Use of an Electromagnetic Device Compared with Chest X-ray to Confirm Nasogastric Feeding Tube Position in Critical Care

Danielle E. Bear; Alice Champion; Katie Lei; John Smith; Richard Beale; Luigi Camporota; Nicholas A. Barrett

doi:10.1177/0148607115575034

Use of an Electromagnetic Device Compared with Chest X-ray to Confirm Nasogastric Feeding Tube Position in Critical Care

Danielle E. Bear^*, Alice Champion, Katie Lei, John Smith, Richard Beale, Luigi Camporota, Nicholas A. Barrett

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

21 Citations (Scopus)

Abstract

Background: Insertion of nasogastric feeding tubes (NGTs) is common in critical care. However, misplacement is frequent and can carry a significant morbidity. Current methods to confirm position of NGTs are not reliable in this setting. We retrospectively compared the position of NGTs using an electromagnetically guided nasogastric tube (e-NGT) with that demonstrated by chest x-ray (CXR), the proportion of lung placements avoided, and the time taken to establish enteral feeding. Methods: This was a retrospective, observational study undertaken in a tertiary referral, adult intensive care unit between February 2006 and November 2013. Patients were included if they had a radiologically confirmed NGT. All CXRs were independently reviewed by an intensivist to determine position, and a subset of patients had their e-NGT image independently reviewed for quality control. Statistical analysis was in the form of sensitivity and specificity and descriptive where indicated. Results: In total, 121 NGT placements in 113 patients were analyzed. We found a sensitivity of 98% (95% confidence interval [CI], 93.9%-99.7%) and a specificity of 100% (95% CI, 48.0%-100.0%) when using the e-NGT compared with CXR. In the subset of 51 independently reviewed e-NGT images, 9 lung placements were avoided. The mean (SD) time from e-NGT placement to CXR was 185 (264.4) minutes and to feeding was 404 (77.8) minutes. Conclusion: When placed by a dedicated team, e-NGT allowed immediate detection of tube misplacement. As such, if used as the sole method for determining NGT position, e-NGTs minimize feeding delay and the need for multiple CXRs with subsequent cost savings.

Original language	English
Pages (from-to)	581-586
Number of pages	6
Journal	Journal of Parenteral and Enteral Nutrition
Volume	40
Issue number	4
DOIs	https://doi.org/10.1177/0148607115575034
Publication status	Published - 1 Jan 2014

Keywords

critical care
enteral access
enteral nutrition
GI access
nutrition support practice

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10.1177/0148607115575034

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title = "Use of an Electromagnetic Device Compared with Chest X-ray to Confirm Nasogastric Feeding Tube Position in Critical Care",

abstract = "Background: Insertion of nasogastric feeding tubes (NGTs) is common in critical care. However, misplacement is frequent and can carry a significant morbidity. Current methods to confirm position of NGTs are not reliable in this setting. We retrospectively compared the position of NGTs using an electromagnetically guided nasogastric tube (e-NGT) with that demonstrated by chest x-ray (CXR), the proportion of lung placements avoided, and the time taken to establish enteral feeding. Methods: This was a retrospective, observational study undertaken in a tertiary referral, adult intensive care unit between February 2006 and November 2013. Patients were included if they had a radiologically confirmed NGT. All CXRs were independently reviewed by an intensivist to determine position, and a subset of patients had their e-NGT image independently reviewed for quality control. Statistical analysis was in the form of sensitivity and specificity and descriptive where indicated. Results: In total, 121 NGT placements in 113 patients were analyzed. We found a sensitivity of 98% (95% confidence interval [CI], 93.9%-99.7%) and a specificity of 100% (95% CI, 48.0%-100.0%) when using the e-NGT compared with CXR. In the subset of 51 independently reviewed e-NGT images, 9 lung placements were avoided. The mean (SD) time from e-NGT placement to CXR was 185 (264.4) minutes and to feeding was 404 (77.8) minutes. Conclusion: When placed by a dedicated team, e-NGT allowed immediate detection of tube misplacement. As such, if used as the sole method for determining NGT position, e-NGTs minimize feeding delay and the need for multiple CXRs with subsequent cost savings.",

keywords = "critical care, enteral access, enteral nutrition, GI access, nutrition support practice",

author = "Bear, {Danielle E.} and Alice Champion and Katie Lei and John Smith and Richard Beale and Luigi Camporota and Barrett, {Nicholas A.}",

year = "2014",

month = jan,

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doi = "10.1177/0148607115575034",

language = "English",

volume = "40",

pages = "581--586",

journal = "Journal of Parenteral and Enteral Nutrition",

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T1 - Use of an Electromagnetic Device Compared with Chest X-ray to Confirm Nasogastric Feeding Tube Position in Critical Care

AU - Bear, Danielle E.

