Verifying Placement of Small-Bore Feeding Tubes: Electromagnetic Device Images Versus Abdominal Radiographs

Bryant, Vera; Phang, Jean S.; Abrams, Kevin

doi:10.4037/ajcc2015493

Cited by 29 publications

(19 citation statements)

References 4 publications

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“…Of the 194 patients in this study, only 1 had data showing discrepancies between the original EMPD verification and the final abdominal radiograph interpretation, providing a 99.5% agreement 26 . Other recent studies and a literature review demonstrated similar conclusions, 27 , 28 while 2 more recent papers point out the potential risk of eliminating x‐ray confirmation with inexperienced operators 29 , 30 …”

Section: Section 4 Enteral Accesssupporting

confidence: 51%

ASPEN Safe Practices for Enteral Nutrition Therapy

Boullata

Carrera²,

Harvey

et al. 2016

J Parenter Enteral Nutr

328

531

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Enteral nutrition (EN) is a valuable clinical intervention for patients of all ages in a variety of care settings. Along with its many outcome benefits come the potential for adverse effects. These safety issues are the result of clinical complications and of process-related errors. The latter can occur at any step from patient assessment, prescribing, and order review, to product selection, labeling, and administration. To maximize the benefits of EN while minimizing adverse events requires that a systematic approach of care be in place. This includes open communication, standardization, and incorporation of best practices into the EN process. This document provides recommendations based on the available evidence and expert consensus for safe practices, across each step of the process, for all those involved in caring for patients receiving EN.

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Section: Section 4 Enteral Accesssupporting

confidence: 51%

ASPEN Safe Practices for Enteral Nutrition Therapy

Boullata

Carrera²,

Harvey

et al. 2016

J Parenter Enteral Nutr

328

531

View full text Add to dashboard Cite

show abstract

“…Feeding tubes were inserted by trained nurses, although the amount of training and experience with feeding tube insertion was inconsistent; nurses received 30 to 120 minutes of classroom training, but some had no supervised clinical placements. 20 Bryant et al reported that all 3 lung placements were not identified on the CORTRAK insertion tracings, and yet these feeding tubes were confirmed to be in the lung by radiography. When the radiograph was obtained, the distal tips of all 3 feeding tubes were visualized in the lower left quadrant of the CORTRAK insertion tracing, which is an unexpected location for tubes placed in the lung.…”

Section: Discussionmentioning

confidence: 99%

“…In a retrospective study of 188 tubes placed by using CORTRAK, Bryant et al 20 reported that 2% (3/188) resulted in lung placement errors. Feeding tubes were inserted by trained nurses, although the amount of training and experience with feeding tube insertion was inconsistent; nurses received 30 to 120 minutes of classroom training, but some had no supervised clinical placements.…”

Section: Discussionmentioning

confidence: 99%

“…Didactic training ranged from policy review and a training video 11 to classroom education 30 to 120 minutes in length. 20,22 Competency assessment of CORTRAK-assisted insertions of feeding tubes fluctuated from 0 to 10 clinical observations, 20 although 2 or 3 observations appeared to be most common. 11,22,23 As with any medical device, if there are concerns about the safety or functionality of the product, the device should be removed from service until it can be assessed and/or repaired.…”

Section: Recommendations For Practicementioning

confidence: 99%

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Cortrak-Assisted Feeding Tube Insertion: A Comprehensive Review of Adverse Events in the MAUDE Database

Bourgault

Aguirre

Ibrahim

2017

American Journal of Critical Care

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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.

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“…Multiple cases have been reported in which clinicians failed to recognize placement of feeding tubes in the respiratory tract while using an ETP device; some of these were associated with fatal outcomes. 53,54 Reports of clinicians failing to recognize tube perforations through the nasopharynx or esophagus while using an ETP device have also been published. 55,56 Radiographic Confirmation 1.…”

Section: Aacn Practice Alertmentioning

confidence: 99%

Initial and Ongoing Verification of Feeding Tube Placement in Adults (applies to blind insertions and placements with an electromagnetic device)

2016

Critical Care Nurse

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Level A Meta-analysis of quantitative studies or metasynthesis of qualita tive studies with results that consis tently support a specifi c action, intervention, or treatment (including systematic review of randomized controlled trials) Level B Well-designed, controlled studies with results that consistently support a specifi c action, intervention, or treatment Level C Qualitative studies, descriptive or correlational studies, integrative reviews, systematic reviews, or randomized controlled trials with inconsistent results Level D Peer-reviewed professional and organizational standards with the support of clinical study recommendations Level E Multiple case reports, theory-based evidence from expert opinions, or peer-reviewed professional organizational standards without clinical studies to support recommendations Level M Manufacturer's recommendations only by AACN on April 4, 2019

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Verifying Placement of Small-Bore Feeding Tubes: Electromagnetic Device Images Versus Abdominal Radiographs

Cited by 29 publications

References 4 publications

ASPEN Safe Practices for Enteral Nutrition Therapy

ASPEN Safe Practices for Enteral Nutrition Therapy

Cortrak-Assisted Feeding Tube Insertion: A Comprehensive Review of Adverse Events in the MAUDE Database

Initial and Ongoing Verification of Feeding Tube Placement in Adults (applies to blind insertions and placements with an electromagnetic device)

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