title: Use of an Electromagnetic Device Compared With Chest X-ray to Confirm Nasogastric Feeding Tube Position in Critical Care.
abstract: Insertion of nasogastric feeding tubes (NGTs) is common in critical care. However, misplacement is frequent and can carry a significant morbidity. Current methods to confirm position of NGTs are not reliable in this setting. We retrospectively compared the position of NGTs using an electromagnetically guided nasogastric tube (e-NGT) with that demonstrated by chest x-ray (CXR), the proportion of lung placements avoided, and the time taken to establish enteral feeding.
  
  
  
  This was a retrospective, observational study undertaken in a tertiary referral, adult intensive care unit between February 2006 and November 2013. Patients were included if they had a radiologically confirmed NGT. All CXRs were independently reviewed by an intensivist to determine position, and a subset of patients had their e-NGT image independently reviewed for quality control. Statistical analysis was in the form of sensitivity and specificity and descriptive where indicated.
  
  
  
  In total, 121 NGT placements in 113 patients were analyzed. We found a sensitivity of 98% (95% confidence interval [CI], 93.9%-99.7%) and a specificity of 100% (95% CI, 48.0%-100.0%) when using the e-NGT compared with CXR. In the subset of 51 independently reviewed e-NGT images, 9 lung placements were avoided. The mean (SD) time from e-NGT placement to CXR was 185 (264.4) minutes and to feeding was 404 (77.8) minutes.
  
  
  
  When placed by a dedicated team, e-NGT allowed immediate detection of tube misplacement. As such, if used as the sole method for determining NGT position, e-NGTs minimize feeding delay and the need for multiple CXRs with subsequent cost savings.
authors.affiliation: Department of Critical Care Department of Nutrition and Dietetics, Guy's and St Thomas's NHS Foundation Trust, London, UK danielle.Bear@gstt.nhs.uk.
authors.forename: Danielle E
authors.initials: DE
authors.lastname: Bear
authors.affiliation: Department of Nutrition and Dietetics, Guy's and St Thomas's NHS Foundation Trust, London, UK.
authors.forename: Alice
authors.initials: A
authors.lastname: Champion
authors.affiliation: Department of Critical Care.
authors.forename: Katie
authors.initials: K
authors.lastname: Lei
authors.affiliation: Department of Critical Care.
authors.forename: John
authors.initials: J
authors.lastname: Smith
authors.affiliation: Department of Nutrition and Dietetics, Guy's and St Thomas's NHS Foundation Trust, London, UK Division of Asthma, Allergy and Lung Biology, King's College London, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Beale
authors.affiliation: Department of Critical Care.
authors.forename: Luigi
authors.initials: L
authors.lastname: Camporota
authors.affiliation: Department of Critical Care.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Barrett
mesh_terms: D000328:Adult; D003422:Critical Care / Q000379:methods*; D055590:Electromagnetic Phenomena; D004750:Enteral Nutrition / Q000379:methods; D006801:Humans; D007362:Intensive Care Units; D007441:Intubation, Gastrointestinal / Q000295:instrumentation / Q000379:methods*; D008168:Lung; D011859:Radiography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013909:Thorax / Q000000981:diagnostic imaging; D016896:Treatment Outcome
keywords: GI access; critical care; enteral access; enteral nutrition; nutrition support practice