title: Comparison of a self-inflating bulb syringe and a colorimetric CO2 indicator with capnography and radiography to detect the misdirection of naso/orogastric tubes into the airway of critically ill adult patients.
abstract: OBJECTIVE
  The objective of this study was to develop a mechanism of discovering misdirection into the airway of naso/orogastric (NG) tubes before they reach their full depth of placement in adults.
  
  
  METHODS
  A prospective, observational study was performed in humans, evaluating both the self-inflating bulb syringe (SIBS) and a colorimetric CO2 detector. A prospective convenience sample of 257 NG tube placements was studied in 199 patients in medical ICUs of a tertiary care medical center. Findings were compared to a "standard" (ie, end tidal CO2 results of a capnograph and the results of a chest radiograph performed at the completion of the tube placement).
  
  
  RESULTS
  On the first tube placement attempt in any patient, the SIBS had a sensitivity of 91.5% and a specificity of 87.0% in detecting nonesophageal placement, while the colorimetric device exhibited 99.4% sensitivity and 91.3% specificity. On subsequent insertions, the SIBS showed 95.7% sensitivity and 100% specificity, while the colorimetric device exhibited 97.8% sensitivity and 100% specificity. The colorimetric device was eight times more expensive than the SIBS.
  
  
  CONCLUSIONS
  The SIBS and the colorimetric CO2 detector are very good at detecting NG tube malpositioning into the airway, although the colorimetric device is slightly more sensitive and specific. Neither method adds substantial time or difficulty to the insertion process. The colorimetric device is substantially more expensive. The decision as to which method to use may be based on local institutional factors, such as expense.
authors: University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester, MA. Electronic address: Nicholas.Smyrnios@umassmemorial.org.
authors: Nicholas A
authors: NA
authors: Smyrnios
authors: University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester, MA.
authors: Richard
authors: R
authors: Lenard
authors: University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester, MA.
authors: Sunil
authors: S
authors: Rajan
authors: University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester, MA.
authors: Michael S
authors: MS
authors: Newman
authors: University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester, MA.
authors: Stephen P
authors: SP
authors: Baker
authors: University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester, MA.
authors: Nehal
authors: N
authors: Thakkar
authors: University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester, MA.
authors: Wahid
authors: W
authors: Wassef
authors: University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester, MA.
authors: Niraj K
authors: NK
authors: Ajmere
authors: University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester, MA.
authors: Richard S
authors: RS
authors: Irwin
mesh_terms: D000818:Animals; D019296:Capnography / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D002245:Carbon Dioxide / Q000032:analysis* / Q000378:metabolism; D003124:Colorimetry / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D003362:Cost-Benefit Analysis; D016638:Critical Illness; D045853:Exhalation / Q000502:physiology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007441:Intubation, Gastrointestinal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D023421:Models, Animal; D011446:Prospective Studies; D013902:Radiography, Thoracic / Q000191:economics / Q000379:methods*; D012137:Respiratory System / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000503:physiopathology; D012680:Sensitivity and Specificity; D013552:Swine; D013594:Syringes
chemical_list: D002245:Carbon Dioxide