Catastrophic complication of an electromagnetic placed postpyloric feeding tube

Helbach, M. Veltcamp; Savelkoul, Claudia; Festen-Spanjer, Barbara; Tjan, David H

doi:10.1136/bcr-2016-216738

Cited by 3 publications

(1 citation statement)

References 3 publications

(3 reference statements)

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“…Feeding tube insertion is also related to unique and complex adverse events. [16][17][18][19][20]27 The therapy requires expertise in unguided placement techniques. In our study, the MATEs were relatively high, partly owing to the limited experience in a newly introduced technique.…”

Section: Discussionmentioning

confidence: 99%

The learning curve in blind bedside postpyloric placement of spiral tubes: data from a multicentre, prospective observational study

Sun

Zheng

et al. 2019

J Int Med Res

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Objective This study sought to quantify the learning curve for the blind bedside postpyloric placement of a spiral tube in critically ill patients. Methods We retrospectively analysed 127 consecutive experiences of three intensivists who performed comparable procedures of blind bedside postpyloric placement of a spiral tube subsequent to failed self-propelled transpyloric migration in a multicentre study. Each intensivist’s cases were divided chronologically into two groups for analysis. The assessment of the learning curve was based on efficiency and safety outcomes. Results All intensivists achieved postpyloric placement for over 80% of their patients. The junior intensivist showed major improvement in both efficiency and safety outcomes, and the learning curve for both outcomes was approximately 20 cases. The junior intensivist showed a significant increase in the success rate of proximal jejunum placement and demonstrated a substantial decrease in the major adverse tube-associated events rate. The time to insertion significantly decreased in each intensivist as case experience accumulated. Conclusions Blind bedside postpyloric placement of a spiral tube involves a significant learning curve, indicating that this technique could be readily acquired by intensivists with no previous experience using an adequate professional training programme.

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Section: Discussionmentioning

confidence: 99%

The learning curve in blind bedside postpyloric placement of spiral tubes: data from a multicentre, prospective observational study

Sun

Zheng

et al. 2019

J Int Med Res

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Cortrak tube placement part 2: guidance to avoid misplacement is inadequate

et al. 2017

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Electromagnetic (EM)-guided tube placement has been successfully used to pre-empt lung misplacement, but undetected misplacements continue to occur. The authors conducted an audit to investigate whether official Cortrak or local guidance enabled differentiation of gastrointestinal (GI) from lung traces. X-ray, pH or an EM trace beyond the gastric body were used to independently confirm gastric position. The authors undertook 596 nasointestinal (NI) tube placements, of which 361 were primary GI placements and 41 lung misplacements. Official guidance that in GI traces a midline deviation is absent cannot differentiate GI from lung traces because deviation is common in both. However, when comparing a trace in the same patient, midline deviation during lung misplacement always occurred >18 cm above the horizontal line compared with only 33% of the subsequent GI deviation (p<0.0001). Official guidance could lead to aborted GI placements or undetected lung placements. EM-guided placement must have an expert-led understanding of the 3D trace pattern, artefact correction and appraised practical experience differentiating GI from lung placement. The authors invite Halyard Health to update guidance in view of these findings.

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Pneumothoraces Prevented With Use of Electromagnetic Device to Place Feeding Tubes

Bourgault

Powers

Aguirre

2020

American Journal of Critical Care

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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.

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Catastrophic complication of an electromagnetic placed postpyloric feeding tube

Cited by 3 publications

References 3 publications

The learning curve in blind bedside postpyloric placement of spiral tubes: data from a multicentre, prospective observational study

The learning curve in blind bedside postpyloric placement of spiral tubes: data from a multicentre, prospective observational study

Cortrak tube placement part 2: guidance to avoid misplacement is inadequate

Pneumothoraces Prevented With Use of Electromagnetic Device to Place Feeding Tubes

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