Successful Identification of Anatomical Markers and Placement of Feeding Tubes in Critically Ill Patients via Camera-Assisted Technology with Real-Time Video Guidance.

Published

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Wischmeyer, PE; McMoon, MM; Waldron, NH; Dye, EJ

Published Date

  • January 2019

Published In

Volume / Issue

  • 43 / 1

Start / End Page

  • 118 - 125

PubMed ID

  • 29924386

Pubmed Central ID

  • 29924386

Electronic International Standard Serial Number (EISSN)

  • 1941-2444

Digital Object Identifier (DOI)

  • 10.1002/jpen.1313

Language

  • eng

Conference Location

  • United States