Electrocardiogram-guided placement of enteral feeding tubes

To evaluate a new electrocardiogram guided method for placing nasoenteral feeding tubes in critically ill patients.

Prospective case series.

Surgical intensive care unit in a tertiary center.

A total of 24 patients requiring enteral feeding tube placement entered the study.

Standard 10-Fr flexible nasoenteral feeding tubes were inserted under direct vision by the nasal route. Before placement, two electrocardiographic reference recordings were made with the use of epigastric area skin electrodes, each 10 cm lateral to the midline 5 cm above the umbilical line. A continuous electrocardiographic tracing from the feeding tube was then monitored throughout the tube insertion process. A change in QRS axis simultaneous with electrocardiographic waveform change from reference point one to two was presumed to indicate tip passage beyond the midline and into the duodenum. Portable abdominal radiography was performed immediately after the procedure to confirm the anatomical location of the tube tip.

In four patients (17%), electrocardiographic tracings in both reference leads were identical and prevented further use of this method. In the remainder, electrocardiogram guided technique compared with portable abdominal radiography confirmed the correct position of the tube tip placed by electrocardiographic guidance. Sensitivity and specificity were 100% and 75%, respectively.

This report describes a new technique of feeding tube placement. This simple and convenient bedside method allows prompt and safe initiation of enteral nutrition.