The use of carbon dioxide monitoring to determine orogastric tube placement in premature infants: a pilot study.

Enteral nutrition, frequently given through gastric tubes inserted through the nose or mouth, is an important part of supportive care for children unable to maintain adequate nutrition orally. To provide safe enteral nutrition, however, correct tube position must be achieved. Capnography, a noninvasive monitoring technique designed to measure expired carbon dioxide (CO2) levels, has been used previously to identify respiratory placement of nasogastric tubes in adults; however, its use in children is understudied. The purpose of this pilot study was to determine the potential of CO2 monitoring to differentiate respiratory from gastric placement of nasogastric/orogastric (NG/OG) tubes in the youngest, most fragile children-premature infants. Immediately prior to chest radiograph, CO2 levels in 7 premature infants were measured at the open ends of both the endotracheal and NG/OG tubes by using a bedside capnography monitor. The 14 CO2 readings from the correctly placed endotracheal tubes ranged from 32 to 61 mmHg (M = 47.6 mmHg, SD = 10.0). CO2 readings were zero in all 14 correctly placed NG/OG tubes. The results of this pilot study provide evidence that capnography may be useful in differentiating respiratory from gastrointestinal tube placement in premature infants.