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Implementation of an electromagnetic imaging system to facilitate nasogastric and post-pyloric feeding tube placement in patients with and without critical illness

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Abstract:

Abstract Background: 

Artificial nutrition support is required to optimise nutritional status in many patients. Traditional methods of placing feeding tubes may incur clinical risk and financial costs. A technique facilitating placement of nasogastric and post-pyloric tubes via electromagnetic visual guidance may reduce the need for X-ray exposure, endoscopy time and the use of parenteral nutrition. The present study aimed to audit use of such a system at initial implementation in patients within an acute NHS Trust. Methods: 

A retrospective review was undertaken of dietetic and medical records for the first 14 months of using the CortrakĀ® system. Data were collected on referral origin, preparation of the patient prior to insertion, placement success rates and need for X-ray. Cost analysis was also performed. Results: 

Referrals were received from primary consultants or consultant intensivists, often on the advice of the dietitian. Fifty-nine percent of patients received prokinetic therapy at the time of placement. Thirty-nine tube placements were attempted. Sixty-nine percent of referrals for post-pyloric tube placement resulted in successful placement. X-ray films were requested for 22% of all attempted post-pyloric placements. Less than half of nasogastric tubes were successfully passed, although none of these required X-ray confirmation. The mean cost per tube insertion attempt was Ā£111. Conclusions: 

This system confers advantages, particularly in terms of post-pyloric tube placement, even at this early stage of implementation. A reduction in clinical risk and cost avoidance related to X-ray exposure, the need for endoscopic tube placement and parenteral nutrition have been achieved. The implementation of this system should be considered in other centres.

Keywords: critical care; enteral tube feeding; health service technology; nutrition support

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1365-277X.2009.01010.x

Affiliations: 1: Department of Nutrition and Dietetics, Pinderfields General Hospital, Wakefield, West Yorkshire, UK 2: Directorate of General Medicine, Dewsbury & District Hospital, Dewsbury, West Yorkshire, UK 3: Directorate of General Medicine, Pinderfields General Hospital, Wakefield, West Yorkshire, UK 4: Department of Gastroenterology, Pinderfields General Hospital, Wakefield, West Yorkshire, UK

Publication date: February 1, 2010

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