Figure 1. Placement of a Side-Stream Capnometer (left) and Mainstream Capnometer (right)
Meyer et al demonstrated that in 100 mechanically ventilated patients, a colorimetric capnometer was able to exclude tracheal placement 100 percent of the time.4 In this study, an NGT was initially inserted to a depth of 30 cm and insufflated and exsufflated with 50 cc of air, then the end of the tube was capped with the colorimetric capnometer. If the color remained purple, indicating an end-tidal CO2 (EtCO2) 15 mmHg, the tube was removed. In a meta-analysis of nine clinical trials of mechanically ventilated patients, the use of either qualitative or quantitative capnometry for tracheal placement of the NGT had sensitivities ranging from 88 to 100 percent and positive likelihood ratios of 15.2–283.5.6 Before your patient leaves the emergency department, a chest X-ray is needed to confirm placement of your NGT/OGT, but end-tidal capnography can help to avoid accidental airway insertion, multiple attempts at placement, and multiple chest X-rays. (See Figure 2 for an algorithm for placing NGT/OGT.)
Figure 2. Suggested Algorithm for Placing NGT/OGT
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