CORTRAK Superuser Competency Assessment and Training Recommendations

Abstract

Background Blind insertion of feeding tubes remains unsafe. Electromagnetic placement devices such as the CORTRAK Enteral Access System allow operators to interpret placement of feeding tubes in real time. However, pneumothoraces have been reported and inadequate user expertise is a concern. Objective To explore factors influencing competency of CORTRAK-assisted feeding tube insertion. Methods A prospective, observational pilot study was conducted. Data collection included demographics, self-confidence, clinical judgment regarding CORTRAK-assisted feeding tube insertion, and general self-efficacy. CORTRAK-assisted feeding tube insertions were performed with the Anatomical Box and CORMAN task trainers. Results Twenty nurses who had inserted a mean of 53 CORTRAK feeding tubes participated. Participants inserted a mean of 2 CORTRAK feeding tubes weekly; each had inserted a feeding tube in the past 7 days. All superusers were competent; 1 required remediation for improper receiver unit placement. Mean (SD) scores were 35 (3.68) on a 40-point scale for self-efficacy, 4.6 (0.68) on a 5-point scale for self-reported feeding tube insertion confidence, and 4.85 (0.49) on a 5-point scale for demonstrated confidence. Participants estimated that 8 CORTRAK-assisted insertions were needed before they felt competent as super users. Confidence with the CORTRAK tracing was estimated to require 10 feeding tube insertions. Six participants continued to assess placement by auscultation, suggesting low confidence in their interpretation of the tracing. Conclusions At least 3 observations should be performed to assess initial competency; the number should be individualized to the operator. Interpretation of the insertion tracing is complex and requires multiple performance opportunities to gain competency and confidence for this high-risk skill.

On track to the stomach! ! Cortrak® for the insertion of nasogastric tubes amongst neuroscience patients – how effective is it?

“…However, it is known that patients scratch their nose due to the itchy sensation of the tape resulting in the removal of the tube. Important points as identified by Bourgault et al (2019) were to correctly identify the patient and any contra-indications for tube insertion such as basal skull fracture or coagulation derangements. The head of bed at 30-45 degrees was also important for successful insertion as with all nasogastric tubes.…”

Developing and Maintaining an RDN‐Led Bedside Feeding Tube Placement Program

“…In Bourgault and colleagues' observational pilot study, they reported previously trained RNs (n = 20) self-reported needing to complete 8 SBFT placements with an EMPD before they felt confident performing this procedure. 30 Interpretation of the insertion tracing was the most commonly observed operator error reported, and the RNs in this cohort self-identified needing to complete 10 placements before "confidence" was established. These authors also suggested that at least 3 observations should be performed to assess initial competency; however, that number may need to be individualized.…”

“…These authors also suggested that at least 3 observations should be performed to assess initial competency; however, that number may need to be individualized. 30 Initial, annual, and/or ongoing competency evaluation is required to ensure the RDN/RN is compliant with policies and procedures, understands techniques, and has developed critical thinking skills for evaluating patient safety or other clinical concerns. Maintaining competency in the placement of SBFTs is especially important for RDNs/RNs who may not have the opportunity to place them on a daily or even weekly basis.…”

Development of a Competency Model for Placement and Verification of Nasogastric and Nasoenteric Feeding Tubes for Adult Hospitalized Patients

“…By placing NE tubes more frequently, clinicians likely become more proficient at this skill and are able to practice at the expert level. Often, these clinicians are designated as a “super user.” A “super user” can be defined as a core team member who is trained, independent, and a validated operator of a feeding tube placement device 90 . This model may work better for smaller healthcare facilities with lower numbers of feeding tube placement orders or for training medical staff.…”

“…In an observational pilot study, Bourgault et al identified previously trained RNs (n = 20) who, through self‐report, estimated that they needed to complete a mean of eight tube placements with an EMPD before they felt confident performing this procedure 90 . Interpretation of the insertion tracing was the most commonly observed operator error reported, and the RNs in this cohort self‐reported needing to complete a mean of 10 placements before “confidence” was established.…”