Colorimetric capnography, a new procedure to ensure correct feeding tube placement in the intensive care unit: An evaluation of a local protocol

Service de Réanimation Médicale, Hôpital Saint-Antoine (AP-HP), 184 rue du faubourg Saint-Antoine, 75571, Paris Cedex 12, France.
Journal of critical care (Impact Factor: 2). 08/2011; 26(4):411-4. DOI: 10.1016/j.jcrc.2010.08.007
Source: PubMed


Radiography is the criterion standard method to ensure correct placement of a feeding tube. Recently, excellent results were reported using a combination of colorimetric capnography and epigastric auscultation, but the impact of this technique has not been studied to date. Objectives were to assess whether our local procedure, using colorimetric capnography to ensure proper feeding tube placement, improves the patient's care, satisfies nurses, and decreases costs compared with the standard procedure requiring systematic radiography.
We performed a monocentric prospective observational study in a medical intensive care unit over a 4-month period. Feeding tube placement was assessed by colorimetric capnography and epigastric auscultation. Radiography was performed when epigastric auscultation was inconclusive.
A total of 69 feeding tubes were placed in 44 patients. Radiography was required in 10.1% of the cases. The new procedure decreased costs ($33.37 ± 13.96 vs $45.92, P < .0001) and was less time consuming (11.6 ± 20.5 minutes vs 87.3 ± 45.2 minutes, P < .0001) than using systematic radiography. All nurses reported confidence in the procedure, which improved the organization of their care.
The use of colorimetric capnography and epigastric auscultation to confirm feeding tube placement improves nurse's organization of care, saves time, and decreases costs.

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    • "Several methods have been suggested for verifying the placement of a NGT, including auscultation, measuring the pH of aspirates from the tube, and chest x-rays. In addition, the use of colorimetric capnography has been demonstrated recently [5,6]. Auscultation with a stethoscope confirms gurgling sounds in the epigastrium when air is injected after NGT insertion. "
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    ABSTRACT: This study was designed to compare the effectiveness of using auscultation, pH measurements of gastric aspirates, and ultrasonography as physical examination methods to verify nasogastric tube(NGT) placement in emergency room patients with low consciousness who require NGT insertion. The study included 47 patients who were all over 18 years of age. In all patients, tube placement was verified by chest X-rays. Auscultation, pH analysis of gastric aspirates, and ultrasonography were conducted on each patient in random order. The mean patient age was 57.62 ± 17.24 years, and 28 males (59.6%) and 19 females (40.4%) were included. The NGT was inserted by an emergency room resident. For pH testing, gastric aspirates were dropped onto litmus paper, and the resulting color of the paper was compared with a reference table. Ultrasonography was performed by an emergency medicine specialist, and the chest X-ray examination was interpreted by a different emergency medicine specialist who did not conduct the ultrasonography test. The results of the auscultation, gastric aspirate pH, and ultrasonography examinations were compared with the results of the chest x-ray examination. The sensitivity and specificity were 100% and 33.3%, respectively, for auscultation and 86.4% and 66.7%, respectively, for ultrasonography. Kappa values were the highest for auscultation at 0.484 compared to chest x-rays, followed by 0.299 for ultrasonography and 0.444 for pH analysis of the gastric aspirate. The ultrasonography has a positive predictive value of 97.4% and a negative predictive value of 25%. Ultrasonography is useful for confirming the results of auscultation after NGT insertion among patients with low consciousness at an emergency center. When ultrasound findings suggest that the NGT placement is not gastric, additional chest X-ray should be performed.
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    • "Radiography is required only when epigastric auscultation is inconclusive (10.1% of cases). This local protocol combining colorimetric capnography and epigastric auscultation had a perfect specificity to confirm correct EFT placement, improves nurse's organization of care, saves time, and decreases costs [34,35]. Another advantage of this procedure is that the accidental tracheobronchial insertion is detected after 30-cm insertion. "
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    ABSTRACT: Chest x-rays (CXRs) are the main imaging tool in intensive care units (ICUs). CXRs also are associated with concerns inherent to their use, considering both healthcare organization and patient perspectives. In recent years, several studies have focussed on the feasibility of lowering the number of bedside CXRs performed in the ICU. Such a decrease may result from two independent and complementary processes: a raw reduction of CXRs due to the elimination of unnecessary investigations, and replacement of the CXR by an alternative technique. The goal of this review is to outline emblematic examples corresponding to these two processes. The first part of the review concerns the accumulation of evidence-based data for abandoning daily routine CXRs in mechanically ventilated patients and adopting an on-demand prescription strategy. The second part of the review addresses the use of alternative techniques to CXRs. This part begins with the presentation of ultrasonography or capnography combined with epigastric auscultation for ensuring the correct position of enteral feeding tubes. Ultrasonography is then also presented as an alternative to CXR for diagnosing and monitoring pneumothoraces, as well as a valuable post-procedural technique after central venous catheter insertion. The combination of the emblematic examples presented in this review supports an integrated global approach for decreasing the number of CXRs ordered in the ICU.
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