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.

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.

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.

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.

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.

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