Use of Electromagnetic Device to Insert Postpyloric Feeding Tubes in a Pediatric Intensive Care Unit

Brown, Ann‐Marie; Perebzak, Christine; Handwork, Colleen; Gothard, M. David; Nagy, Kristine

doi:10.4037/ajcc2017202

Cited by 11 publications

(15 citation statements)

References 17 publications

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“…However, EN administration, including decision‐making surrounding PP tube placement in our PICU, is guided by a stepwise nutrition algorithm for which audits have shown reasonable compliance and consistent practice . We present data from 100 patients with comparable demographics and clinical status as previously published studies including a similar median patient age, weight, and reliance on mechanical ventilation . Although the success of our training strategy may not be guaranteed when applied to other institutions, the lack of reliance on assistive devices or special tubes increases the potential universal application of this approach.…”

Section: Discussionmentioning

confidence: 96%

“…PP tubes can be placed with other techniques including electromagnetic or fluoroscopy guidance and weighted, migrating feeding tubes. The reported success rates of PP tube placement in critically ill pediatric patients using electromagnetic guidance is 82%–100%, and the reported success rate of using weighted feeding tubes is 89.5% . Success rates of fluoroscopic placement have not been reported.…”

Section: Discussionmentioning

confidence: 99%

“…The reported success rates of PP tube placement in critically ill pediatric patients using electromagnetic guidance is 82%-100%, and the reported success rate of using weighted feeding tubes is 89.5%. [20][21][22][23][24] Success rates of fluoroscopic placement have not been reported. These approaches, however, require special tubes and assistive devices that likely increase the cost of tube placement or require transport outside of the PICU, as is the case with fluoroscopic guidance.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to careful selection of patients who might benefit from PP feeding, challenges surrounding PP tube placement must be considered. A variety of techniques have been reported to obtain PP access, which depend on different levels of expertise and resources and have varied rates of success . In some centers, inability to place a PP tube may be a barrier to providing PP EN delivery .…”

Section: Introductionmentioning

confidence: 99%

“…A variety of techniques have been reported to obtain PP access, which depend on different levels of expertise and resources and have varied rates of success. [13][14][15][16][17][18][19][20][21][22][23][24] In some centers, inability to place a PP tube may be a barrier to providing PP EN delivery. 25 We developed a bedside PP tube-placement competency program to train bedside staff registered nurses (RNs) in the pediatric intensive care unit (PICU) in the blind placement of PP tubes without the use special or assistive devices.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Bedside Postpyloric Tube Placement and Enteral Nutrition Delivery in the Pediatric Intensive Care Unit

Turner¹,

Hamilton²,

Callif

et al. 2020

Nut in Clin Prac

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Background Enteral nutrition (EN) delivery may be more effective via a postpyloric (PP) feeding tube in critically ill children, but tube placement can be challenging. We aimed to describe PP tube placement and EN practices in a multidisciplinary pediatric intensive care unit (PICU) after the implementation of a nurse‐led bedside PP tube‐placement program. Methods In a single‐center retrospective study, we identified 100 consecutive patients admitted to the PICU for >48 hours and for whom PP tube placement was attempted. Demographics, clinical characteristics, and details of PP tube placement and EN delivery were examined. Results The study cohort had a median age (25th, 75th percentiles) of 3.89 years (0.55, 14.86); 66% were male. Respiratory illness was the primary diagnosis of admission (55%); 92% were on respiratory support. Risk of aspiration was the primary indication for PP tube placement (48%). Bedside placement was the initial technique for PP tube placement in 93% of patients (successful for 84.9%) and was not associated with serious complications. Eighty‐seven patients with a PP tube started EN and received a median 73.9% (12.3%, 100%) of prescribed energy goal on day 3 after EN initiation. PP EN allowed 14 of 39 patients receiving parenteral nutrition (PN) to transition off PN 7 days after EN initiation. Thirty‐five percent of EN interruptions were due to feeding‐tube dysfunction. Conclusion Bedside PP tube placement is safe and feasible and allows for effective EN delivery and decreased PN use when applicable. Interruptions in PP EN due to tube malfunction are prevalent.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Bedside Postpyloric Tube Placement and Enteral Nutrition Delivery in the Pediatric Intensive Care Unit

