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Original Research: Critical Care |

Comparison of a Self-Inflating Bulb Syringe and a Colorimetric CO2 Indicator With Capnography and Radiography to Detect the Misdirection of Naso/Orogastric Tubes Into the Airway of Critically Ill Adult PatientsVerifying Naso/Orogastric Tube Placement

Nicholas A. Smyrnios, MD, FCCP; Richard Lenard, RRT-NPS, RPFT; Sunil Rajan, MD, FCCP; Michael S. Newman, DO; Stephen P. Baker, MScPH; Nehal Thakkar, MD, FCCP; Wahid Wassef, MD; Niraj K. Ajmere, MD; Richard S. Irwin, MD, Master FCCP
Author and Funding Information

From the University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester, MA.

CORRESPONDENCE TO: Nicholas A. Smyrnios, MD, FCCP, University of Massachusetts Medical School, Division of Pulmonary, Allergy, and Critical Care Medicine, 55 N Lake Ave, Worcester, MA 01655; e-mail: Nicholas.Smyrnios@umassmemorial.org


FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(6):1523-1529. doi:10.1378/chest.14-0663
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OBJECTIVE:  The objective of this study was to develop a mechanism of discovering misdirection into the airway of naso/orogastric (NG) tubes before they reach their full depth of placement in adults.

METHODS:  A prospective, observational study was performed in humans, evaluating both the self-inflating bulb syringe (SIBS) and a colorimetric CO2 detector. A prospective convenience sample of 257 NG tube placements was studied in 199 patients in medical ICUs of a tertiary care medical center. Findings were compared to a “standard” (ie, end tidal CO2 results of a capnograph and the results of a chest radiograph performed at the completion of the tube placement).

RESULTS:  On the first tube placement attempt in any patient, the SIBS had a sensitivity of 91.5% and a specificity of 87.0% in detecting nonesophageal placement, while the colorimetric device exhibited 99.4% sensitivity and 91.3% specificity. On subsequent insertions, the SIBS showed 95.7% sensitivity and 100% specificity, while the colorimetric device exhibited 97.8% sensitivity and 100% specificity. The colorimetric device was eight times more expensive than the SIBS.

CONCLUSIONS:  The SIBS and the colorimetric CO2 detector are very good at detecting NG tube malpositioning into the airway, although the colorimetric device is slightly more sensitive and specific. Neither method adds substantial time or difficulty to the insertion process. The colorimetric device is substantially more expensive. The decision as to which method to use may be based on local institutional factors, such as expense.

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