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Capnography confirms correct feeding tube placement in intensive care unit patients

[La capnographie permet de confirmer la position appropriée de la sonde d'alimentation chez les patients de l'unité des soins intensifs]

A. Shawn Kindopp, MD^*, John W. Drover , MD FRCS(c) and Daren K. Heyland , MD FRCP(c)

^* From the Departments of Anesthesiology,
Surgery, and
Medicine, Queen's University, Kingston, Ontario, Canada.

Address correspondence to: Dr. A. Shawn Kindopp, Department of Anesthesia, Royal University Hospital, University of Saskatchewan, 103 Hospital Drive, Saskatoon, Saskatchewan S7N 0W8, Canada. Phone: 306-655-1183; Fax: 306-655-1279; E-mail: shawnkindopp{at}hotmail.com

Purpose: To test the accuracy and potential time savings of capnography as compared with a two-step radiographic method in placing feeding tubes in critically ill patients.

Methods: One hundred feeding tube placements were studied in our tertiary care intensive care unit. All placements utilized a two-step radiographic method, but capnography was added to the procedure. The procedure was then completed or abandoned depending on radiographic interpretation.

Results: Radiography showed 11 feeding tubes projecting within the tracheobronchial tree. In all 11 of these placements, the capnography unit displayed a normal capnogram. Radiography revealed 86 tube placements in the midesophageal region. In all 86 of these placements, capnography displayed a "purging warning". In three placements, radiography indicated that the tube was coiled in the oropharynx. In these cases, the capnograph displayed one "no purging/no capnogram" result, and two "purging" warnings. If using capnography alone, an average of 72.5 min would be required to complete a feeding tube placement (which includes time for requisite "pre-feed radiograph"). The two-step radiological approach took an average of 169.4 min, a difference of 96.9 min (P <0.0001) between the two methods.

Conclusions: Capnography accurately identified all intratracheal feeding tube placements in this study. This study also shows that the use of capnography would significantly shorten the time needed for tube placement compared with a two-step radiologic method. Capnography should be considered for routine use when placing feeding tubes since it adds little time to the procedure and may improve patient safety.

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