title: Real-time image-guided nasogastric feeding tube placement: A case series using Kangaroo with IRIS Technology in an ICU.
abstract: OBJECTIVE
  Pulmonary misplacement during the blind insertion of enteral feeding tubes is frequent, particularly in ventilated and neurologically impaired patients. This is probably the first clinical study using the Kangaroo Feeding Tube with IRIS technology (IRIS) which incorporates a camera designed to provide anatomic landmark visualization during insertion. The study aim was to evaluate IRIS performance during bedside gastric placement.
  
  
  METHODS
  This is the first prospective study to collect data on the use of IRIS. Twenty consecutive unconscious patients requiring enteral nutrition were recruited at a single center. IRIS placement was considered complete when a clear image of the gastric mucosa appeared. Correct placement was confirmed using a contrast-enhanced abdominal X-ray. To evaluate the device performance over time, the camera was activated every other day up to 17 d postplacement.
  
  
  RESULTS
  In 7 (35%) patients, the trachea was initially visualized, requiring a second placement attempt with the same tube. The IRIS camera allowed recognition of the gastric mucosa in 18 (90%) patients. The esophagogastric junction was identified in one patient, while in a second patient the quality of visualization was poor. Contrast-enhanced X-ray confirmed the gastric placement of IRIS in all patients. IRIS allowed identification of gastric mucosa in 14 (70%) patients 3 d after placement. Performance progressively declined with time (P = 0.006, chi-square for trend).
  
  
  CONCLUSIONS
  IRIS placement could have spared X-ray confirmation in almost all patients and prevented misplacement into the airway in about one third. Visualization quality needs to be improved, particularly after the first week.
authors.affiliation: Department of Anesthesiology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Mizzi
authors.affiliation: Department of Anesthesiology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Silvano
authors.initials: S
authors.lastname: Cozzi
authors.affiliation: Department of Anesthesiology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Beretta
authors.affiliation: Department of Anesthesiology, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Greco
authors.affiliation: Department of Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy. Electronic address: Braga.marco@hsr.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Braga
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007441:Intubation, Gastrointestinal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014965:X-Rays; D055815:Young Adult
keywords: Complications; Critically ill patients; Enteral feeding; Feeding tube; Pulmonary misplacement