Clinical costs of feeding tube placement.
BACKGROUND
Although small-bore tube placement is common, insertion can lead to serious complications. We investigated the use of radiographs, fluoroscopy, feeding tubes, and complications associated with blind feeding-tube placement.


METHODS
The electronic and paper records of adult patients receiving a small-bore feeding tube in 2005 were retrospectively reviewed for the following variables: demographics, desired location (gastric or postpyloric), number of radiographs, number of tubes per individual, time interval between medical prescription, tube placement and delivery of the diet, complications, transport for fluoroscopy, and hospital location of placement (intensive care unit vs floor).


RESULTS
We identified 1822 tubes placed into 729 patients (male: 449, 61.6%; female: 280, 38.4%; median age: 59 years old, range 18-98). All tubes were placed by nurses unless fluoroscopically placed in radiology or placed after head and neck surgery in the operating room. An average of 2.5 (range 1-20) tubes was used per patient. A total of 2696 radiographs were obtained for an average of 3.7 (range 0-32) films per patient and 1.5 (range 0-11) per feeding tube. Successful placement was higher for intragastric (93.3%) than for postpyloric position (60.4%; p < .001). Fluoroscopy was needed in 18.6% of the patients, mostly for postpyloric insertion (p < .001). Respiratory tree misplacement occurred in 23 (3.2%) patients; 9 (1.2%) had a pneumothorax and 4 (0.5%) died. Patients with a malpositioned feeding tube underwent more tube insertions (6.8 +/- 5.4; range 2-20) than patients without complications (2.2 +/- 1.8; range 1-18; p < .001).


CONCLUSIONS
The incidence of airway misplacement of feeding tubes (3.2%) at a major tertiary referral university hospital was alarming. Mandatory radiographs may eliminate the risk of respiratory administration of feedings but not misplacements. The associated costs of radiographs, unsuccessful placements, fluoroscopy, and complications are significant. A solution to this problem will require focused attention and development of specific protocols, possibly using new technologies.
de Aguilar-Nascimento
Jose Eduardo
JE
Department of Surgery, Federal University of Mato Grosso, Cuiaba, Brazil.
Kudsk
Kenneth A
KA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016099:Endoscopy, Gastrointestinal / Q000191:economics*; D004750:Enteral Nutrition / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation / Q000379:methods; D005260:Female; D005471:Fluoroscopy / Q000191:economics; D005773:Gastroscopy / Q000191:economics; D005774:Gastrostomy / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation / Q000379:methods; D007582:Jejunostomy / Q000191:economics; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000209:etiology; D011708:Pylorus; D011860:Radiography, Abdominal / Q000191:economics; D012189:Retrospective Studies; D014481:United States