title: Analysis of an electromagnetic tube placement device versus a self-advancing nasal jejunal device for postpyloric feeding tube placement.
abstract: BACKGROUND
  Initiation of enteral feeding is an important part of the best practice model for critically ill patients. Although nasogastric feeding is appropriate for the majority of patients requiring short-term nutrition support, certain patients benefit greatly from postpyloric feeding.
  
  
  OBJECTIVE
  To determine which of 2 specialized enteral tube systems achieved postpyloric placement on initial insertion attempt most efficiently.
  
  
  METHODS
  Retrospective study comparing the Tiger 2 tube (T2T) and Cortrak Enteral Access System (C-EAS).
  
  
  METHODS
  Academic medical center, mixed intensive care unit (ICU).
  
  
  METHODS
  All patients admitted to the ICU between 2009 and 2013 who had either a C-EAS or T2T placed.
  
  
  METHODS
  Success rate for postpyloric placement, congruency of real-time tube placement with x-ray confirmation for C-EAS, and complication rates.
  
  
  RESULTS
  Seventy-one T2T and 74 C-EAS patients were included. The T2T was postpyloric 62% (44/71) of attempted placements. C-EAS was postpyloric 43% (32/74) of attempted placements (P = 0.03). C-EAS tracings accurately reflected chest x-ray findings 83% and 82% for postpyloric and non-postpyloric insertion, respectively. During the entire study period, no adverse events were recorded.
  
  
  CONCLUSIONS
  Our institution evaluated 2 different systems designed to ensure postpyloric placement of a small bore feeding tube. No literature exists directly comparing the 2 systems. Our retrospective review, although limited, showed that the T2T was more effective at postpyloric placement on first attempt. Although 1 benefit of the C-EAS system may be real-time visualization, our practice showed this system to be user dependent, which likely led to less success with postpyloric placement.
authors.affiliation: Department of Medicine, Madigan Army Medical Center, Tacoma, Washington.
authors.forename: Nathan
authors.initials: N
authors.lastname: Boyer
authors.forename: Mary S
authors.initials: MS
authors.lastname: McCarthy
authors.forename: Cristin A
authors.initials: CA
authors.lastname: Mount
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055590:Electromagnetic Phenomena; D004750:Enteral Nutrition / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D007583:Jejunum / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011708:Pylorus / Q000000981:diagnostic imaging*; D011859:Radiography; D012189:Retrospective Studies