AU - Champion, Alice

AU - Lei, Katie

AU - Smith, John

AU - Beale, Richard

AU - Camporota, Luigi

AU - Barrett, Nicholas A.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Background: Insertion of nasogastric feeding tubes (NGTs) is common in critical care. However, misplacement is frequent and can carry a significant morbidity. Current methods to confirm position of NGTs are not reliable in this setting. We retrospectively compared the position of NGTs using an electromagnetically guided nasogastric tube (e-NGT) with that demonstrated by chest x-ray (CXR), the proportion of lung placements avoided, and the time taken to establish enteral feeding. Methods: This was a retrospective, observational study undertaken in a tertiary referral, adult intensive care unit between February 2006 and November 2013. Patients were included if they had a radiologically confirmed NGT. All CXRs were independently reviewed by an intensivist to determine position, and a subset of patients had their e-NGT image independently reviewed for quality control. Statistical analysis was in the form of sensitivity and specificity and descriptive where indicated. Results: In total, 121 NGT placements in 113 patients were analyzed. We found a sensitivity of 98% (95% confidence interval [CI], 93.9%-99.7%) and a specificity of 100% (95% CI, 48.0%-100.0%) when using the e-NGT compared with CXR. In the subset of 51 independently reviewed e-NGT images, 9 lung placements were avoided. The mean (SD) time from e-NGT placement to CXR was 185 (264.4) minutes and to feeding was 404 (77.8) minutes. Conclusion: When placed by a dedicated team, e-NGT allowed immediate detection of tube misplacement. As such, if used as the sole method for determining NGT position, e-NGTs minimize feeding delay and the need for multiple CXRs with subsequent cost savings.

AB - Background: Insertion of nasogastric feeding tubes (NGTs) is common in critical care. However, misplacement is frequent and can carry a significant morbidity. Current methods to confirm position of NGTs are not reliable in this setting. We retrospectively compared the position of NGTs using an electromagnetically guided nasogastric tube (e-NGT) with that demonstrated by chest x-ray (CXR), the proportion of lung placements avoided, and the time taken to establish enteral feeding. Methods: This was a retrospective, observational study undertaken in a tertiary referral, adult intensive care unit between February 2006 and November 2013. Patients were included if they had a radiologically confirmed NGT. All CXRs were independently reviewed by an intensivist to determine position, and a subset of patients had their e-NGT image independently reviewed for quality control. Statistical analysis was in the form of sensitivity and specificity and descriptive where indicated. Results: In total, 121 NGT placements in 113 patients were analyzed. We found a sensitivity of 98% (95% confidence interval [CI], 93.9%-99.7%) and a specificity of 100% (95% CI, 48.0%-100.0%) when using the e-NGT compared with CXR. In the subset of 51 independently reviewed e-NGT images, 9 lung placements were avoided. The mean (SD) time from e-NGT placement to CXR was 185 (264.4) minutes and to feeding was 404 (77.8) minutes. Conclusion: When placed by a dedicated team, e-NGT allowed immediate detection of tube misplacement. As such, if used as the sole method for determining NGT position, e-NGTs minimize feeding delay and the need for multiple CXRs with subsequent cost savings.

KW - critical care

KW - enteral access

KW - enteral nutrition

KW - GI access

KW - nutrition support practice

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DO - 10.1177/0148607115575034

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C2 - 25758256

AN - SCOPUS:84966714060

SN - 0148-6071

VL - 40

SP - 581

EP - 586

JO - Journal of Parenteral and Enteral Nutrition

JF - Journal of Parenteral and Enteral Nutrition

IS - 4

ER -

Use of an Electromagnetic Device Compared with Chest X-ray to Confirm Nasogastric Feeding Tube Position in Critical Care

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