE (2007) Complications related to feeding tube placement. Curr Opin Gastroenterol 23:178–182
Burns SM, Carpenter R, Blevins C, Bragg S, Marshall M, Browne L, Perkins M, Bagby R, Blackstone K, Truwit JD (2006) Detection of inadvertent airway intubation during gastric tube insertion: capnography versus a colorimetric carbon dioxide detector. Am J Crit Care 15:188–195
NHS National Patient Safety Agency (2005) Reducing the harm caused by misplaced nasogastric feeding tubes
Rassias AJ, Ball PA, Corwin HL (1998) A prospective study of tracheopulmonary complications associated with the placement of narrow-bore enteral feeding tubes. Critical Care 2:25–28
Araujo-Preza CE, Melhado ME, Gutierrez FJ, Maniatis T, Castellano MA (2002) Use of capnometry to verify feeding tube placement. Crit Care Med 30:2255–2259
Kindopp AS, Drover JW, Heyland DK (2001) Capnography confirms correct feeding tube placement in intensive care unit patients. Can J Anesth 48:705–710
Harrison AM, Clay B, Grant MJ, Sanders SV, Webster HF, Reading JC, Dean JM, Witte MK (1997) Nonradiographic assessment of enteral feeding tube position. Crit Care Med 25:2055–2059
Acknowledgments
We are grateful to Merck Pharmaceuticals, Leicestershire, UK for providing the fine-bore feeding tubes necessary to complete this study.
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Ward, M.M., McEwen, A.M., Robbins, P.M. et al. A simple aspiration test to determine the accuracy of oesophageal placement of fine-bore feeding tubes. Intensive Care Med 35, 722–724 (2009). https://doi.org/10.1007/s00134-008-1312-4
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DOI: https://doi.org/10.1007/s00134-008-1312-4