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Colorimetric Capnometry and Feeding Tube Placement

  • Jean-Rémi Lavillegrand
  • Georges Offenstadt
  • Eric Maury
  • Bertrand Guidet
  • Arnaud Galbois
Reference work entry

Abstract

Most guidelines recommend confirming enteral feeding tube placement by radiography before starting enteral nutrition. Capnography and colorimetric capnometry have been described as an accurate alternative method to chest X-ray in this indication. In a meta-analysis, accuracy of capnography or colorimetric capnometry to ensure correct enteral feeding tube placement was found to be excellent (sensitivity = 0.99 (0.93–1.00), specificity = 0.99 (0.97–0.99), AUROC = 0.9959). Colorimetric capnometry is as accurate as capnography for detecting carbon dioxide during placement of enteral feeding tube. In comparison to chest X-ray, these methods prevent pneumothorax, improve a nurse’s organization of care, save time, and decrease costs and patients’ irradiation. Procedures using these methods to ensure correct enteral feeding tube placement should include some crucial steps: control that the enteral feeding tube is not coiled in the oropharynx, verification of its permeability, and epigastric auscultation to ensure that the enteral feeding tube is not coiled in the esophagus. In the rare cases of inconclusive epigastric auscultation, a chest X-ray must be ordered before starting enteral nutrition.

Keywords

Enteral Nutrition Guide Wire Correct Placement Care Intensive Care Unit Enteral Feeding Tube 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

List of Abbreviations

EN

Enteral nutrition

EFT

Enteral feeding tube

References

  1. Araujo-Preza CE, Melhado ME, Gutierrez FJ, Maniatis T, Castellano MA. Use of capnometry to verify feeding tube placement. Crit Care Med. 2002;30(10):2255–9.CrossRefPubMedGoogle Scholar
  2. Burns SM, Carpenter R, Truwit JD. Report on the development of a procedure to prevent placement of feeding tubes into the lungs using end-tidal CO2 measurements. Crit Care Med. 2001;29(5):936–9.CrossRefPubMedGoogle Scholar
  3. Burns SM, Carpenter R, Blevins C, Bragg S, Marshall M, Browne L, et al. Detection of inadvertent airway intubation during gastric tube insertion: capnography versus a colorimetric carbon dioxide detector. Am J Crit Care. 2006;15(2):188–95.PubMedGoogle Scholar
  4. Chau JP, Lo SH, Thompson DR, Fernandez R, Griffiths R. Use of end-tidal carbon dioxide detection to determine correct placement of nasogastric tube: a meta-analysis. Int J Nurs Stud. 2011;48(4):513–21.CrossRefPubMedGoogle Scholar
  5. Druyan ME, Compher C, Boullata JI, Braunschweig CL, George DE, Simpser E, et al. Clinical guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients: applying the GRADE system to development of A.S.P.E.N. clinical guidelines. JPEN J Parenter Enteral Nutr. 2012;36(1):77–80.CrossRefPubMedGoogle Scholar
  6. 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 J Surg. 1994;37(5):404–8.PubMedGoogle Scholar
  7. Elpern EH, Killeen K, Talla E, Perez G, Gurka D. Capnometry and air insufflation for assessing initial placement of gastric tubes. Am J Crit Care. 2007;16(6):544–9; quiz 50.PubMedGoogle Scholar
  8. Galbois A, Vitry P, Ait-Oufella H, Baudel JL, Guidet B, Maury E, et al. Colorimetric capnography, a new procedure to ensure correct feeding tube placement in the intensive care unit: an evaluation of a local protocol. J Crit Care. 2011;26(4):411–4.CrossRefPubMedGoogle Scholar
  9. Hejblum G, Ioos V, Vibert JF, Boelle PY, Chalumeau-Lemoine L, Chouaid C, et al. A web-based Delphi study on the indications of chest radiographs for patients in ICUs. Chest. 2008;133(5):1107–12.CrossRefPubMedGoogle Scholar
  10. Hendry PJ, Akyurekli Y, McIntyre R, Quarrington A, Keon WJ. Bronchopleural complications of nasogastric feeding tubes. Crit Care Med. 1986;14(10):892–4.CrossRefPubMedGoogle Scholar
  11. Howes DW, Shelley ES, Pickett W. Colorimetric carbon dioxide detector to determine accidental tracheal feeding tube placement. Can J Anaesth. 2005;52(4):428–32.CrossRefPubMedGoogle Scholar
  12. Ioos V, Galbois A, Chalumeau-Lemoine L, Guidet B, Maury E, Hejblum G. An integrated approach for prescribing fewer chest x-rays in the ICU. Ann Intensive Care. 2011;1(1):4.CrossRefPubMedPubMedCentralGoogle Scholar
  13. Jolliet P, Pichard C, Biolo G, Chiolero R, Grimble G, Leverve X, et al. Enteral nutrition in intensive care patients: a practical approach. Working Group on Nutrition and Metabolism, ESICM. European Society of Intensive Care Medicine. Intensive Care Med. 1998;24(8):848–59.CrossRefPubMedGoogle Scholar
  14. Kindopp AS, Drover JW, Heyland DK. Capnography confirms correct feeding tube placement in intensive care unit patients. Can J Anaesth. 2001;48(7):705–10.CrossRefPubMedGoogle Scholar
  15. Kunis K. Confirmation of nasogastric tube placement. Am J Crit Care. 2007;16(1):19; author reply.PubMedGoogle Scholar
  16. McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically Ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2009;33(3):277–316.CrossRefPubMedGoogle Scholar
  17. Metheny NA. Preventing respiratory complications of tube feedings: evidence-based practice. Am J Crit Care. 2006;15(4):360–9.PubMedGoogle Scholar
  18. Meyer P, Henry M, Maury E, Baudel JL, Guidet B, Offenstadt G. Colorimetric capnography to ensure correct nasogastric tube position. J Crit Care. 2009;24(2):231–5.CrossRefPubMedGoogle Scholar
  19. Nazir T, Punekar S. Images in clinical medicine. Pneumothorax – an uncommon complication of a common procedure. N Engl J Med. 2010;363(5):462.CrossRefPubMedGoogle Scholar
  20. Ortega R, Connor C, Kim S, Djang R, Patel K. Monitoring ventilation with capnography. N Engl J Med. 2012;367(19):e27.CrossRefPubMedGoogle Scholar
  21. 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(1):184–8.CrossRefPubMedGoogle Scholar
  22. Thomas BW, Falcone RE. Confirmation of nasogastric tube placement by colorimetric indicator detection of carbon dioxide: a preliminary report. J Am Coll Nutr. 1998;17(2):195–7.CrossRefPubMedGoogle Scholar
  23. Torrington KG, Bowman MA. Fatal hydrothorax and empyema complicating a malpositioned nasogastric tube. Chest. 1981;79(2):240–2.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Jean-Rémi Lavillegrand
    • 1
  • Georges Offenstadt
    • 1
    • 2
    • 3
  • Eric Maury
    • 1
    • 2
    • 3
  • Bertrand Guidet
    • 1
    • 2
    • 3
  • Arnaud Galbois
    • 1
  1. 1.Service de Réanimation MédicaleAP–HP, Hôpital Saint–AntoineParisFrance
  2. 2.UPMC, Université Pierre et Marie CurieUniv Paris 06, Sorbonne UniversitésParisFrance
  3. 3.INSERMUMR_S 707ParisFrance

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