title: Naso-enteric Tube Placement: A Review of Methods to Confirm Tip Location, Global Applicability and Requirements.
abstract: BACKGROUND
  The insertion of a tube through the nose and into the stomach or beyond is a common clinical procedure for feeding and decompression. The safety, accuracy and reliability of tube insertion and methods used to confirm the location of the naso-enteric tube (NET) tip have not been systematically reviewed. The aim of this study is to review and compare these methods and determine their global applicability by end-user engagement.
  
  
  METHODS
  A systematic literature review of four major databases was performed to identify all relevant studies. The methods for NET tip localization were then compared for their accuracy with reference to a gold standard method (radiography or endoscopy). The global applicability of the different methods was analysed using a house of quality matrix.
  
  
  RESULTS
  After applying the inclusion and exclusion criteria, 76 articles were selected. Limitations were found to be associated with the 20 different methods described for NET tip localization. The method with the best combined sensitivity and specificity (where n > 1) was ultrasound/sonography, followed by external magnetic guidance, electromagnetic methods and then capnography/capnometry. The top three performance criteria that were considered most important for global applicability were cost per tube/disposable, success rate and cost for non-disposable components.
  
  
  CONCLUSIONS
  There is no ideal method for confirming NET tip localisation. While radiography (the gold standard used for comparison) and ultrasound were the most accurate methods, they are costly and not universally available. There remains the need to develop a low-cost, easy-use, accurate and reliable method for NET tip localization.
authors.affiliation: Department of Biomedical Engineering, University of Auckland, Auckland, New Zealand.
authors.forename: S A
authors.initials: SA
authors.lastname: Milsom
authors.forename: J A
authors.initials: JA
authors.lastname: Sweeting
authors.forename: H
authors.initials: H
authors.lastname: Sheahan
authors.forename: E
authors.initials: E
authors.lastname: Haemmerle
authors.forename: J A
authors.initials: JA
authors.lastname: Windsor
mesh_terms: D001785:Blood Gas Monitoring, Transcutaneous; D019296:Capnography; D006801:Humans; D007421:Intestine, Small / Q000000981:diagnostic imaging*; D007441:Intubation, Gastrointestinal / Q000009:adverse effects* / Q000191:economics / Q000295:instrumentation; D060306:Magnetometry; D015203:Reproducibility of Results; D012449:Safety; D012680:Sensitivity and Specificity; D013270:Stomach / Q000000981:diagnostic imaging*; D014463:Ultrasonography