CORTRAK Superuser Competency Assessment and Training Recommendations

2019 ◽  
Vol 28 (1) ◽  
pp. 30-40 ◽  
Author(s):  
Annette M. Bourgault ◽  
Laura Gonzalez ◽  
Lillian Aguirre ◽  
Joseph A. Ibrahim
Keyword(s):  
Clinical Judgment ◽  
Self Efficacy ◽  
Feeding Tube ◽  
Competency Assessment ◽  
Point Scale ◽  
Tube Insertion ◽  
Feeding Tubes ◽  
Self Confidence ◽  
User Expertise ◽  
Receiver Unit

Background Blind insertion of feeding tubes remains unsafe. Electromagnetic placement devices such as the CORTRAK Enteral Access System allow operators to interpret placement of feeding tubes in real time. However, pneumothoraces have been reported and inadequate user expertise is a concern. Objective To explore factors influencing competency of CORTRAK-assisted feeding tube insertion. Methods A prospective, observational pilot study was conducted. Data collection included demographics, self-confidence, clinical judgment regarding CORTRAK-assisted feeding tube insertion, and general self-efficacy. CORTRAK-assisted feeding tube insertions were performed with the Anatomical Box and CORMAN task trainers. Results Twenty nurses who had inserted a mean of 53 CORTRAK feeding tubes participated. Participants inserted a mean of 2 CORTRAK feeding tubes weekly; each had inserted a feeding tube in the past 7 days. All superusers were competent; 1 required remediation for improper receiver unit placement. Mean (SD) scores were 35 (3.68) on a 40-point scale for self-efficacy, 4.6 (0.68) on a 5-point scale for self-reported feeding tube insertion confidence, and 4.85 (0.49) on a 5-point scale for demonstrated confidence. Participants estimated that 8 CORTRAK-assisted insertions were needed before they felt competent as super users. Confidence with the CORTRAK tracing was estimated to require 10 feeding tube insertions. Six participants continued to assess placement by auscultation, suggesting low confidence in their interpretation of the tracing. Conclusions At least 3 observations should be performed to assess initial competency; the number should be individualized to the operator. Interpretation of the insertion tracing is complex and requires multiple performance opportunities to gain competency and confidence for this high-risk skill.

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.

Endoscopic Insertion of Nasojejunal Feeding Tube at Bedside for Critically Ill Patients: Relationship between Tube Position and Intragastric Countercurrent of Contrast Medium

2019 ◽  
Vol 75 (3) ◽  
pp. 163-167
Author(s):  
Hiroomi Tatsumi ◽  
Masayuki Akatsuka ◽  
Satoshi Kazuma ◽  
Yoichi Katayama ◽  
Yuya Goto ◽  
...  
Keyword(s):  
Contrast Medium ◽  
Feeding Tube ◽  
Tube Insertion ◽  
Abdominal Radiography ◽  
Feeding Tubes ◽  
Tube Position ◽  
Endoscopic Insertion ◽  
Endoscopic Placement ◽  
Nasojejunal Feeding ◽  
Enteral Nutrients

Background and Oblectives: We evaluated the success rate of endoscopically positioned nasojejunal feeding tubes and the intragastric countercurrent of contrast medium thereafter. Method: This retrospective observational study investigated patients who were admitted to a single intensive care unit and required endoscopic placement of a post-pyloric feeding tube between January 2010 and June 2016. The feeding tube was grasped with forceps via a transoral endoscope and inserted into the duodenum or jejunum. Thereafter, we assessed the position of the tube and the intragastric countercurrent using abdominal radiography with contrast medium. Results: The tube tip was inserted at the jejunum and the duodenal fourth portion in 55.8 and 33.6% of patients, respectively. The tip of the inserted tube had moved into the jejunum of 71.7% of patients by the following day. The countercurrent rate was significantly lower among patients with a tube inserted into the duodenal fourth portion or more distal than among those with tubes inserted more proximally (8.4 vs. 45.4%, p = 0.0022). Conclusions: The endoscopic insertion and positioning of a nasojejunal feeding tube seemed effective because the rate of tube insertion into the duodenal fourth portion or more distal was about 90%. The findings of intragastric countercurrents indicated that feeding tubes should be inserted into the duodenal fourth portion or beyond to prevent vomiting and the aspiration of enteral nutrients.

