Effectiveness of an Electromagnetic Feeding Tube Placement Device in Detecting Inadvertent Respiratory Placement

2014 ◽  
Vol 23 (3) ◽  
pp. 240-248 ◽  
Author(s):  
Norma A. Metheny ◽  
Kathleen L. Meert
Keyword(s):  
Main Bronchus ◽  
Feeding Tube ◽  
Tube Placement ◽  
Medline Search ◽  
Feeding Tubes ◽  
Ovid Medline ◽  
Use Of Technology ◽  
The Us ◽  
User Facility ◽  
The Right

Background Use of technology capable of electromagnetically tracking advancement of a feeding tube on a monitoring screen during insertion may enable detection of deviation of the tube from the midline as it advances through the chest, possibly indicating entry of the tube into the right or left main bronchus. Purposes To describe (1) published peer-reviewed studies that report on the detection of malpositioned tubes inserted by an electromagnetic tube placement device, and (2) events reported to the US Food and Drug Administration’s Manufacturer and User Facility Device Experience (MAUDE) database regarding use of such a device. Methods An Ovid MEDLINE search was conducted to locate peer-reviewed studies published between 2007 and 2012 that referred to use of an electromagnetic tube placement device to detect inadvertent respiratory placements of feeding tubes. In addition, an online search of the MAUDE database was conducted for the years 2007 through 2012. Results The Ovid MEDLINE search yielded 6 studies that referred to respiratory placements; no cases of pneumothorax were reported. The MAUDE database search yielded 21 adverse events associated with use of an electromagnetic tube placement device (including 17 cases of pneumothorax and 2 deaths). As the MAUDE database relies on voluntary reports, this number should not be construed as the incidence of malpositioned tubes during this period. Conclusions The ability of clinicians to place feeding tubes correctly by using an electromagnetic tube placement device varies. Thus, it is reasonable to question the wisdom of eliminating radiographic confirmation of tube position before starting feedings.

Update on Effectiveness of an Electromagnetic Feeding Tube–Placement Device in Detecting Respiratory Placements

2017 ◽  
Vol 26 (2) ◽  
pp. 157-161 ◽  
Author(s):  
Norma A. Metheny ◽  
Kathleen L. Meert
Keyword(s):  
Respiratory Tract ◽  
Case Reports ◽  
Left Lung ◽  
Feeding Tube ◽  
Brand Names ◽  
Tube Placement ◽  
Success Rates ◽  
User Facility ◽  
The Right ◽  
Feeding Tube Placement

Background Radiography is the accepted gold standard for testing feeding tube placement; however, an electromagnetic tube-placement device (ETPD) is sometimes used in lieu of radiography for this purpose. High success rates have been reported when the device was used by well-trained individuals. However, authors previously described 20 cases that occurred between 2007 and 2012 in which clinicians voluntarily reported inability to detect inadvertent tube insertions in the respiratory tract while using an ETPD. Objective To describe case reports to the US Food and Drug Administration’s Manufacturer and User Facility Device Experience (MAUDE) database between 2013 and 2015 regarding inadvertent respiratory placement of feeding tubes by operators using an ETPD. Methods The MAUDE database was searched for cases dated from January 1, 2013, through December 31, 2015, along with selected brand names. A total of 34 cases (25 after removal of duplicates) were located in which a feeding tube was inserted into the respiratory tract during insertions assisted by an ETPD. Results Sites of the malpositioned tubes included the right lung (n = 13), left lung (n = 6), unspecified lung (n = 4), and bronchus (n = 2). A pneumothorax occurred in 17 of the 25 misplacements; feedings were administered in 6 cases. Conclusions Many case reports involved clinicians failing to recognize tube misplacements in the respiratory tract while using an ETPD. These reports provide evidence that not all clinicians can use the device effectively to detect malpositioned tubes. Thus, one must continue to question the wisdom of eliminating radiographic confirmation of tube position before starting feedings.

