Detection of inadvertent airway intubation during gastric tube insertion: Capnography versus a colorimetric carbon dioxide detector.
BACKGROUND
In the medical intensive care unit at the University of Virginia Health System, capnography is used to detect end-tidal carbon dioxide to protect patients from inadvertent airway cannulation during placement of gastric tubes.


OBJECTIVE
To compare the method in which capnography is used with a method in which a colorimetric carbon dioxide detector is used and to determine what variables affect accurate placement of gastric tubes.


METHODS
A prospective convenience sample of 195 gastric tube insertions was studied in 130 adult patients in a medical intensive care unit. Standard insertions of gastric tubes (done with capnography) were simultaneously monitored by using a disposable colorimetric device, with a color change indicating the presence of carbon dioxide.


RESULTS
Insertion variables included tube type (60% Salem sump tubes, 40% soft-bore feeding tubes), route of insertion (71% oral, 29% nasal), mechanical ventilation (81%), and decreased mental status (72%). Carbon dioxide was successfully detected with the colorimetric indicator (within seconds) in all insertions in which carbon dioxide was detected by capnography. When carbon dioxide was detected (27% of insertions), the tubes were withdrawn and reinserted. Carbon dioxide detection during tube placement was significantly associated with nasal insertions (P = .03) and spontaneously breathing/nonintubated status (P = .01) but not with mental status or tube type.


CONCLUSIONS
A colorimetric device is as accurate as capnography for detecting carbon dioxide during placement of gastric tubes.
Burns
Suzanne M
SM
School of Nursing, University of Virginia Health System, Charlottesville, VA, USA.
Carpenter
Richard
R
Blevins
Cheri
C
Bragg
Sharon
S
Marshall
Mary
M
Browne
Liz
L
Perkins
Martha
M
Bagby
Rebecca
R
Blackstone
Kris
K
Truwit
Jonathon D
JD
D000328:Adult; D002151:Calorimetry / Q000295:instrumentation / Q000379:methods*; D019296:Capnography / Q000295:instrumentation; D002245:Carbon Dioxide / Q000032:analysis*; D003422:Critical Care; D004868:Equipment Failure; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D007442:Intubation, Intratracheal
D002245:Carbon Dioxide