Colorimetric capnography to ensure correct nasogastric tube position

Abstract Purpose We evaluate a procedure, combining colorimetric capnography with epigastric auscultation, to ensure nasogastric (NG) feeding tube correct position without any radiograph. Methods We first evaluated the accuracy of colorimetric capnography in detecting tracheal positioning in a contr...

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Bibliographic Details
Published in:Journal of critical care 2009-06, Vol.24 (2), p.231-235
Main Authors: Meyer, Pascal, MD, Henry, Matthieu, MD, Maury, Eric, MD, PhD, Baudel, Jean-Luc, MD, Guidet, Bertrand, MD, Offenstadt, Georges, MD
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Auscultation
Calorimetry, Indirect
Capnography
Capnography - methods
Critical Care
Epigastric auscultation
Female
Humans
Intensive care
Intubation
Intubation, Gastrointestinal - methods
Life support systems
Male
Middle Aged
Nasogastric feeding tube
Nutrition
Ostomy
Parenteral nutrition
Patients
Permeability
Prospective Studies
Radiography
Teaching hospitals
Trachea
Ventilation
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Summary:Abstract Purpose We evaluate a procedure, combining colorimetric capnography with epigastric auscultation, to ensure nasogastric (NG) feeding tube correct position without any radiograph. Methods We first evaluated the accuracy of colorimetric capnography in detecting tracheal positioning in a control group of 100 mechanically ventilated patients. The procedure was thereafter evaluated in a study group including patients requiring an NG tube. The NG tube was first inserted 30 cm and connected to a colorimetric capnograph (first step). If the capnograph did not detect carbon dioxide, insertion was completed to a total distance of 50 cm. An epigastric auscultation after air insufflation and a second capnography (second step) were performed. A radiograph evaluated correct tube position. Results In the control group, colorimetric capnograph sensitivity to detect tracheal placement was 100%. In the study group, negative predictive value of first-step capnography to rule out tracheobronchial insertion was 100%. The association of a first-step negative capnography with a positive epigastric auscultation correctly identified all but one gastric insertions, yielding a sensitivity of 98.5% (95% confidence interval, 95.7-100). The positive predictive value of this association to detect gastric placement was 100%. Conclusion Colorimetric capnography combined with epigastric auscultation is safe and accurate in ensuring correct gastric tube insertion.
ISSN:0883-9441
1557-8615
DOI:10.1016/j.jcrc.2008.06.003