Pulmonary complications of feeding tubes: a new technique of insertion and monitoring malposition.

OBJECTIVE

To confirm the value of a new technique that will ensure safe introduction of feeding tubes.

DESIGN

Two case reports; an anatomical and physiologic description of deglutition; and a case study.

SETTING

A level 2 regional referral centre.

PATIENTS

Thirteen anesthetized adult patients and 7 awake subjects, comprising patients scheduled to undergo elective surgery, medical staff and health care volunteers.

INTERVENTIONS

Airway sampling for carbon dioxide with capnography in 13 anesthetized adults with the tip of the feeding tube in the pharynx, in the esophagus and in the trachea, and airway sampling for carbon dioxide from the pharynx and esophagus in 7 awake subjects during introduction of the feeding tube. Fluoroscopic monitoring of the position of the tip of the feeding tube during introduction in two patients and two volunteers.

MAIN OUTCOME MEASURES

Carbon dioxide levels at the tip of the feeding tube during introduction.

RESULTS

In all patients, with the tube either in the trachea or pharynx, a normal capnogram was displayed. When the tube was introduced into the esophagus no capnogram curve was seen, indicating the absence of carbon dioxide. With the subject lying down during introduction, the weighted tube followed the posterior pharyngeal wall to the upper esophageal sphincter.

CONCLUSION

Positioning of the patient lying down with the head flexed and capnographic measurement of carbon dioxide levels from the tip of the feeding tube during insertion is a safe, accurate and cost-effective method for the introduction of feeding tubes.