Matthew M. Ward Andrew M. McEwen Peter M. Robbins Mark J. Bennett A simple aspiration test to determine the accuracy of oesophageal placement of fine-bore feeding tubes Received: 6 March 2008 Accepted: 25 September 2008 Published online: 14 October 2008 Ó Springer-Verlag 2008 M. M. Ward Á A. M. McEwen Á P. M. Robbins Á M. J. Bennett ( ) ) South West Cardiothoracic Centre, Level 6, Derriford Hospital, Plymouth PL6 8DH, UK e-mail: mark.bennett@phnt.swest.nhs.uk Tel.: ?44-1752-431103 Fax: ?44-1752-763835 Abstract Objective: To evaluate whether a simple aspiration test can be used to accurately confirm the correct placement of fine-bore feed- ing tubes in the oesophagus and prevent their inadvertent placement in the bronchial tree. Design: We conducted an ethically approved, randomised, blinded trial to assess the accuracy of a simple aspiration test to differentiate between oesophageal and tracheal placement. Setting: A tertiary referral cardiothoracic surgi- cal unit. Patients and participants: Twenty patients under-going elective cardiac surgery. Intervention: Once anesthetised, a fine-bore feeding tube was inserted into the oesophagus or trachea and a researcher, blinded to the position, then performed the test. This involved attempted aspiration of C10 ml of air before and after insufflation of 10 ml of air and comparison with capnog- raphy, a test that has been shown to be highly sensitive and specific. Measurements and results: With this small number of patients, the test accurately differentiated between ten oesophageal and ten tracheal place- ments. Conclusions: A simple aspiration test could be a useful adjunct to prevent inadvertent bron- chial placement of fine-bore feeding tubes. Careful attention must be paid to the technique to ensure that no false positives occur. Keyword Enteral nutrition Introduction Enteral feeding tubes are used to deliver nutrition into the stomach (gastric) and small bowel (either duodenal or jejunal). Fine-bore feeding tubes are used in long-term established gastric feeding and for achieving post pyloric enteral feeding tube placement [1]. Irrespective of the final position of the tube, it is first inserted via the oesophagus and then advanced blindly into the stomach. Only in this position is confirmation of gastric placement made, either by pH testing of the aspirate or by abdominal X-ray. A recent review of the complications related to feeding tube placement concluded that most are due to inadvertent placement in the respiratory tract [2], which may occur, at least initially, in one in four insertions [3]. Guidelines to help confirm accurate gastric placement, including those by the National Patient Safety Agency [4], do not prevent traumatic complications that may follow inadvertent bronchial placement, which include pleural puncture and pneumothorax. If these occur there is a high incidence of morbidity, with death occurring in 0.3% of incidents [5]. It is therefore important to confirm correct oesophageal placement before further tube advancement, because lung puncture and pleural placement can occur at a distance that would otherwise place the tube in the stomach. Side-stream capnography has been reported to verify oesophageal and gastric placement of fine-bore feeding tubes in intubated, mechanically ventilated patients with a 100% specificity and sensitivity [6], but may be unavailable even in the critical care setting where carbon dioxide is often detected using crossbeam infrared spectroscopy. Intensive Care Med (2009) 35:722–724 DOI 10.1007/s00134-008-1312-4 BRIEF REPORT