Blind Bedside Placement of Feeding Tubes: Treatment or Threat?

Enteral nutrition is the preferred route for the provision of nutrition support in patients with a functional gastrointestinal tract. Soft, small bore feeding tubes are easily placed at the bedside, and have become the preferred method for providing temporary enteral nutrition access for acutely ill patients. It is estimated that more than 1.2 million small bore feeding tubes are used each year in the United States alone. Evidence accumulated over more than 25 years documents that between 1-2 percent of small bore feeding tubes that are placed blindly at the bedside enter the airway undetected, and a proportion of these misplacements result in pulmonary injury that is not preventable even by a single confirmatory radiograph. Although the overall percentage of injury and death from blind feeding tube placement is relatively low, the large number of feeding tube placements results in unacceptable numbers of unnecessary harm to patients. Fortunately, morbidity and mortality from enteral access is largely preventable because placement techniques and technology to guide insertion of feeding tubes at bedside are now available. However, an under appreciation of the frequency of injuries and death from blind feeding tube placement, and lack of education regarding placement techniques and technology contribute to the failure to adopt safety measures for bedside placement of enteral access at many institutions. Assessment of feeding tube position after it has been placed to approximately 30 cm allows repositioning of misplaced tubes and can prevent pulmonary injury. All available evidence suggests that blind placement of small bore feeding tubes is an unnecessary risk and should be abolished to enhance patient safety.