Published in BMJ Open Gastroenterology, October 2021
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Enteral feeding via nasogastric or nasojejunal tubes provide a vital route of nutrition support. Despite guidelines recommending the use of gastric aspiration and X-ray to help determine the correct position of the feeding tube, misplacements can occur with grave consequences. This paper (Bristol, UK) documents a preliminary guide to the use of ‘IRIS’, a real-time imaging system for tube placement.
The IRIS (Cardinal Health) tube incorporates a 3mm camera within the tip to display an endoscope-like image via a cable link on a bed side console. Anatomical features can be identified in real time as the tube is being positioned.
The tube was placed in a convenience sample of 45 adults (≥18 years) who required a gastric or intestinal tube placement. The images were interpreted by a non-endoscopist (research dietitian) compared against interpretation by a consultant gastroenterologist and standard pH testing or X-ray confirmation of the tube position. Analysis was intended to be descriptive to inform future IRIS use and studies.
Of the 45 patient tube placements, 3 were aborted due to refusal (n1) or inability to enter the oesophagus (n2). Of the remaining 43 tubes, 12 initially entered the respiratory tract but were pulled back. Of the 38 used for feeding, all were confirmed to be within the GI tract by either gastric residues or X-ray. The paper reports the advantages and problems encountered with this system and suggest several design changes to improve ease of placement. Overall it highlights that a non-endoscopist was able to accurately identify major features of the respiratory and alimentary tracts.
The authors conclude ‘by permitting real-time confirmation of tube position, direct vision may reduce risk of lung complications’. A preliminary guide using video of external and internal images and a photographic bank to assist training requires validation in a larger study.