{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T20:41:38Z","timestamp":1774989698494,"version":"3.50.1"},"reference-count":23,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2023,4,27]],"date-time":"2023-04-27T00:00:00Z","timestamp":1682553600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["aspenjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nut in Clin Prac"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Unguided (blind) tube placement commonly results in lung (1.6%) and oesophageal (5%) misplacement, which can lead to pneumothorax, aspiration pneumonia, death, feeding delays, and increased cost. Use of real\u2010time direct vision may reduce risk. We validated the accuracy of a guide to train new operators in the use of direct vision\u2013guided tube placement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Using direct vision, operators matched anatomy viewed to anatomical markers in a preliminary operator guide. We examined how accurately the guide predicted tube position, specifically whether respiratory and gastrointestinal placement could be differentiated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 100 patients each had one tube placement. Placement was aborted in 6% because of inability to enter or move beyond the oesophagus. In 15 of 20 placements in which the glottic opening was identified, the tube was maneuvered to avoid entry into the respiratory tract. Of 96 tubes that reached the oesophagus, 17 had entered the trachea; all were withdrawn pre\u2010carina. One or more specific characteristics identified each organ, differentiating the trachea\u2010oesophagus (<jats:italic>P<\/jats:italic>\u2009&lt;\u20090.0001), oesophagus\u2010stomach, and stomach\u2010intestine in 100%. End\u2010of\u2010procedure tube position was ascertained by pH \u22644.0 (gastric) of aspirated fluid and\/or x\u2010ray (gastric or intestinal). In patients with a trauma risk (13%), it was avoided by identification that the tube remained within the nasal, oesophageal, or gastric lumen.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Operators successfully matched anatomy seen by direct vision to images and descriptions of anatomy in the \u201coperator guide.\u201d This validated that the operator guide accurately facilitates interpretation of tube position and enabled avoidance of lung trauma and oesophageal misplacement.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ncp.10997","type":"journal-article","created":{"date-parts":[[2023,4,27]],"date-time":"2023-04-27T04:59:15Z","timestamp":1682571555000},"page":"1360-1367","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Validation of image interpretation for direct vision\u2010guided feeding tube placement"],"prefix":"10.1002","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3970-1819","authenticated-orcid":false,"given":"Stephen J.","family":"Taylor","sequence":"first","affiliation":[{"name":"Department of Nutrition and Dietetics Southmead Hospital Bristol UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danielle","family":"Milne","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics Southmead Hospital Bristol UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zeino","family":"Zeino","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Princess Campbell Office, Southmead Hospital Bristol UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leonard","family":"Griffiths","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Princess Campbell Office, Southmead Hospital Bristol UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rowan","family":"Clemente","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics Southmead Hospital Bristol UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frances","family":"Greer\u2010Rogers","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics Southmead Hospital Bristol UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jules","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Anaesthetics Southmead Hospital Bristol UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,4,27]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Healthcare Safety Investigation Branch (HSIB). Placement of nasogastric tubes. Independent report by the Healthcare Safety Investigation Branch I2019\/006. December2020. Accessed April 12 2023.https:\/\/hsibkqcco125media.s3.amazonaws.com\/assets\/documents\/HSIB_Placement_of_nasogastric_tubes_Report_V07.pdf"},{"key":"e_1_2_8_3_1","unstructured":"JonesBJM. A position paper on nasogastric safety: time to put patient safety first. Prepared by the Nasogastric Tube Special Interest Group of the British Association of Parenteral and Enteral Nutrition. September2020. Accessed April 6 2023.https:\/\/www.bapen.org.uk\/news-and-media\/news\/825-ngsigs-position-paper-time-to-put-patient-safety-first"},{"key":"e_1_2_8_4_1","volume-title":"Guided Feeding Tube Placement","author":"Taylor SJ","year":"2022"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2004.03.011"},{"key":"e_1_2_8_6_1","unstructured":"NHSI. NHS Improvement. Nasogastric tube misplacement: continuing risk of death and severe harm. 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Guided tube placement novel tech assessments. BDA CCSG;2022. Accessed April 6 2023.https:\/\/www.bda.uk.com\/specialist-groups-and-branches\/critical-care-specialist-group\/guided-tube-placement\/guided-tube-placement-novel-tech-assessments.html"},{"key":"e_1_2_8_17_2","unstructured":"https:\/\/www.bapen.org.uk\/about-bapen\/bapen-special-interest-groups\/ng-sig\/novel-tech-assessment"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1177\/17511437221095336"},{"key":"e_1_2_8_19_1","unstructured":"North Bristol NHS Trust. Enteral nutrition policy;2020."},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clnu.2021.07.026"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1259\/bjr.20210432"},{"key":"e_1_2_8_22_1","unstructured":"TaylorSJ MilneD ZeinoZ GriffithsL KarpasitiT PhillipsM. IRIS images: \u00a9 North Bristol NHS Trust. Image bank. BDA: Critical Care Specialist Group; 2022. 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