Metheny Norma A, Meert Kathleen L
Norma A. Metheny is a professor of nursing and holds the Dorothy A. Votsmier Endowed Chair in Nursing at Saint Louis University School of Nursing, St Louis, Missouri. Kathleen L. Meert is a professor of medicine in the Department of Pediatrics, Wayne State University, and chief, Division of Critical Care Medicine, Children's Hospital of Michigan, Detroit, Michigan.
Am J Crit Care. 2017 Mar;26(2):157-161. doi: 10.4037/ajcc2017390.
Radiography is the accepted gold standard for testing feeding tube placement; however, an electromagnetic tube-placement device (ETPD) is sometimes used in lieu of radiography for this purpose. High success rates have been reported when the device was used by well-trained individuals. However, authors previously described 20 cases that occurred between 2007 and 2012 in which clinicians voluntarily reported inability to detect inadvertent tube insertions in the respiratory tract while using an ETPD.
To describe case reports to the US Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database between 2013 and 2015 regarding inadvertent respiratory placement of feeding tubes by operators using an ETPD.
The MAUDE database was searched for cases dated from January 1, 2013, through December 31, 2015, along with selected brand names. A total of 34 cases (25 after removal of duplicates) were located in which a feeding tube was inserted into the respiratory tract during insertions assisted by an ETPD.
Sites of the malpositioned tubes included the right lung (n = 13), left lung (n = 6), unspecified lung (n = 4), and bronchus (n = 2). A pneumothorax occurred in 17 of the 25 misplacements; feedings were administered in 6 cases.
Many case reports involved clinicians failing to recognize tube misplacements in the respiratory tract while using an ETPD. These reports provide evidence that not all clinicians can use the device effectively to detect malpositioned tubes. Thus, one must continue to question the wisdom of eliminating radiographic confirmation of tube position before starting feedings.
放射照相术是检测饲管放置位置的公认金标准；然而，有时会使用电磁饲管放置装置（ETPD）来替代放射照相术进行此项检测。据报道，训练有素的人员使用该装置时成功率较高。然而，作者此前描述了2007年至2012年间发生的20起案例，其中临床医生自愿报告称，在使用ETPD时无法检测到饲管意外插入呼吸道的情况。
描述2013年至2015年间向美国食品药品监督管理局的制造商和用户设施设备经验（MAUDE）数据库报告的关于操作人员使用ETPD时饲管意外进入呼吸道的案例。
在MAUDE数据库中搜索2013年1月1日至2015年12月31日期间的案例以及选定的品牌名称。共找到34例案例（去除重复案例后为25例），其中在ETPD辅助插入过程中饲管插入了呼吸道。
位置不当的饲管所在部位包括右肺（n = 13）、左肺（n = 6）、未指明的肺（n = 4）和支气管（n = 2）。25例误置中有17例发生了气胸；6例进行了喂食。
许多案例报告涉及临床医生在使用ETPD时未能识别饲管在呼吸道中的误置情况。这些报告提供了证据，表明并非所有临床医生都能有效地使用该装置检测到位置不当的饲管。因此，在开始喂食前，必须继续质疑取消饲管位置放射学确认的合理性。