Rapid Placement of Transpyloric Feeding Tubes: A Comparison of pH-assisted and Standard Insertion Techniques in Children

PEDIATRICS ◽  
1996 ◽  
Vol 98 (2) ◽  
pp. 242-248
Author(s):  
Brian Krafte-Jacobs ◽  
Melody Persinger ◽  
Jeannean Carver ◽  
Lori Moore ◽  
Richard Brilli
Keyword(s):  
Hospital Costs ◽  
Caloric Intake ◽  
Feeding Tube ◽  
Cost Comparison ◽  
Tube Placement ◽  
Critically Ill Children ◽  
Standard Group ◽  
Feeding Tubes ◽  
Feeding Tube Placement ◽  
Placement Technique

Objective. To compare transpyloric feeding tube placement using a pH-assisted placement technique versus a standard placement technique in pediatric patients requiring enteral nutrition. Methods. Critically ill children younger than 4 years were prospectively and randomly assigned to either a pH-assisted or a standard feeding tube placement group. Identical pH-assisted feeding tubes were used in both groups; however, feeding tubes in the standard group were not attached to a portable pH meter. Successful transpyloric placement was confirmed by radiography before beginning feedings. If placement was not successful, a second placement attempt was made after metoclopramide administration. Information regarding tube placement success, number of radiographs, time to initiaction of feedings, and daily caloric intake was collected. A cost comparison between the two groups was performed. Results. Thirty-four patients were enrolled in the pH-assisted group, and 34 were enrolled in the standard feeding tube group. Ninety-seven percent of patients in the pH-assisted group had successful placement after the first attempt, compared with 53% of patients in the standard group. The average time to successful placement of pH-assisted feeding tubes was 6 minutes. All patients in the pH-assisted group had successful placement after the second attempt, compared with 78% of patients in the standard group. A pH of greater than 5.6 accurately predicted transpyloric placement in 97% (33 of 34) of individuals in the pH-assisted group. Children in the pH-assisted group required significantly fewer radiographs than those in the standard group. Hospital costs were $114 per patient in the pH-assisted group and $135 per patient in the standard group. Conclusions. Our findings indicate that bedside transpyloric placement of pH-assisted feeding tubes can be accomplished rapidly and with a high success rate. This method is associated with decreased radiation exposure and economic savings when compared with a standard placement technique.

scholarly journals Erythromycin for Promoting the Postpyloric Placement of Feeding Tubes: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Qing-Jun Jiang ◽  
Cai-Feng Jiang ◽  
Qi-Tong Chen ◽  
Jian Shi ◽  
Bin Shi
Keyword(s):  
Systematic Review ◽  
Adverse Effects ◽  
Success Rate ◽  
Meta Analysis ◽  
Feeding Tube ◽  
Tube Placement ◽  
Intravenous Route ◽  
Tube Insertion ◽  
Feeding Tubes ◽  
Feeding Tube Placement

Background. Critically ill patients can benefit from enteral nutrition with postpyloric feeding tubes, but the low success rate limits its wide use. Erythromycin could elevate the success rate of tube insertion, but its clinical efficiency still remains controversial. Methods. Included studies must be RCTs which assessed the success rate of postpyloric feeding tube insertion using erythromycin. Results. 284 patients were enrolled in six studies. Meta-analysis showed that erythromycin significantly increases the rate of successful postpyloric feeding tube placement (RR 1.45, 95% CI (1.12, 1.86)) and did not increase the risk of adverse effects (RR 2.15, 95% CI (0.20, 22.82)). Subgroup analysis showed that unweighted feeding tubes (RR 1.47, 95% CI (1.03, 2.11)) could significantly increase the success rate. Country of study, intravenous route of erythromycin, and year of participant enrollment did not influence these results. Conclusions. Erythromycin significantly increases the success rate of postpyloric feeding tube placement. This suggests that erythromycin can be used as an auxiliary method to improve the success rate of bedside insertion.

scholarly journals A Novel Technique for Post-pyloric Feeding Tube Placement in Critically Ill Patients: A Pilot Study

2005 ◽  
Vol 33 (2) ◽  
pp. 229-234 ◽  
Author(s):  
R. J. Young ◽  
M. J. Chapman ◽  
R. Fraser ◽  
R. Vozzo ◽  
D. P. Chorley ◽  
...  
Keyword(s):  
Gastric Emptying ◽  
Pilot Study ◽  
Real Time ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Feeding Tube ◽  
Insertion Time ◽  
Tube Placement ◽  
Feeding Tubes ◽  
Feeding Tube Placement

