Use of a pressure gauge to differentiate gastric from pulmonary placement of nasoenteral feeding tubes

Nasogastric tube insertion in anaesthetized patients: a comprehensive review

“…While fluroscopy and endoscopy have the advantage of direct visualization, they are both are costly, risky and time-consuming [42]. There are a few studies evaluating the use of manometer to aid correct NGT placement and which showed a positive pressure reading when the NGT was correctly placed in stomach [43,44]. They also showed that for confirmation of gastric placement, the auscultation technique had a sensitivity of 100% and a specificity of 79.3%.…”

“…Ultrasonography [30] Ph indicator [36,37] Stridor [47] Pulmonary aspiration [50] Sort maneuver [22,23] Airway scope [31] Electromagnetic device [38] Pneumothorax [51] Nelaton [32] Chemical assessment of aspirates (Ph, trypsin, bilirubin, CO 2 and pepsin) [39,40] Perforation of lamina cribrosa [52] Tube length End tidal CO 2 monitoring [41] Retropharyngeal abcess [47] Fluroscopy [42] Stricture formation Endoscopy [42] Aortoesophageal fistula [52] Manometer [43,44] Nasogastric tube syndrome [53,54] (TEE) probe insertion (See video at: http://atlasofscience. org/nasogastric-tube-insertion-the-simple-yet-impossible/ accessed 11 Nov 2016).…”

Capnography confirms correct feeding tube placement in intensive care unit patients

“…These include pH testing or visual inspection of tube aspirates, insufflation of air via the tube while auscultating over the epigastrium, listening for air movement at the tube's proximal end, observing for bubbling when the proximal tube end is held underwater, and utilizing pressure manometry attached to the tube. 2,6,11,12 All have proven fallible and the issue of diagnosing abnormal location too late can also occur with these techniques because they are employed after full tube placement. Further methods include utilizing fluoroscopy, endoscopy, and direct visualization of the tube passing into the esophagus.…”

“…[1][2][3][4][5][6][7][8][9][10] Unfortunately, complications may have occurred by the time a radiograph is obtained with this approach. Feeding tubes are normally passed to a depth of 50-80 cm in order to reach the desired gastric or small bowel location.…”

Oral and nasal enteral tube placement errors and complications in a pediatric intensive care unit*

“…This technique may be useful in limiting exposure to radiographs and their cost, which in the pediatric intensive care population may be especially significant, as this population is at risk for recurrent exposure to radiographs. Pressure gauges have been discussed as an efficient and reliable bedside method of differentiating gastrointestinal from respiratory tree placement (19). This study of 46 adult patients showed this method reliably detected respiratory tract placement.…”