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Successful Identification of Anatomical Markers and Placement of Feeding Tubes in Critically Ill Patients via Camera-Assisted Technology with Real-Time Video Guidance.
JPEN J Parenter Enteral Nutr. 2019 01; 43(1):118-125.JJ

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.

Authors+Show Affiliations

Department of Anesthesiology and Surgery, Duke University, Durham, North Carolina, USA. Duke Clinical Research Institute, Durham, North Carolina, USA.Advanced Practice and Nutrition Support Team, Duke Regional Hospital, Durham, North Carolina, USA.Department of Anesthesiology, Duke University, Durham, North Carolina, USA.Clinical Operations, Cardinal Health Patient Recovery, Mansfield, Massachusetts, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29924386

Citation

Wischmeyer, Paul E., et al. "Successful Identification of Anatomical Markers and Placement of Feeding Tubes in Critically Ill Patients Via Camera-Assisted Technology With Real-Time Video Guidance." JPEN. Journal of Parenteral and Enteral Nutrition, vol. 43, no. 1, 2019, pp. 118-125.
Wischmeyer PE, McMoon MM, Waldron NH, et al. Successful Identification of Anatomical Markers and Placement of Feeding Tubes in Critically Ill Patients via Camera-Assisted Technology with Real-Time Video Guidance. JPEN J Parenter Enteral Nutr. 2019;43(1):118-125.
Wischmeyer, P. E., McMoon, M. M., Waldron, N. H., & Dye, E. J. (2019). Successful Identification of Anatomical Markers and Placement of Feeding Tubes in Critically Ill Patients via Camera-Assisted Technology with Real-Time Video Guidance. JPEN. Journal of Parenteral and Enteral Nutrition, 43(1), 118-125. https://doi.org/10.1002/jpen.1313
Wischmeyer PE, et al. Successful Identification of Anatomical Markers and Placement of Feeding Tubes in Critically Ill Patients Via Camera-Assisted Technology With Real-Time Video Guidance. JPEN J Parenter Enteral Nutr. 2019;43(1):118-125. PubMed PMID: 29924386.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Successful Identification of Anatomical Markers and Placement of Feeding Tubes in Critically Ill Patients via Camera-Assisted Technology with Real-Time Video Guidance. AU - Wischmeyer,Paul E, AU - McMoon,Michelle M, AU - Waldron,Nathan H, AU - Dye,Elizabeth J, Y1 - 2018/06/20/ PY - 2018/03/14/received PY - 2018/04/25/revised PY - 2018/05/16/accepted PY - 2018/6/21/pubmed PY - 2020/8/18/medline PY - 2018/6/21/entrez KW - critical care KW - enteral access KW - enteral feeding KW - enteral nutrition KW - feeding tube KW - malnutrition KW - postpyloric KW - safety SP - 118 EP - 125 JF - JPEN. Journal of parenteral and enteral nutrition JO - JPEN J Parenter Enteral Nutr VL - 43 IS - 1 N2 - 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. SN - 1941-2444 UR - https://www.unboundmedicine.com/medline/citation/29924386/Successful_Identification_of_Anatomical_Markers_and_Placement_of_Feeding_Tubes_in_Critically_Ill_Patients_via_Camera_Assisted_Technology_with_Real_Time_Video_Guidance_ L2 - https://doi.org/10.1002/jpen.1313 DB - PRIME DP - Unbound Medicine ER -