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Updated: Jul 10, 2026

Expired CO2 Measurement in Intubated or Spontaneously Breathing Patients from the Emergency Department
Published on: January 29, 2011
Capnometry and air insufflation for assessing initial placement of gastric tubes
Ellen H Elpern1, Kathryn Killeen, Erlinda Talla
1Rush University Medical Center, Chicago, Illinois, USA. Ellen_H_Elpern@rush.edu
Background:
Nurses are often responsible for placement of large-bore gastric tubes. Tube misplacement into the lungs is a potential complication with serious sequelae. The reliability of common bedside methods for differentiating between pulmonary and gastric placement has not been acceptable.
Objective:
To compare the accuracy of capnometry (colorimetric indicator of end-tidal carbon dioxide) and air insufflation/auscultation with the accuracy of radiography in detecting the location of gastric tubes.
Methods:
A prospective convenience sample of insertions of Salem sump gastric tubes was studied. Tubes were inserted by nurses according to the unit's standard procedure, and air insufflation/auscultation, capnometry, and radiography were used to detect the position of the tubes. Results obtained with each of the methods were compared.
Results:
A total of 91 tube placements were studied in 69 patients. No radiographically documented instances of lung placement occurred. Capnometry incorrectly indicated 15 of 91 gastric placements (16%) as placements in the lung. Air insufflation/auscultation incorrectly indicated 5 of 91 gastric placements (5%) as placements in the lung.
Conclusions:
Neither air insufflation nor capnometry is a fail-safe method for determining placement of gastric tubes. Radiography remains the preferred method.
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