Electromagnetic-Guided Bedside Placement of Nasoenteral Feeding Tubes by Nurses Is Non-Inferior to Endoscopic Placement by Gastroenterologists: A Multicenter Randomized Controlled Trial.
Electromagnetic (EM)-guided bedside placement of nasoenteral feeding tubes by nurses may improve efficiency and reduce patient discomfort and costs compared with endoscopic placement by gastroenterologists. However, evidence supporting this task shift from gastroenterologists to nurses is limited. We aimed to compare the effectiveness of EM-guided and endoscopic nasoenteral feeding tube placement.



We performed a multicenter randomized controlled non-inferiority trial in 154 adult patients who required nasoenteral feeding and were admitted to gastrointestinal surgical wards in five Dutch hospitals. Patients were randomly assigned (1:1) to undergo EM-guided or endoscopic nasoenteral feeding tube placement. The primary end point was the need for reinsertion of the feeding tube (e.g., after failed initial placement or owing to tube-related complications) with a prespecified non-inferiority margin of 10%.



Reinsertion was required in 29 (36%) of the 80 patients in the EM-guided group and 31 (42%) of the 74 patients in the endoscopy group (absolute risk difference -6%, upper limit of one-sided 95% confidence interval 7%; P for non-inferiority=0.022). No differences were noted in success and complication rates. In the EM-guided group, there was a reduced time to start of feeding (424 vs. 535 min, P=0.001). Although the level of discomfort was higher in the EM-guided group (Visual Analog Scale (VAS) 3.9 vs. 2.0, P=0.009), EM-guided placement received higher recommendation scores (VAS 8.2 vs. 5.5, P=0.008).



EM-guided bedside placement of nasoenteral feeding tubes by nurses was non-inferior to endoscopic placement by gastroenterologists in surgical patients and may be considered the preferred technique for nasoenteral feeding tube placement.
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.|Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Arja
A
Gerritsen
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Thijs
T
de Rooij
Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands.
Marcel G
MG
Dijkgraaf
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Olivier R
OR
Busch
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
Jacques J
JJ
Bergman
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Dirk T
DT
Ubbink
Department of Surgery, Gelre Hospital, Apeldoorn, The Netherlands.
Peter
P
van Duijvendijk
Department of Gastroenterology, Gelre Hospital, Apeldoorn, The Netherlands.
G Willemien
GW
Erkelens
Department of Dietetics, Gelre Hospital, Apeldoorn, The Netherlands.
Mariël
M
Klos
Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands.
Philip M
PM
Kruyt
Department of Gastroenterology, Hospital Gelderse Vallei, Ede, The Netherlands.
Dirk Jan
DJ
Bac
Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
Camiel
C
Rosman
Department of Gastroenterology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.
Adriaan C
AC
Tan
Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
I Quintus
IQ
Molenaar
Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
Jan F
JF
Monkelbaan
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
Elisabeth M
EM
Mathus-Vliegen
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Marc G
MG
Besselink
D000368:Aged; D016145:Endoscopy, Digestive System / Q000379:methods*; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D000072102:Gastroenterologists; D018589:Gastroparesis / Q000628:therapy*; D006801:Humans; D045823:Ileus / Q000628:therapy; D007441:Intubation, Gastrointestinal / Q000379:methods*; D059346:Magnets; D008297:Male; D044342:Malnutrition / Q000628:therapy*; D008875:Middle Aged; D009726:Nurses; D010195:Pancreatitis / Q000628:therapy; D019095:Point-of-Care Systems; D011183:Postoperative Complications / Q000628:therapy*