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Feeding Tube Insertion and Placement Confirmation Using Electromagnetic Guidance: A Team Review
Author(s) -
McCutcheon Kevin P.,
Whittet Wanda L.,
Kirsten Julie L.,
Fuchs John L.
Publication year - 2018
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1002/jpen.1015
Subject(s) - medicine , feeding tube , radiography , anatomical landmark , confidence interval , surgery
Abstract Background Challenges for bedside placement of small‐bore feeding tube (SBFT) include iatrogenic injury, multiple exposures to x‐rays, and prolonged placement times. In 2011, the study facility began a feeding tube placement team (FTPT) using the CORTRAK system (CS) in the adult intensive care unit (ICU) and medical‐surgical populations. In 2013, a protocol was implemented using the CS to determine final SBFT location. Methods Serial retrospective reviews were done of patients with SBFT placement by the FTPT during July 2011–December 2012 and 2015. Measures included pulmonary deviation, tube location, placement agreement beyond chance for CS tracing and confirmation radiography (CR), x‐ray frequency, and placement time intervals. Results A total of 6290 SBFT placements were completed for 4239 patients. First‐attempt SBFT locations were 12.78% gastric, 13.39% first through fourth portion of duodenum, and 73.83% ligament of Treitz/jejunum, with zero placements in esophagus or lung. In 2015, staff avoided 68 lung placements by recognizing proximal pulmonary deviation. X‐ray preprotocol vs protocol (mean [SD]: 1.02 [0.15] vs 0.26 [0.44]) resulted in 74% x‐ray reduction and cost avoidance of $346,000. Time intervals (mean [SD]; N = 6290) were 14.90 (12.74) minutes for insertion, 46.04 (13.80) minutes for placement event, and 3.85 (2.23) hours for consult conclusion. Agreement for n = 1692 placements was 85.28%, with k score of 0.622 (95% confidence limit: 0.582, 0.661; P = .0005). Conclusions Team management of SBFT placement using the CS optimizes patient safety, standardizes practice, and decreases cost. Using the CS to determine final SBFT location is a safe alternative to CR.