scholarly journals The complications associated with feeding tube insertion: is X-ray a gold standard for confirmation of feeding tube position?

2015 ◽  
Vol 22 (3) ◽  
pp. 179-180
Author(s):  
Masayuki Kamochi ◽  
Keiji Aibara
Keyword(s):  
Gold Standard ◽  
Feeding Tube ◽  
Tube Insertion ◽  
X Ray ◽  
Tube Position

Use of an Electromagnetic Device Compared With Chest X-ray to Confirm Nasogastric Feeding Tube Position in Critical Care

2015 ◽  
Vol 40 (4) ◽  
pp. 581-586 ◽  
Author(s):  
Danielle E. Bear ◽  
Alice Champion ◽  
Katie Lei ◽  
John Smith ◽  
Richard Beale ◽  
...  
Keyword(s):  
Critical Care ◽  
Feeding Tube ◽  
Nasogastric Feeding ◽  
X Ray ◽  
Electromagnetic Device ◽  
Nasogastric Feeding Tube ◽  
Tube Position ◽  
Chest X Ray

Endoscopic Insertion of Nasojejunal Feeding Tube at Bedside for Critically Ill Patients: Relationship between Tube Position and Intragastric Countercurrent of Contrast Medium

2019 ◽  
Vol 75 (3) ◽  
pp. 163-167
Author(s):  
Hiroomi Tatsumi ◽  
Masayuki Akatsuka ◽  
Satoshi Kazuma ◽  
Yoichi Katayama ◽  
Yuya Goto ◽  
...  
Keyword(s):  
Contrast Medium ◽  
Feeding Tube ◽  
Tube Insertion ◽  
Abdominal Radiography ◽  
Feeding Tubes ◽  
Tube Position ◽  
Endoscopic Insertion ◽  
Endoscopic Placement ◽  
Nasojejunal Feeding ◽  
Enteral Nutrients

Background and Oblectives: We evaluated the success rate of endoscopically positioned nasojejunal feeding tubes and the intragastric countercurrent of contrast medium thereafter. Method: This retrospective observational study investigated patients who were admitted to a single intensive care unit and required endoscopic placement of a post-pyloric feeding tube between January 2010 and June 2016. The feeding tube was grasped with forceps via a transoral endoscope and inserted into the duodenum or jejunum. Thereafter, we assessed the position of the tube and the intragastric countercurrent using abdominal radiography with contrast medium. Results: The tube tip was inserted at the jejunum and the duodenal fourth portion in 55.8 and 33.6% of patients, respectively. The tip of the inserted tube had moved into the jejunum of 71.7% of patients by the following day. The countercurrent rate was significantly lower among patients with a tube inserted into the duodenal fourth portion or more distal than among those with tubes inserted more proximally (8.4 vs. 45.4%, p = 0.0022). Conclusions: The endoscopic insertion and positioning of a nasojejunal feeding tube seemed effective because the rate of tube insertion into the duodenal fourth portion or more distal was about 90%. The findings of intragastric countercurrents indicated that feeding tubes should be inserted into the duodenal fourth portion or beyond to prevent vomiting and the aspiration of enteral nutrients.

Pneumothoraces Prevented With Use of Electromagnetic Device to Place Feeding Tubes

2020 ◽  
Vol 29 (1) ◽  
pp. 22-32 ◽  
Author(s):  
Annette M. Bourgault ◽  
Jan Powers ◽  
Lillian Aguirre
Keyword(s):  
Respiratory Tract ◽  
Real Time ◽  
Feeding Tube ◽  
Pulmonary Complications ◽  
Tube Insertion ◽  
Feeding Tubes ◽  
Pulmonary System ◽  
Tube Position ◽  
Real Time Visualization ◽  
Time Of Feeding

