A team-based protocol and electromagnetic technology eliminate feeding tube placement complications.
OBJECTIVE
To examine whether feeding tube placement into high-risk patients using a team-based protocol and electromagnetic tube tracking reduces complications associated with blind tube placement and to evaluate safety of blind tube placement in alert, low-risk patients.


BACKGROUND
Approximately 1·2 million feeding tubes with stylets are placed annually in the US. Serious complications during placement exceed the rates of retained sponges and wrong site surgery. Several suggested solutions to the problem have been proposed but none completely eliminate the serious complications and many are neither cost-effective nor practical.


METHODS
In a retrospective, single center study, we compared complications after bedside feeding tube placement using a blind technique in 2005 to a hospital protocol mandating tube placement in high-risk patients by a Tube Team in 2007 using electromagnetic tracking. Outcome variables included airway placement, pneumothorax, death, and radiology resource utilization.


RESULTS
The Tube Team protocol eliminated airway tube placement (0 of 1154 vs. 20 of 1822, P < 0.001), pneumothorax (0/715 vs. 11/1822, P = 0.009), and all mortality whereas improving placement (83.9% success vs. 60.5%, P<0.001) in high-risk patients compared to the 2005 study. The number of x-rays obtained per tube (1.07 +/− 0.01 vs. 1.49 +/− 0.026, P < 0.001) and need for fluoroscopy (2.1% vs. 10.9%, P < 0.001) significantly dropped with the Tube Team. A final comparison was made to low-risk patients considered acceptable for blind tube placement in 2007 due to their alertness and ability to cooperate and provide feedback during tube placement. Although no mortality occurred during blind placement in low risk, alert patients, blind placement resulted in significantly increased airway placement (3/143, p = 0.001) and pneumothorax (2 of 143, P = 0.01) compared to the Tube Team protocol. Most patients who would have required fluoroscopic placement of feeding tube due to failed blind technique had successful placement by the Team avoiding fluoroscopy.


CONCLUSIONS
Feeding tube placement by a dedicated team using electromagnetic tracking eliminates the morbidity and mortality of this common hospital procedure. Blind placement is not acceptable in awake, alert patients.
Department of Surgery, Veterans Administration Surgical Services,William S. Middleton Memorial Veterans Hospital, Madison, WI, USA.
Matthew C
MC
Koopmann
Kenneth A
KA
Kudsk
Molly J
MJ
Szotkowski
Susan M
SM
Rees
D055590:Electromagnetic Phenomena; D004750:Enteral Nutrition / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010348:Patient Care Team; D011030:Pneumothorax / Q000209:etiology; D011785:Quality Assurance, Health Care; D013902:Radiography, Thoracic