Delivery of enteral nutrition in critically ill patients is often hampered by gastric stasis necessitating direct feeding into the small intestine. Current techniques for placement of post-pyloric feeding catheters are complex, time consuming or both, and improvements in feeding tube placement techniques are required. The Cathlocator™ is a novel device that permits real time localisation of the end of feeding tubes via detection of a magnetic field generated by a small electric current in a coil incorporated in the tip of the tube. We performed a pilot study evaluating the feasibility of the Cathlocator™ system to guide and evaluate the placement of (1) nasoduodenal feeding tubes, and (2) nasogastric drainage tubes in critically ill patients with feed intolerance due to slow gastric emptying. A prospective study of eight critically ill patients was undertaken in the intensive care unit of a tertiary hospital. The Cathlocator™ was used to (1) guide the positioning of the tubes post-pylorically and (2) determine whether nasogastric and nasoduodenal tubes were placed correctly. Tube tip position was compared with data obtained by radiology. Data are expressed as median (range). Duodenal tube placement was successful in 7 of 8 patients (insertion time 12.6 min (5.3–34.4)). All nasogastric tube placements were successful (insertion time 3.4 min (0.6–10.0)). The Cathlocator™ accurately determined the position of both tubes without complication in all cases. The Cathlocator™ allows placement and location of an enteral feeding tube in real time in critically ill patients with slow gastric emptying. These findings warrant further studies into the application of this technique for placement of post-pyloric feeding tubes.

scholarly journals Hydrocyclone for pre-filtering of irrigation water

2004 ◽  
Vol 61 (2) ◽  
pp. 134-140 ◽  
Author(s):  
Olívio José Soccol ◽  
Tarlei Arriel Botrel
Keyword(s):  
Irrigation Water ◽  
Clay Soil ◽  
Suspended Sediments ◽  
Fine Sand ◽  
Feeding Tube ◽  
Total Efficiency ◽  
Feeding Tubes ◽  
System Type ◽  
Comparison Criteria ◽  
The Right

The use of water containing suspended sediments causes serious problems to irrigation systems. Choosing the right filtering system type and capacity is essential to avoid increases in operational and maintenance costs of irrigation resulting from the need for cleaning and frequent component replacing. Pre-filters, such as the hydrocyclone, are important for their significant capability of retaining particles suspended in the water. Data on hydrocyclones performance for pre-filtering of irrigation water can be found in the literature, but research data in Brazil are scarce. Therefore, four Rietema type hydrocyclones (50 mm diameter) were constructed, one with circular-end and the other three presenting rectangular-end feeding tubes. The evaluation of hydrocyclones performance was conducted by using suspensions of fine sand and clay soil particles under varied pressure differentials. The comparison criteria were the discharge and the separation capability, given by total efficiency and reduced total efficiency. The hydrocyclone with circular-end feeding tube presented the highest indexes for the adopted criteria, considering sand and soil suspensions.

Cortrak-Assisted Feeding Tube Insertion: A Comprehensive Review of Adverse Events in the MAUDE Database

2017 ◽  
Vol 26 (2) ◽  
pp. 149-156 ◽  
Author(s):  
Annette M. Bourgault ◽  
Lillian Aguirre ◽  
Joseph Ibrahim
Keyword(s):  
Adverse Events ◽  
Secondary Analysis ◽  
Left Lung ◽  
Feeding Tube ◽  
Tube Placement ◽  
Tube Insertion ◽  
Electromagnetic Devices ◽  
User Expertise ◽  
User Facility ◽  
Feeding Tube Placement

Background Electromagnetic devices to guide feeding tube placement such as the CORTRAK Enteral Access System have shown promising results; however, researchers in recent studies have expressed concern that a higher level of user expertise may be required for safe use. Objectives To review adverse events related to CORTRAK-assisted feeding tube insertion reported in the Food and Drug Administration’s Manufacturer and User Facility Device Experience (MAUDE) database. Methods A retrospective, secondary analysis of the MAUDE database was performed to evaluate adverse events (ie, injury or death of patient) related to CORTRAK. Results Fifty-four adverse events between January 1, 2006 and February 29, 2016 were identified and reviewed. Most events (98%) involved feeding tube placement in the lungs (37%, left lung; 46%, right lung; 15%, not specified). Lung complications included pneumothorax (77%) and pneumonitis (21%). Death occurred in 17% of lung placements. Clinicians failed to recognize placement in 89% of CORTRAK insertion tracings reviewed. Conclusions Lung placement is not unique to CORTRAK and is an inherent risk of all feeding tube insertions. In known or suspected lung placement, feeding tubes should be removed and radiography performed to assess for pneumothorax. Clinicians must observe closely for lung placement and discriminate lung from gastric placement on insertion tracings. Clinicians require specialized training and experience to develop competency in using the CORTRAK device, although the exact amount of experience needed is unknown.

scholarly journals Esophagojejunostomy Feeding Tube Placement in 5 Dogs with Pancreatitis and Anorexia

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Forrest Cummings ◽  
Catherine A. Daley
Keyword(s):  
Veterinary Medicine ◽  
Enteral Feeding ◽  
Feeding Tube ◽  
Tube Placement ◽  
Loose Stool ◽  
Neurologic Diseases ◽  
Feeding Tubes ◽  
Patient Discomfort ◽  
Enteral Feeding Tube ◽  
Feeding Tube Placement

