Enteral feeding is a common and necessary practice in critical care. Clinical practice for verification of small- and large-bore feeding tubes is variable. Although radiographic confirmation is the reference standard for blindly inserted small-bore tubes, it is not consistently performed to verify large-bore tubes before administration of formula or medication.
These practices raise concerns; both small- and large-bore tube placement in the tracheobronchial tree have been reported.1,–6 Malpositioning has also involved the intracranial cavity.7 In a review of more than 2000 insertions of small-bore tubes, 50 pulmonary placements (3%) were detected.6 In another study,1 the incidence of inadvertent pulmonary placement did not differ between small- and large-bore tubes. Of note, endotracheal or tracheostomy tube cuffs do not prevent pulmonary malposition.6
Unfortunately, pulmonary malplacement may occur silently, without coughing, dyspnea, or oxygen desaturation.3 Adding confusion,...
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