Paul E Wischmeyer1,2, Michelle M McMoon3, Nathan H Waldron4, Elizabeth J Dye5. 1. Department of Anesthesiology and Surgery, Duke University, Durham, North Carolina, USA. 2. Duke Clinical Research Institute, Durham, North Carolina, USA. 3. Advanced Practice and Nutrition Support Team, Duke Regional Hospital, Durham, North Carolina, USA. 4. Department of Anesthesiology, Duke University, Durham, North Carolina, USA. 5. Clinical Operations, Cardinal Health Patient Recovery, Mansfield, Massachusetts, USA.
Abstract
BACKGROUND: Enteral feeding via feeding tube (FT) provides essential nutrition support to critically ill patients or those who cannot intake adequate nutrition via the oral route. Unfortunately, 1%-2% of FTs placed blindly at bedside enter the airway undetected (as confirmed by x-ray), where they could result in adverse events. Misplaced FTs can cause complications including pneumothorax, vocal cord injury, bronchopleural fistula, pneumonia, and death. X-ray is typically performed to confirm FT placement before feeding, but may delay nutrition intake, may not universally identify misplacement, and adds cost and radiation exposure. METHODS: A prospective case series was conducted to evaluate a novel FT with a camera to provide real-time visualization, guiding placement. The primary end point was the clinician's ability to identify anatomical markers in the gastrointestinal tract and/or airway using the camera. RESULTS: The Kangaroo Feeding Tube with IRIS Technology tube was placed in 45 subjects with 1 misplaced tube; 3 placements were postpyloric, with the remainder gastric. Clinicians correctly identified the stomach in 44 of 45 placements at a median depth of 60.0 cm (range 45.0-85.0 cm). A stomach image was obtained in 42 subjects (93.3%). Agreement between camera image and radiographic confirmation of placement was 93% (P = .014) with small deviations in recognizing stomach vs small bowel. No device-related adverse events occurred. CONCLUSIONS: Direct visualization of the stomach using a camera-equipped FT can assist with FT placement, help avoid misplacements, and with further studies to evaluate the safety of eliminating confirmatory x-ray before feeding, could potentially preclude the need for radiographic confirmation.
BACKGROUND: Enteral feeding via feeding tube (FT) provides essential nutrition support to critically illpatients or those who cannot intake adequate nutrition via the oral route. Unfortunately, 1%-2% of FTs placed blindly at bedside enter the airway undetected (as confirmed by x-ray), where they could result in adverse events. Misplaced FTs can cause complications including pneumothorax, vocal cord injury, bronchopleural fistula, pneumonia, and death. X-ray is typically performed to confirm FT placement before feeding, but may delay nutrition intake, may not universally identify misplacement, and adds cost and radiation exposure. METHODS: A prospective case series was conducted to evaluate a novel FT with a camera to provide real-time visualization, guiding placement. The primary end point was the clinician's ability to identify anatomical markers in the gastrointestinal tract and/or airway using the camera. RESULTS: The Kangaroo Feeding Tube with IRIS Technology tube was placed in 45 subjects with 1 misplaced tube; 3 placements were postpyloric, with the remainder gastric. Clinicians correctly identified the stomach in 44 of 45 placements at a median depth of 60.0 cm (range 45.0-85.0 cm). A stomach image was obtained in 42 subjects (93.3%). Agreement between camera image and radiographic confirmation of placement was 93% (P = .014) with small deviations in recognizing stomach vs small bowel. No device-related adverse events occurred. CONCLUSIONS: Direct visualization of the stomach using a camera-equipped FT can assist with FT placement, help avoid misplacements, and with further studies to evaluate the safety of eliminating confirmatory x-ray before feeding, could potentially preclude the need for radiographic confirmation.