Tube placement using ‘IRIS’: A pilot assessment of its utility and safety

Taylor, Stephen J.; Sayer, Kaylee; Terlevich, Ana; Campbell, David B.

doi:10.1016/j.iccn.2021.103077

Cited by 2 publications

(1 citation statement)

References 6 publications

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“…[26] inserted 13 out of 15 feeding tubes successfully in gastric position [26]. Mizzi et al [24] successfully positioned feeding tubes in the lower third of the stomach in 20 patients in a neurological ICU using IRIS-technology [24].…”

Section: Discussionmentioning

confidence: 99%

Video-assisted placement of enteral feeding tubes using the Integrated Real-Time Imaging System (IRIS)-technology in critically ill patients

et al. 2021

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Introduction: In critically ill patients, nasogastric (NG) and nasojejunal (NJ) feeding tube placements are standard procedures. However, about 1.9% of blind tube insertions are malpositioned in the tracheopulmonary system, whereas guided procedures may result in a significant delay in nutritional delivery. Guided methods, such as Cortrak and fluoroscopy, have success rates of 82.6e85% and 93% respectively. The current study aims to investigate the performance of video-assisted feeding tube placement in the post-pyloric position using Integrated Real Time Imaging System (IRIS-) technology. Methods: A prospective cohort study in patients requiring enteral feeding was conducted in a mixed medical-surgical intensive care unit (ICU). The primary outcome was the post-pyloric placement of IRIS feeding tubes, as confirmed by X-ray. Secondary study objectives included gastric placement, ease of use and adverse events. Results: Thirty-one feeding tubes were placed using IRIS-technology; one patient was excluded for analysis due to protocol violation. One procedure was terminated due to significant bleeding (epistaxis) and desaturation. Only eighteen (58%) feeding tubes were placed in post-pyloric position (including two past the ligament of Treitz). In subjects who needed post-pyloric placement due gastroparesis, IRIS was mostly unsuccessful (success rate of 25%). However, when gastric placement was the primary objective, 96.8% of tubes were correctly placed. During insertion, tracheal visualization occurred in 27% of cases, and the IRIS feeding tube was repositioned early in the procedure without causing patient harm. Conclusions: Real-time video-assisted post-pyloric feeding tube placement in critically ill ICU patients was only successful in 58% of cases and therefore currently cannot be recommended for this indication. However, a high success rate (96.8%) for gastric placement was achieved. IRIS tube placement detected tracheal misplacement immediately and had few adverse events.

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Section: Discussionmentioning

confidence: 99%

Video-assisted placement of enteral feeding tubes using the Integrated Real-Time Imaging System (IRIS)-technology in critically ill patients

et al. 2021

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X-ray checks of NG tube position: a case for guided tube placement

Taylor

Manara

2021

BJR

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Objectives: Checking nasogastric (NG) tube position by X-ray is too late to prevent 1.5% of blind tube placements entering the lung and results in delays to feeding and drugs. We audit the safety of the tube position and delay incurred by X-ray. Methods: From Radiology reports, we determined whether tube position was safe for feeding, factors associated with an X-ray request and the time delay from X-ray request to that report. For tubes misplaced into the lung, the distance from the carina to tube tip was measured and compared with that from published records of guided tube placement. Results: From 1 July 2019 to 30 June 2020, 1934 X-rays were done to check NG tube position in 891 patients. Gastric placement was confirmed in 85% but, because of tube proximity to the oesophagus, only 73% were deemed safe to feed. The 2.2% of tubes reported to be in the lung were a median of 18 cm beyond the carina compared to 12 cm and 0 cm for electromagnetic and direct vision methods of guided placement. X-ray checks delayed feed and drug treatment by >2 h in 51% of placements and 33% of patients required >3 X-rays during their enteral episode. Conclusion: X-ray checks are common and detect a high percentage of unsafe tube placements, leading to repeated X-ray and delayed delivery of drugs and nutrition. Interpretation can be difficult even when following standard national criteria and post-placement X-ray cannot prevent deep lung placement. Guided or combined methods of confirming tube placement should be investigated. Advances in knowledge: Reports included 27.5% of placements as unsafe, 2.2% in the lung at a median depth of 18 cm beyond the carina and too late to prevent 7 pneumothoraces. X-rays were repeated >3 times in 33% of patients over their enteral course and we are associated with clinically significant delays to drug treatment (and nutrition) in 51%; combined methods of tube confirmation or guided placement may be safer and more efficient.

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Tube placement using ‘IRIS’: A pilot assessment of its utility and safety

Cited by 2 publications

References 6 publications

Video-assisted placement of enteral feeding tubes using the Integrated Real-Time Imaging System (IRIS)-technology in critically ill patients

Video-assisted placement of enteral feeding tubes using the Integrated Real-Time Imaging System (IRIS)-technology in critically ill patients

X-ray checks of NG tube position: a case for guided tube placement

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