Safety of blind versus guided feeding tube placement: Misplacement and pneumothorax risk

Taylor, Stephen J.; Karpasiti, Terpsi; Milne, Danielle

doi:10.1016/j.iccn.2023.103387

Cited by 8 publications

(16 citation statements)

References 28 publications

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“…7,8 Compared with undetected blind lung misplacement (0.015%), EM misplacement by experts was lower (0.005%) but higher among non-experts (0.21%). 3 Errors appear because of EM trace misinterpretation, potentially because training was inadequate [9][10][11] or inaccurate. 8 Guided placement using direct vision may suffer the same problems.…”

Section: Introductionmentioning

confidence: 94%

“…20 Placing a tube blindly is associated with a 0.5% risk of pneumothorax or pneumonia, regardless of whether misplacement is detected. 3 Conversely, use of direct vision should pre-empt most tube-related complications by operators knowing tube position in real time, including the definite transition from oesophagus to stomach. This would obviate the 2.1 h delay to x-ray, or 4.8 h when requiring the tube to be repositioned.…”

Section: Main Findingsmentioning

confidence: 99%

“…Although direct vision allows identification of anatomy during tube placement, the safety and efficacy of direct vision is reliant on expert interpretation of anatomical characteristics. 3,[12][13][14][15] Training in use of direct vision may be challenging when operators lack gastroenterology or endoscopy support and supervision.…”

Section: Introductionmentioning

confidence: 99%

“…It is estimated that over 2 million feeding tubes are placed in the UK and US per year 1,2 . Most tubes are placed “blind,” but 1.6% of these enter the lung and 0.5% cause pneumothorax, 3 increasing to 36.5% after repeated misplacement 4 . End‐of‐procedure pH, or x‐ray checks of tube position, 5 fail to prevent pneumothorax.…”

Section: Introductionmentioning

confidence: 99%

“…Bedside tube placement guided by electromagnetic (EM) tracking or direct vision has the potential to reduce the risk of lung complications and oesophageal misplacement and avoid delays but requires expert‐level training to safely interpret the guidance 7,8 . Compared with undetected blind lung misplacement (0.015%), EM misplacement by experts was lower (0.005%) but higher among non‐experts (0.21%) 3 . Errors appear because of EM trace misinterpretation, potentially because training was inadequate 9–11 or inaccurate 8 .…”

Section: Introductionmentioning

confidence: 99%

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Validation of image interpretation for direct vision‐guided feeding tube placement

et al. 2023

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BackgroundUnguided (blind) tube placement commonly results in lung (1.6%) and oesophageal (5%) misplacement, which can lead to pneumothorax, aspiration pneumonia, death, feeding delays, and increased cost. Use of real‐time direct vision may reduce risk. We validated the accuracy of a guide to train new operators in the use of direct vision–guided tube placement.MethodsUsing direct vision, operators matched anatomy viewed to anatomical markers in a preliminary operator guide. We examined how accurately the guide predicted tube position, specifically whether respiratory and gastrointestinal placement could be differentiated.ResultsA total of 100 patients each had one tube placement. Placement was aborted in 6% because of inability to enter or move beyond the oesophagus. In 15 of 20 placements in which the glottic opening was identified, the tube was maneuvered to avoid entry into the respiratory tract. Of 96 tubes that reached the oesophagus, 17 had entered the trachea; all were withdrawn pre‐carina. One or more specific characteristics identified each organ, differentiating the trachea‐oesophagus (P < 0.0001), oesophagus‐stomach, and stomach‐intestine in 100%. End‐of‐procedure tube position was ascertained by pH ≤4.0 (gastric) of aspirated fluid and/or x‐ray (gastric or intestinal). In patients with a trauma risk (13%), it was avoided by identification that the tube remained within the nasal, oesophageal, or gastric lumen.ConclusionOperators successfully matched anatomy seen by direct vision to images and descriptions of anatomy in the “operator guide.” This validated that the operator guide accurately facilitates interpretation of tube position and enabled avoidance of lung trauma and oesophageal misplacement.

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