To test the accuracy of capnography in the differential placement of feeding tubes into the trachea versus the oesophagus.
Method
Nineteen pigs were anesthetised, and feeding tubes were placed into their tracheas and oesophagi. A naïve examiner attached a capnography to the tube and evaluated the presence or absence of flow waveforms on the capnography. In the next step experiment, we gave 20 intentional oesophageal ventilations to the animals to create a distended stomach. The feeding tubes were reinserted, and examined by a naïve examiner by capnography.
Results
Capnography demonstrated continuous flow waveforms for the feeding tubes placed in the tracheas, but no waveforms were observed for those placed in the oesophagi. In the next step experiment, we found the same results.
Conclusion
Capnography can be used to accurately determine the placement of tracheal versus oesophageal feeding tubes based on the presence or absence of flow waveforms.
MethenyN.A., ClouseR.E., ChangY.H., StewartB.J., OliverD.A., KollefM.H.Tracheobronchial aspiration of gastric contents in critically ill tube-fed patients: frequency, outcomes and risk factors.Crit Care Med2006; 34(4): 1007–15.
4.
DuthornL., SteinbergH.S., HauserH., NeeserG., PrackiP.Accident intravascular placement of a feeding tube.Anesthesiology1998; 89(1): 251–3.
5.
KesekD.R., AkerlindL, KarlssonT.Early enteral nutrition in the cardiothoracic intensive care unit.Clin Nutr2002; 21(4): 303–7.
6.
MardersteinE.L., SimmonsR.L., OchoaJ.B.Patient safety: effect of institutional protocols on adverse events related to feeding tube placement in the critically ill.J Am Coll Surg2004; 199(1): 39–47.
7.
KindoppA.S., DroverJ.W., HeylandD.K.Capnography confirms correct feeding tube placement in intensive care unit patients.Can J Anaesth2001; 48(7): 705–10.
8.
BurnsS.M., CarpenterR., TruwitJ.D.Report on the development of a procedure to prevent placement of feeding tubes into the lungs using end-tidal CO2 measurements.Crit Care Med2001; 29(5): 936–9.
9.
BurnsS.M., CarpenterR., BlevinsC., BraggS., MarshallM., BrowneL.Detection of inadvertent airway intubation during gastric tube insertion: capnography versus a colorimetric carbon dioxide detector.Am J Crit Care2006; 15(2): 188–95.
10.
ElpernE.H., KilleenK., TallaE., PerezG., FurkaD.Capnometry and air insufflations for assessing initial placement of gastric tubes.Am J Crit Care2007; 16(6): 544–9; quiz 550.
11.
PuntervollS.A., SoreideE., JacewiczW., BjellandE.Rapid detection of oesophageal intubation: take care when using colorimetric capnometry.Acta Anaesthesiol Scand2002; 46(4): 455–7.
12.
LinkoK., PaloheimoM., TammistoT.Capnography for detection of accidental oesophageal intubation.Acta Anaesthesiol Scand1983; 27(3): 199–202.
13.
BirminghamP.K., CheneyF.W., WardR.J.Esophageal intubation: a review of detection techniques.Anesth Analg1986; 65(8): 886–91.
14.
GrmecS.Comparison of three different methods to confirm tracheal tube placement in emergency intubation.Intensive Care Med2002; 28(6): 701–4.
15.
RudrarajuP., EisenL.A.Confirmation of endotracheal tube position: a narrative review.J Intensive Care Med2009; 24(5): 283–92.
ChenaitiaH., BrunP.M., QuerellouE., LeyralJ., BessereauJ.; WINFOCUS (World Interactive Network Focused On Critical Ultrasound) Group France. Ultrasound to confirm gastric tube placement in prehospital management.Resuscitation2012; 83(4): 447–51.
22.
BercikP., SchlageterV., MauroM., RawlinsonJ., KuceraP., ArmstrongD.Noninvasive verification of nasogastric tube placement using a magnet-tracking system: a pilot study in healthy subjects.JPEN J Parenter Enteral Nutr2005; 29(4): 305–10.
23.
KearnsP.J., DonnaC.A controlled comparison of traditional feeding tube verification methods to a bedside, electromagnetic technique.JPEN J Parenter Enteral Nutr2001; 25(4): 210–5.