Background A US Food and Drug Administration safety letter warned about the risk for pneumothoraces during feeding tube insertion despite the use of electromagnetic placement devices that provide real-time visualization of feeding tube position. Objectives To systematically assess pulmonary placement and pneumothoraces in CORTRAK-assisted feeding tube insertions. Methods CINAHL, MEDLINE, and Cochrane databases were searched for studies of CORTRAK-assisted feeding tube insertion. Thirty-two studies documenting pulmonary placement and/or complications of feeding tube insertion were found. Results Operators recognized pulmonary placement on insertion tracings during 202 CORTRAK-assisted feeding tube insertion procedures, resulting in the immediate withdrawal of 199 feeding tubes. One pneumothorax was identified later by radiography. Seven pulmonary placements were not recognized by CORTRAK operators at the time of feeding tube insertion, resulting in 2 pneumothoraces. The incidence of pneumothorax for CORTRAK-assisted feeding tube insertions was 0.02% (3 of 17039). Of the feeding tubes inserted into the pulmonary system – either found during or after the procedure −1.4% (3 of 209) resulted in pneumothoraces (as opposed to the 19% to 28% incidence of pneumothorax for blind feeding tube insertions. Operators recognizing pulmonary placement on CORTRAK insertion tracings may have prevented 97% (202 of 209) of feeding tubes from being inserted farther into the respiratory tract. Conclusions Feeding tube insertion with an electromagnetic placement device is advantageous over blind feeding tube insertion because the operator can recognize pulmonary placement early and withdraw the feeding tube, thus decreasing the risk of pulmonary complications.

Cortrak feeding tube placement: interpretation agreement of the ‘GI flexure’ system versus X-ray

2020 ◽  
Vol 29 (12) ◽  
pp. 662-668
Author(s):  
Stephen J Taylor ◽  
Alex Manara ◽  
Jules Brown ◽  
Kaylee Allan ◽  
Rowan Clemente ◽  
...  
Keyword(s):  
Feeding Tube ◽  
Tube Placement ◽  
Radiological Investigation ◽  
X Ray ◽  
System Versus ◽  
Radiological Images ◽  
Blinded Study ◽  
Tube Position ◽  
Feeding Tube Placement ◽  
Nasointestinal Tube

Background: Blind (unguided) feeding tube placement results in 0.5% of patients suffering major complications mainly due to lung misplacement detected prior to feeding. Electromagnet-guided (Cortrak) tube placement could pre-empt such complications but undetected misplacements still occur due to incorrect trace interpretation. By identifying gastrointestinal (GI) flexures from the trace, ‘the GI flexure system’, it has been proposed that tube position can be interpreted. Aims: To audit agreement between standards of interpreting tube position: the Cortrak ‘GI flexure’ system versus X-ray. Methods: In 185 primary nasointestinal tube placements tube position determined by Cortrak trace interpretation (GI flexure) was retrospectively compared with radiological position in a blinded study. Findings: Radiological and Cortrak interpretation agreed in 92.2–98.3% of placements at different GI flexures. Discrepancy mainly occurred because some radiological images were unclear or did not cover all anatomical points. Conclusion: The GI flexure method of Cortrak interpretation appears safe but would necessitate prospective radiological investigation to definitively test equivalence.

Diagnostic efficacy and suitability of trans-thoracic ultrasonography for pleural fluid detection – The future non-invasive gold-standard?

2020 ◽  
Vol 13 (4) ◽  
pp. 184-190
Author(s):  
Muhammad Irfan ◽  
Abdul Rasheed Qureshi ◽  
Zeeshan Ashraf ◽  
Muhammad Amjad Ramzan ◽  
Tehmina Naeem ◽  
...  
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Accuracy ◽  
Pleural Fluid ◽  
Gold Standard ◽  
Pleural Effusions ◽  
Diagnostic Efficacy ◽  
Chest Sonography ◽  
X Ray ◽  
Non Invasive ◽  
Fluid Detection

