Cortrak feeding tube placement: accuracy of the ‘GI flexure system’ versus manufacturer guidance

Abstract

Electromagnetic (EM) guided enteral tube placement may reduce lung misplacement to almost zero in expert centres, but more than 60 undetected misplacements had occurred by 2016 resulting in major morbidity or death. Aim: Determine the accuracy of manufacturer guidance in trace interpretation against what is referred to as the ‘GI flexure system’. Methods: The authors prospectively observed the accuracy of the ‘GI flexure system’ of trace interpretation against manufacturer guidance in primary nasointestinal (NI) tube placements. Findings: Contrary to manufacturer guidance, 33% of traces deviated >5 cm from the sagittal midline and 26.5% were oesophageal when entering the lower left quadrant, incorrectly indicating lung and gastric placement, respectively. Conversely, the GI flexure system identified ≥99.4% of GI traces when they reached the gastric body flexure; 100% at the superior duodenal flexure. All lung misplacements were identified by the absence of GI flexures. Conclusion: Current manufacturer guidance should be updated to the GI flexure system of interpretation.

Nasointestinal tube placement: Techniques that increase success

“…Anatomical points were interpreted from trace characteristics, previously described. [20][21][22] This permitted the operator, an ICU dietitian or consultant, to guide tube placement and confirm final position. Tubes left in situ were used for feeding.…”

Sonden und PEGs zur Ernährung und Dekompression

“…So kann die Positionierung der Sonde unmittelbar auf einem Monitor verfolgt werden, was bei entsprechender Expertise zu einer geringeren Fehlplatzierungsrate und geringeren Belastung der Patienten führen kann. Aber auch hier sollte im Zweifel die Positionierung radiologisch validiert werden [23].…”

Integrated real-time imaging system, ‘IRIS’, Kangaroo feeding tube: a guide to placement and image interpretation

“…The large tube tip and possibly tube curvature appear to result in more tubes initially deflecting into the trachea (28%), similar to the 20%-35% found in previous studies, 8 17 but more than the 11.4% of smaller-tipped EM-guided tubes. 11 However, IRIS tubes detect misplacement precarina and usually without inducing coughing. Conversely, blind and EM tube placements may enter more deeply into the lung and induce coughing that leads the tube being repositioned before the X-ray or EM trace can evidence respiratory placement.…”

“…EM placement has a lower rate of undetected lung misplacement than blind placement in high-use centres (0.006% vs 0.01%), but it is higher than blind placement in low-use centres (0.35% vs 0.01%). [9][10][11][12] Most errors were due to misinterpretation of the EM traces 13 14 through insufficient training. 15 In addition, interpretation based on manufacturer guidance may be inaccurate in about 25%-30% of cases.…”