Innovative Strategy for Safe and Effective Confirmation of Feeding Tube Location

Introduction: The most concerning complication associated with feeding tube insertion is pulmonary misplacement resulting in pneumothorax leading to increased morbidity and even death. Past research shows a 3.2% incidence of complications. Ongoing controversy remains as to the best method for verification of feeding tube placement. Existing tube verification methods lack consistent validity. Historically, radiography was the gold standard for feeding tube placement confirmation within the GI tract. However, inaccurate radiology interpretation may also occur (12% in one study). Based on previous evidence, we adopted a two RN dual verification method in critical care areas at a large Midwest hospital in northeast Indiana for determining distal tube location for feeding tubes.


Methods: The purpose of this study was to determine safety and efficacy using a dual verification process to confirm feeding tube location when using an Electromagnetic placement device (EMPD). This retrospective study reviewed all feeding tube placements from 2022-2024 to evaluate the process of two RN dual verification to assess feeding tube location.


Results: A total of 2395 feeding tube placements were completed over the 3-year period in the ICUs. Of these placements, 1618 (68%) used dual verification for placement confirmation. There were no lung placements or any other adverse events associated with this verification technique. Interestingly, 39 tubes that were dual verified also had an abdominal radiograph completed, most commonly due to simultaneous placement of a gastric decompression tube. The radiology interpretation was consistent with nurse verification using EMPD tracing. The feeding tube placements that did not have dual verification had a radiograph to confirm placement. The most common reason cited was not having another expert nurse available to confirm placement.


Conclusions: Based on existing data and our local experience, a dual verification process with EMPD placements is a feasible, effective and safe procedure. NThis challenges radiographic verification as a gold standard when EMPD is used for feeding tube placement. This procedure requires skilled clinicians to safely identify any concerns with placements.