ABSTRACT Background: Conventionally Pleural effusions are suspected by history of pleuritis, evaluated by physical signs and multiple view radiography. Trans-thoracic pleural aspiration is done and aspirated pleural fluid is considered the gold-standard for pleural effusion. Chest sonography has the advantage of having high diagnostic efficacy over radiography for the detection of pleural effusion. Furthermore, ultrasonography is free from radiation hazards, inexpensive, readily available  and feasible for use in ICU, pregnant and pediatric patients. This study aims to explore the diagnostic accuracy of trans-thoracic ultrasonography for pleural fluid detection, which is free of such disadvantages. The objective is to determine the diagnostic efficacy of trans-thoracic ultrasound for detecting pleural effusion and also to assess its suitability for being a non-invasive gold-standard.   Subject and Methods: This retrospective study of 4597 cases was conducted at pulmonology  OPD-Gulab Devi Teaching Hospital, Lahore from November 2016 to July 2018. Adult patients with clinical features suggesting pleural effusions were included while those where no suspicion of pleural effusion, patients < 14 years and pregnant ladies were excluded. Patients were subjected to chest x-ray PA and Lateral views and chest ultrasonography was done by a senior qualified radiologist in OPD. Ultrasound-guided pleural aspiration was done in OPD & fluid was sent for analysis. At least 10ml aspirated fluid was considered as diagnostic for pleural effusion. Patient files containing history, physical examination, x-ray reports, ultrasound reports, pleural aspiration notes and informed consent were retrieved, reviewed and findings were recorded in the preformed proforma. Results were tabulated and conclusion was drawn by statistical analysis. Results: Out of 4597 cases, 4498 pleural effusion were manifested on CXR and only 2547(56.62%) pleural effusions were proved by ultrasound while 2050 (45.57%) cases were reported as no Pleural effusion. Chest sonography demonstrated sensitivity, specificity, PPV, NPV and diagnostic accuracy 100 % each. Conclusions: Trans-thoracic ultrasonography revealed an excellent efficacy that is why it can be considered as non-invasive gold standard for the detection of pleural effusion.

ASSESSMENT OF OSTEOARTHRITIS INITIATIVE–KELLGREN AND LAWRENCE SCORING PROJECTS QUALITY USING COMPUTER ANALYSIS

2010 ◽  
Vol 13 (04) ◽  
pp. 197-201 ◽  
Author(s):  
Lior Shamir ◽  
David T. Felson ◽  
Luigi Ferrucci ◽  
Ilya G. Goldberg
Keyword(s):  
Image Analysis ◽  
Gold Standard ◽  
Population Studies ◽  
Detection Accuracy ◽  
X Rays ◽  
Analysis Method ◽  
Image Analysis Method ◽  
X Ray ◽  
Osteoarthritis Initiative ◽  
Kellgren And Lawrence

The detection of knee osteoarthritis (OA) is a subjective task, and even two highly experienced and well-trained readers might not always agree on a specific case. This problem is noticeable in OA population studies, in which different scoring projects provide significantly different scores for the same knee X-rays. Here we propose a method for quantitative assessment and comparison of knee X-ray scoring projects in OA population studies. The method works by applying an image analysis method that automatically detects OA in knee X-ray images, and comparing the consistency of the scores when using each of the scoring projects as "gold standard." The method was applied to compare the osteoarthritis initiative (OAI) clinic reading derived Kellgren and Lawrence (K&L) scores to central reading, and showed that when using the derived K&L scores the automatic image analysis method was able to accurately differentiate between healthy joints and moderate OA joints in ~70% of the cases. When the OAI central reading scores were used as gold standard, the detection accuracy was elevated to ~77%. These results show that the OAI central readings scores are more consistent with the X-rays, indicating that the central reading better reflects the radiographic features associated with OA, compared to the OAI K&L scores derived from clinic readings.

Unusual Nasogastric Tube Position Leading to Delay in Diagnosis of Tracheoesophageal Fistula

2021 ◽  
pp. 097321792110367
Author(s):  
Monika Kaushal ◽  
Saima Asghar ◽  
Ayush Kaushal
Keyword(s):  
Early Diagnosis ◽  
Nasogastric Tube ◽  
Common Type ◽  
X Ray ◽  
Delay In Diagnosis ◽  
Atypical Symptoms ◽  
Tube Position ◽  
Esophageal Pouch ◽  
High Index Of Suspicion ◽  
Surgical Unit

Aim: This case highlights the importance of high index of suspicion for early diagnosis and thorough clinical examination of a newborn with tracheoesophageal atresia and fistula. Case Report: We report a case of most common type of tracheoesophageal atresia with fistula where diagnosis was missed due to unusual gastric position of nasogastric tube. Nasogastric tube reached stomach in esophageal atresia with fistula, delaying the diagnosis and management of condition. After accidental removal of tube and failure to pass again raised suspicion and was confirmed with coiled tube in esophageal pouch in X-Ray chest. Baby shifted to surgical unit for treatment, fortunately baby recovered and discharged home after surgical correction. Conclusion: Tracheoesophageal atresia with fistula can present with atypical symptoms and unusual events, challenging the early diagnosis and treatment of common types of conditions. Other association like VACTERL should be looked for, in patients.

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