Implementation of an electromagnetic imaging system to facilitate nasogastric and post-pyloric feeding tube placement in patients with and without critical illness.
BACKGROUND
Artificial nutrition support is required to optimise nutritional status in many patients. Traditional methods of placing feeding tubes may incur clinical risk and financial costs. A technique facilitating placement of nasogastric and post-pyloric tubes via electromagnetic visual guidance may reduce the need for X-ray exposure, endoscopy time and the use of parenteral nutrition. The present study aimed to audit use of such a system at initial implementation in patients within an acute NHS Trust.


METHODS
A retrospective review was undertaken of dietetic and medical records for the first 14 months of using the Cortrak system. Data were collected on referral origin, preparation of the patient prior to insertion, placement success rates and need for X-ray. Cost analysis was also performed.


RESULTS
Referrals were received from primary consultants or consultant intensivists, often on the advice of the dietitian. Fifty-nine percent of patients received prokinetic therapy at the time of placement. Thirty-nine tube placements were attempted. Sixty-nine percent of referrals for post-pyloric tube placement resulted in successful placement. X-ray films were requested for 22% of all attempted post-pyloric placements. Less than half of nasogastric tubes were successfully passed, although none of these required X-ray confirmation. The mean cost per tube insertion attempt was 111 pounds.


CONCLUSIONS
This system confers advantages, particularly in terms of post-pyloric tube placement, even at this early stage of implementation. A reduction in clinical risk and cost avoidance related to X-ray exposure, the need for endoscopic tube placement and parenteral nutrition have been achieved. The implementation of this system should be considered in other centres.
Department of Nutrition and Dietetics, Pinderfields General Hospital, Wakefield, West Yorkshire, UK. mark.windle@midyorks.nhs.uk
E M
EM
Windle
D
D
Beddow
E
E
Hall
J
J
Wright
N
N
Sundar
D000328:Adult; D000368:Aged; D016638:Critical Illness / Q000628:therapy; D055590:Electromagnetic Phenomena; D004750:Enteral Nutrition / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012017:Referral and Consultation; D012189:Retrospective Studies