title: Elimination of radiographic confirmation for small-bowel feeding tubes in critical care.
abstract: BACKGROUND
  A variety of techniques are used for placement of small-bowel feeding tubes. Standard practice at the study institution is for postpyloric placement using an electromagnetically guided placement device (EMPD). EMPD placement is performed by bedside nurses trained in the placement technique and may reduce radiograph exposures and time to initiation of enteral nutrition.
  
  
  OBJECTIVE
  To evaluate how changes in SBFT placement verification procedures in critical care patients-from use of EMPD with radiographic confirmation, to placement verification by using EMPD without radiographic confirmation-influenced successful placement, misinterpretations of locations, and radiographic verification of tube locations.
  
  
  METHODS
  The research was conducted at an 800-bed quaternary care referral hospital located in the Midwest. Nine-hundred four feeding tubes were placed in 632 critical care patients by using bedside EMPD instead of radiographic confirmation as the standard of care. Prospectively collected EMPD audit form data were retrospectively analyzed.
  
  
  RESULTS
  Small-bowel (duodenum or jejunum) placement was achieved by bedside nurses in 97.2% of all EMPD placements, with 2.8% placed in the stomach because gastric placement was ordered or small-bowel placement could not be achieved. Radiographic confirmation was required in only 7.7% of placements. No adverse events or pulmonary placements occurred.
  
  
  CONCLUSIONS
  Use of EMPD technology allowed clinicians to safely and effectively place feeding tubes at the bedside and eliminate radiographs in most cases. EMPD placement was not limited to specialized nurses or teams. This procedure should be easily reproducible in other critical care environments.
authors.affiliation: All authors work at St Vincent Hospital in Indianapolis, Indiana. Jan Powers is the director of clinical nurse specialists and nursing research and a clinical nurse specialist in the trauma/surgical/neurological intensive care unit. Mary H. Fischer is a clinical nurse specialist in the cardiovascular thoracic transplant unit. Mary Ziemba-Davis is the neuroscience research director and a clinical nurse specialist team research scientist. Jamie Brown is a clinical nurse specialist in the medical intensive care unit. Donna M. Phillips is a clinical supervisor in the medical intensive care unit.
authors.forename: Jan
authors.initials: J
authors.lastname: Powers
authors.forename: Mary H
authors.initials: MH
authors.lastname: Fischer
authors.forename: Mary
authors.initials: M
authors.lastname: Ziemba-Davis
authors.forename: Jamie
authors.initials: J
authors.lastname: Brown
authors.forename: Donna M
authors.initials: DM
authors.lastname: Phillips
mesh_terms: D003422:Critical Care / Q000379:methods*; D055590:Electromagnetic Phenomena; D004750:Enteral Nutrition / Q000295:instrumentation / Q000379:methods* / Q000451:nursing; D006801:Humans; D007196:Indiana; D007362:Intensive Care Units; D007441:Intubation, Gastrointestinal / Q000295:instrumentation / Q000379:methods* / Q000451:nursing; D011446:Prospective Studies; D011708:Pylorus; D011860:Radiography, Abdominal / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D013997:Time Factors