Effectiveness of an electromagnetic feeding tube placement device in detecting inadvertent respiratory placement.
BACKGROUND
Use of technology capable of electromagnetically tracking advancement of a feeding tube on a monitoring screen during insertion may enable detection of deviation of the tube from the midline as it advances through the chest, possibly indicating entry of the tube into the right or left main bronchus.


OBJECTIVE
To describe (1) published peer-reviewed studies that report on the detection of malpositioned tubes inserted by an electromagnetic tube placement device, and (2) events reported to the US Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database regarding use of such a device.


METHODS
An Ovid MEDLINE search was conducted to locate peer-reviewed studies published between 2007 and 2012 that referred to use of an electromagnetic tube placement device to detect inadvertent respiratory placements of feeding tubes. In addition, an online search of the MAUDE database was conducted for the years 2007 through 2012.


RESULTS
The Ovid MEDLINE search yielded 6 studies that referred to respiratory placements; no cases of pneumothorax were reported. The MAUDE database search yielded 21 adverse events associated with use of an electromagnetic tube placement device (including 17 cases of pneumothorax and 2 deaths). As the MAUDE database relies on voluntary reports, this number should not be construed as the incidence of malpositioned tubes during this period.


CONCLUSIONS
The ability of clinicians to place feeding tubes correctly by using an electromagnetic tube placement device varies. Thus, it is reasonable to question the wisdom of eliminating radiographic confirmation of tube position before starting feedings.
Norma A. Metheny is a professor at the Saint Louis University School of Nursing in St Louis, Missouri. Kathleen L. Meert is a critical care physician in the Department of Pediatrics at Children's Hospital of Michigan and a professor at Wayne State University in Detroit, Michigan.
Norma A
NA
Metheny
Kathleen L
KL
Meert
D057785:Catheters / Q000009:adverse effects*; D004574:Electromagnetic Fields; D004750:Enteral Nutrition / Q000295:instrumentation*; D005069:Evaluation Studies as Topic; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000295:instrumentation*; D011030:Pneumothorax / Q000209:etiology* / Q000517:prevention & control*; D011446:Prospective Studies