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.

Pneumothoraces Prevented With Use of Electromagnetic Device to Place Feeding Tubes

2020 ◽  
Vol 29 (1) ◽  
pp. 22-32 ◽  
Author(s):  
Annette M. Bourgault ◽  
Jan Powers ◽  
Lillian Aguirre
Keyword(s):  
Respiratory Tract ◽  
Real Time ◽  
Feeding Tube ◽  
Pulmonary Complications ◽  
Tube Insertion ◽  
Feeding Tubes ◽  
Pulmonary System ◽  
Tube Position ◽  
Real Time Visualization ◽  
Time Of Feeding

Background A US Food and Drug Administration safety letter warned about the risk for pneumothoraces during feeding tube insertion despite the use of electromagnetic placement devices that provide real-time visualization of feeding tube position. Objectives To systematically assess pulmonary placement and pneumothoraces in CORTRAK-assisted feeding tube insertions. Methods CINAHL, MEDLINE, and Cochrane databases were searched for studies of CORTRAK-assisted feeding tube insertion. Thirty-two studies documenting pulmonary placement and/or complications of feeding tube insertion were found. Results Operators recognized pulmonary placement on insertion tracings during 202 CORTRAK-assisted feeding tube insertion procedures, resulting in the immediate withdrawal of 199 feeding tubes. One pneumothorax was identified later by radiography. Seven pulmonary placements were not recognized by CORTRAK operators at the time of feeding tube insertion, resulting in 2 pneumothoraces. The incidence of pneumothorax for CORTRAK-assisted feeding tube insertions was 0.02% (3 of 17039). Of the feeding tubes inserted into the pulmonary system – either found during or after the procedure −1.4% (3 of 209) resulted in pneumothoraces (as opposed to the 19% to 28% incidence of pneumothorax for blind feeding tube insertions. Operators recognizing pulmonary placement on CORTRAK insertion tracings may have prevented 97% (202 of 209) of feeding tubes from being inserted farther into the respiratory tract. Conclusions Feeding tube insertion with an electromagnetic placement device is advantageous over blind feeding tube insertion because the operator can recognize pulmonary placement early and withdraw the feeding tube, thus decreasing the risk of pulmonary complications.

Feeding Tube and Survival Among Patients with Severe Cognitive Impairment (DRAFT)

2018 ◽  
Author(s):  
Claudio Adile
Keyword(s):  
Cognitive Impairment ◽  
Study Design ◽  
Survival Benefit ◽  
Clinical Case ◽  
Feeding Tube ◽  
Advanced Dementia ◽  
Tube Insertion ◽  
Feeding Tubes ◽  
Study Intervention

This chapter provides an overview and commentary on the study published by Teno and colleagues in 2012 that analyzed if feeding tube insertion and its timing affect survival in patients with advanced dementia. The study concluded that insertion of feeding tubes, irrespective of the timing of insertion, does not confer a survival benefit. This chapter describes the basics of the study, including funding, year study began, year study was published, study location, who was studied, who was excluded, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, gives a summary and discusses implications, and concludes with a relevant clinical case.