Turner¹,

Hamilton²,

Callif

et al. 2020

Nut in Clin Prac

View full text Add to dashboard Cite

show abstract

Feeding Tube Insertion and Placement Confirmation Using Electromagnetic Guidance: A Team Review

McCutcheon

Whittet

Kirsten

et al. 2017

J Parenter Enteral Nutr

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Background: Challenges for bedside placement of small-bore feeding tube (SBFT) include iatrogenic injury, multiple exposures to x-rays, and prolonged placement times. In 2011, the study facility began a feeding tube placement team (FTPT) using the COR-TRAK system (CS) in the adult intensive care unit (ICU) and medical-surgical populations. In 2013, a protocol was implemented using the CS to determine final SBFT location. Methods: Serial retrospective reviews were done of patients with SBFT placement by the FTPT during July 2011-December 2012 and 2015. Measures included pulmonary deviation, tube location, placement agreement beyond chance for CS tracing and confirmation radiography (CR), x-ray frequency, and placement time intervals. Results: A total of 6290 SBFT placements were completed for 4239 patients. First-attempt SBFT locations were 12.78% gastric, 13.39% first through fourth portion of duodenum, and 73.83% ligament of Treitz/jejunum, with zero placements in esophagus or lung. In 2015, staff avoided 68 lung placements by recognizing proximal pulmonary deviation. X-ray preprotocol vs protocol (mean [SD]: 1.02 [0.15] vs 0.26 [0.44]) resulted in 74% x-ray reduction and cost avoidance of $346,000. Time intervals (mean [SD]; N = 6290) were 14.90 (12.74) minutes for insertion, 46.04 (13.80) minutes for placement event, and 3.85 (2.23) hours for consult conclusion. Agreement for n = 1692 placements was 85.28%, with k score of 0.622 (95% confidence limit: 0.582, 0.661; P = .0005). Conclusions: Team management of SBFT placement using the CS optimizes patient safety, standardizes practice, and decreases cost. Using the CS to determine final SBFT location is a safe alternative to CR. (JPEN J Parenter Enteral Nutr. 2018;42:247-254)

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Pediatric Nasogastric Tube Placement and Verification: Best Practice Recommendations From the NOVEL Project

et al. 2018

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The placement of a nasogastric tube (NGT) in a pediatric patient is a common practice that is generally perceived as a benign bedside procedure. There is potential risk for NGT misplacement with each insertion. A misplaced NGT compromises patient safety, increasing the risk for serious and even fatal complications. There is no standardized method for verification of the initial NGT placement or reverification assessment of NGT location prior to use. Measurement of the acidity or pH of the gastric aspirate is the most frequently used evidence-based method to verify NGT placement. The radiograph, when properly obtained and interpreted, is considered the gold standard to verify NGT location. However, the uncertainty regarding cumulative radiation exposure related to radiographs in pediatric patients is a concern. To minimize risk and improve patient safety, there is a need to identify best practice and to standardize care for initial and ongoing NGT location verification. This article provides consensus recommendations for best practice related to NGT location verification in pediatric patients. These consensus recommendations are not intended as absolute policy statements; instead, they are intended to supplement but not replace professional training and judgment. These consensus recommendations have been approved by the American Society for Parental and Enteral Nutrition (ASPEN) Board of Directors.

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Use of Electromagnetic Device to Insert Postpyloric Feeding Tubes in a Pediatric Intensive Care Unit

Abstract: Successful placement of postpyloric feeding tubes by nurse practitioners was safely enhanced using an electromagnetic device. Establishing users' expertise with the device before studying outcomes may improve effectiveness.

Cited by 11 publications

References 17 publications

Bedside Postpyloric Tube Placement and Enteral Nutrition Delivery in the Pediatric Intensive Care Unit

Bedside Postpyloric Tube Placement and Enteral Nutrition Delivery in the Pediatric Intensive Care Unit

Feeding Tube Insertion and Placement Confirmation Using Electromagnetic Guidance: A Team Review

Pediatric Nasogastric Tube Placement and Verification: Best Practice Recommendations From the NOVEL Project

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