Enteral feeding tube placement has been described in veterinary medicine for several years. Indications include oral, esophageal, gastrointestinal, pancreatic, hepatic, and neurologic diseases. In this paper, endoscopically assisted placement of an esophagojejunostomy (EJ) feeding tube in dogs with pancreatitis and prolonged anorexia is described. To the author’s knowledge there are no published reports of this procedure. Esophagojejunostomy feeding tubes provide an alternative to other forms of postgastric feeding tube placement (e.g., nasojejunal, gastrojejunostomy, and jejunostomy tubes) without the associated complications of patient discomfort, sneezing, epistaxis, and peritonitis. Tube occlusion, transient vomiting and loose stool were the most commonly reported complications.

scholarly journals Methods Used by Critical Care Nurses to Verify Feeding Tube Placement in Clinical Practice

2015 ◽  
Vol 35 (1) ◽  
pp. e1-e7 ◽  
Author(s):  
Annette M. Bourgault ◽  
Janie Heath ◽  
Vallire Hooper ◽  
Mary Lou Sole ◽  
Elizabeth G. Nesmith
Keyword(s):  
Critical Care ◽  
American Association ◽  
Feeding Tube ◽  
Critical Care Nurses ◽  
Tube Placement ◽  
Evidence Based ◽  
Clinical Practices ◽  
Feeding Tubes ◽  
Verification Methods ◽  
Feeding Tube Placement

BACKGROUNDThe American Association of Critical-Care Nurses practice alert on verification of feeding tube placement makes evidence-based practice recommendations to guide nursing management of adult patients with blindly inserted feeding tubes. Many bedside verification methods do not allow detection of improper positioning of a feeding tube within the gastrointestinal tract, thereby increasing aspiration risk.OBJECTIVESTo determine how the expected practices from the American Association of Critical-Care Nurses practice alert were implemented by critical care nurses.METHODSThis study was part of a larger national, online survey that was completed by 370 critical care nurses. Descriptive statistics were used to analyze the data.RESULTSSeventy-eight percent of nurses used a variety of methods to verify initial placement of feeding tubes, although 14% were unaware that tube position should be confirmed every 4 hours. Despite the inaccuracy of auscultation methods, only 12% of nurses avoided this practice all of the time.CONCLUSIONSImplementation of expected clinical practices from this guideline varied. Nurses are encouraged to implement expected practices from this evidence-based, peer reviewed practice alert to minimize risk for patient harm.

Verifying Placement of Small-Bore Feeding Tubes: Electromagnetic Device Images Versus Abdominal Radiographs

2015 ◽  
Vol 24 (6) ◽  
pp. 525-530 ◽  
Author(s):  
Vera Bryant ◽  
Jean Phang ◽  
Kevin Abrams
Keyword(s):  
Feeding Tube ◽  
Tube Placement ◽  
Electromagnetic System ◽  
Lower Quadrant ◽  
Feeding Tubes ◽  
Left Lower Quadrant ◽  
Electromagnetic Device ◽  
Abdominal Radiographs ◽  
Feeding Tube Placement ◽  
Optimal Site

Background Clinicians are unsure if radiography is needed to confirm correct positioning of feeding tubes inserted with assistance from an electromagnetic system. Objectives To compare radiographic reports of feeding tube placement with images generated by an electromagnetic feeding tube placement device. Methods The medical records of 200 consecutive patients who had feeding tubes inserted with assistance from an electromagnetic feeding tube placement device were reviewed retrospectively. Radiographic reports of tube site were compared with images generated by the device. Results Radiographic evidence of tube sites was available in 188 cases: 184 tubes were located in portions of the gastrointestinal tract. Ninety of the 188 tubes were situated in the optimal site (distal duodenum or jejunum) radiographically. Images generated by the electromagnetic device were available in 176 cases; of these, 52 tubes appeared to end in the expected left lower quadrant. Tubes shown on radiographs to be in other sites also occasionally appeared to end in the left lower quadrant. Nurses using the device did not recognize 4 of the 188 tubes (2.1%) that were inadvertently placed in the lung. No consistent pattern of quadrant distribution was found for tubes positioned in the stomach or proximal duodenum. Conclusions Images generated by the electromagnetic tube placement device provided inconsistent results regarding tube location. A small percentage of seriously malpositioned tubes were not detected by using the electromagnetic device. These findings do not support eliminating radiographs to confirm correct tube placement following use of an electromagnetic tube placement device.

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