Bedside electromagnetic-guided feeding tube placement: an improvement over traditional placement technique?
BACKGROUND
Registered dietitian/registered nurse (RD/RN) teams were created to place small bowel feeding tubes (SBFT) at the bedside in intensive care unit (ICU) patients using an electromagnetic tube placement device (ETPD). The primary objective of this study was to evaluate the safety of placing feeding tubes at the ICU bedside using an ETPD. Secondary outcomes included success rate, cost, and timeliness of feeding initiation.


METHODS
Data were collected prospectively on 20 SBFT blind placements in ICU patients (control group). After implementing a protocol for RD/RN teams to place SBFTs with an ETPD, 81 SBFTs were placed (study group). Complications, success rate, number of x-rays after tube placement, x-ray cost, and time from physician order to initiation of feedings were compared between the groups.


RESULTS
No adverse events occurred in either group. Successful SBFT placement was 63% (12/19) in the control group and 78% (63/81) in the study group (not significant, NS). The median time between physician order for tube placement and feeding initiation decreased from 22.3 hours (control group) to 7.8 hours (study group, p = .003). The median number of x-rays to confirm correct placement was 1 in the study group compared with 2 in the control group (p = .0001), resulting in a 50% decrease in the mean cost for x-rays.


CONCLUSIONS
No adverse events occurred with the implementation of bedside feeding tube placement using an ETPD. In addition, SBFT placement with an ETPD by designated ICU RD/RN teams resulted in lower x-ray costs and more timely initiation of enteral feedings compared with blind placement.
Gray
Rebecca
R
Baylor University Medical Center, Nutrition Services, 3500 Gaston Ave, Dallas, TX 75246, USA. rebeccam@baylorhealth.edu
Tynan
Cameo
C
Reed
Lisa
L
Hasse
Jeanette
J
Kramlich
Mary
M
Roberts
Susan
S
Suneson
Judy
J
Thompson
Jennifer
J
Neylon
Jacquelyn
J
D003362:Cost-Benefit Analysis; D003422:Critical Care / Q000379:methods; D004046:Dietetics / Q000295:instrumentation / Q000379:methods / Q000592:standards; D055590:Electromagnetic Phenomena; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007421:Intestine, Small / Q000000981:diagnostic imaging; D007441:Intubation, Gastrointestinal / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography / Q000191:economics / Q000706:statistics & numerical data*; D012449:Safety; D013997:Time Factors