Complex Decisions Involving Gastrostomy Feeding Tubes: When You’re Never Right or Wrong

2010 ◽  
Vol 15 (2) ◽  
pp. 42-47 ◽  
Author(s):  
Paula Leslie ◽  
James Coyle
Keyword(s):  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Oral Intake ◽  
Clinical Decision ◽  
Feeding Tube ◽  
Care Practice ◽  
Health Care Practice ◽  
Feeding Tubes ◽  
Patient Values

Clinical decision-making in most cases of dysphagia is neither black nor white. Risk factors predisposing a person to pneumonia, malnutrition, or dehydration can never be reduced to zero chance. Clinicians often believe that patients they consider as “unsafe for oral intake” will somehow have the best outcome if they eliminate aspiration while swallowing by using a feeding tube. In many cases, there is no evidence or reasonable expectation that a feeding tube will maintain or improve the patient's quality of life, health, or life expectancy. Feeding tubes can increase discomfort, worsen outcomes, or result in earlier mortality. Clinical decisions must integrate best clinical judgment, patient values and expectations, and best external evidence of a patient's whole health status not just dysphagia. We must carefully consider ethical imperatives governing health care practice, especially when a feeding tube is a possible intervention choice.

Insight into strategies adopted by the residents who passed exit fellowship examination in first few attempts

2020 ◽  
Vol 14 (1) ◽  
pp. 10-15
Author(s):  
Humera Zafar Ali Khan ◽  
Amina Ahmad ◽  
Abid Ashar ◽  
Hamid Mahmood
Keyword(s):  
Learning Strategies ◽  
Self Efficacy ◽  
Self Regulation ◽  
Structural Description ◽  
Snowball Sampling ◽  
Emotional Wellbeing ◽  
Self Directed Learning ◽  
Self Confidence ◽  
Helpful Factors ◽  
Emotional Burnout

Background: The residents who pass exit fellowship examination in few attempts adopt certain strategies for early success. The lived experiences of residents passing FCPS final examination in few attempts, barriers to success and strategies to overcome those barriers were studied. Participants and methodology: This phenomenological research study was conducted at Services Hospital, Lahore, Pakistan from June 2015 to May 2017. Purposeful snowball sampling was done. Eleven residents who passed their Final FCPS examination in few attempts, in the last 15 years were included in the study. Semi-structured open-ended interview of the residents was audio-recorded and transcribed. Three themes of helpful factors, barriers encountered and suggestions to overcome those barriers to get through the final FCPS examination and the emerging sub-themes were analyzed and textural and structural description were assigned. Results: Three themes were based on the aim of study and their related emerging sub-themes were found. The helpful factors included self-directed learning, peer assisted learning, interactive educational environment, rehearsal and self-determination. Barriers encountered were related to learning difficulties, competing responsibilities and physical and emotional burnout. Lastly, suggestions to overcome the barriers were use of multiple technology based learning strategies, developing self-confidence and self-efficacy together with prioritization of emotional and physical wellbeing. Conclusions: This study found that self-regulation and internal motivation were important strategies for success in the FCPS exit examination. Barriers can be overcome through technology based learning and increased self-efficacy and prioritizing physical and emotional wellbeing.

Effects of a Low-Element Challenge Course on Abstinence Self-Efficacy and Group Cohesion

2011 ◽  
Vol 22 (2) ◽  
pp. 151-158 ◽  
Author(s):  
Jamie M. Clem ◽  
Thomas E. Smith ◽  
Kristin V. Richards
Keyword(s):  
Outcome Measures ◽  
Self Efficacy ◽  
Group Cohesion ◽  
Future Research ◽  
Chemically Dependent ◽  
Challenge Course ◽  
Self Confidence ◽  
Therapeutic Value ◽  
Before And After ◽  
Group Unity

Substance abuse researchers identify self-efficacy and group cohesion as important components in alcohol and other drug-dependency treatment. Objectives: The purpose of this single-group, pretest–posttest study is to explore the therapeutic value of a challenge course intervention on the self-efficacy and group cohesion of nine chemically dependent, adult females. Methods: Data were collected using two validated outcome measures administered before and after the intervention. Focus groups provided insight into the experiences of participants and were examined using manifest and latent theme analysis. Results: Findings indicate statistically significant improvements on both outcome measures with medium to large effect sizes. Several themes were identified including group unity, trust, interpersonal growth, and self-confidence. Conclusions: Suggestions for practice and future research are provided.

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