title: Successful placement of postpyloric enteral tubes using electromagnetic guidance in critically ill children.
abstract: OBJECTIVE
  Initiation of postpyloric feeding is often delayed by difficulties in placement of enteral tubes. We evaluated the effectiveness of bedside postpyloric enteral tube (PET) placement using an electromagnetic (EM)-guided device. We hypothesized that: 1) EM-guided placement of PETs would be successful more often than standard blind placement with a shorter total time to successful placement and 2) the EM-guided technique would have similar overall costs to the standard technique.
  
  
  METHODS
  Prospective cohort trial with serial control groups in a pediatric intensive care unit at a tertiary care children's hospital.
  
  
  METHODS
  We collected data on a cohort of consecutive pediatric intensive care unit patients who underwent PET placement by standard blind technique followed by a cohort who underwent EM-guided placement. The primary outcome measure was successful placement determined by abdominal radiography.
  
  
  RESULTS
  One hundred seven patients were evaluated in the trial: 57 in the standard group and 50 in the EM-guided group. Demographic data, percent intubated, and admission diagnosis were similar in both groups. Forty-one of 50 patients (82%) in the EM-guided group had successful placement compared with 22 of 57 in the standard group (38%) (p < 0.0001). The average time to successful placement was 1.7 vs. 21 hours in the EM-guided group and standard group, respectively (p < 0.0001). Children in the EM-guided group received fewer radiographs (p = 0.007) and were given more prokinetic drugs (p = 0.045). There were no episodes of pneumothorax in either group. After controlling for prokinetic drug use, EM-guided placement was more likely to result in successful placement than the standard blind technique (odds ratio 6.4, 95% confidence interval 2.5-16.3). An annual placement rate of 250 PETs by EM guidance, based on our institution's current utilization rates, is associated with a cost savings of $55.46 per PET placed.
  
  
  CONCLUSIONS
  EM guidance is an efficient and cost-effective method of bedside PET placement.
authors.affiliation: New York State University School of Medicine, New York, NY, USA. to2122@columbia.edu
authors.forename: Tessie W
authors.initials: TW
authors.lastname: October
authors.forename: George E
authors.initials: GE
authors.lastname: Hardart
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D016638:Critical Illness; D004502:Education, Medical, Continuing; D055590:Electromagnetic Phenomena; D004750:Enteral Nutrition / Q000191:economics / Q000295:instrumentation*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D011706:Pyloric Antrum; D016896:Treatment Outcome; D055815:Young Adult