Reducing Lung Injury from Blind Insertion of Small-Bore Feeding Tubes

Area of Science:

• Medical Devices
• Patient Safety
• Quality Improvement

Background:

• Blind insertion of small-bore feeding tubes poses a risk of lung perforation and mortality.
• Two serious patient safety events and six lung perforations occurred over two years at a level 2 trauma center.
• These events necessitated an evaluation of alternative, evidence-based insertion practices.

Purpose of the Study:

• To describe a quality improvement project implementing capnography-guided small-bore feeding tube placement.
• To reduce complications, specifically lung perforation, associated with feeding tube insertion.
• To enhance patient safety and care through improved insertion techniques.

Main Methods:

• A multidisciplinary team reviewed literature and evaluated placement methods including fluoroscopy, X-ray, electromagnetic visualization, and capnography.
• Capnography was selected as the most effective method to mitigate blind insertion complications.
• A quality improvement project was conducted from December 2021 to April 2022 to implement capnography-guided placement.

Main Results:

• Following the implementation of capnography-guided placement, no lung injuries or perforations were reported.
• Capnography was identified as a cost-effective, noninvasive technology for safe feeding tube insertion.
• The project demonstrated a reduction in adverse events related to feeding tube placement.

Conclusions:

• Capnography-guided small-bore feeding tube insertion is a safe and effective method.
• This technique significantly decreases the incidence of lung perforation and other adverse events.
• Implementing capnography improves overall patient care and safety in healthcare settings.