Feeding Tube Insertion and Placement Confirmation Using Electromagnetic Guidance: A Team Review

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.