Electromagnetic Sensor-Guided Enteral Access Systems: A Literature Review

Abstract

Enteral feeding is the nutritional support of choice for acutely ill patients with functional gastrointestinal tracts who are unable to swallow. Several benefits including reduced mortality and length of hospital stay have been associated with early initiation of enteral feeding. However, misplacement of conventional nasoenteric tubes is relatively common and can result in complications including pneumothorax. In addition, the need to confirm the position by X-ray can delay the start of using the tube. Eliminating these delays can help patients start feeding, and minimise the adverse impact on initiating hydration and medication. The purpose of this review was to critically examine whether electromagnetic sensor-guided enteral access systems (EMS-EAS) can help overcome the challenges of conventional nasoenteric feeding tube placement and confirmation. The Royal Society of Medicine’s library performed two searches on Medline (1946–March 2014) and Embase (1947–March 2014) covering all papers on Cortrak or electromagnetic or magnetic guidance systems for feeding tubes in adults. Results from the literature search found an agreement between the radiographic and EMS-EAS confirmation of placement. EMS-EAS virtually eliminated the risk of misplacement and pneumothorax was not reported. In addition, studies showed a small decrease in the number of X-rays with EMS-EAS and a reduced average time to start feeding compared with blind placement. This review suggests that EMS-EAS reduces several complications associated with the misplacement of nasoenteric feeding tubes, and that there could be considerable improvements in mortality, morbidity, patient experience and cost if EMS-EAS is used instead of conventional methods.

ASPEN Safe Practices for Enteral Nutrition Therapy

“…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 …”

Successful Placement of Nasointestinal Feeding Tubes Using an Electromagnetic Sensor‐Guided Enteral Access System in Patients With Left Ventricular Assist Devices

“…There is no published case series on the utilization of EMS‐EAS in patients with heart failure with implanted cardiac devices. A review of the literature shows that there is a 43%–95% success rate of achieving postpyloric placement using EMS‐EAS in a variety of patient populations without implanted cardiac devices . Our success rate of 69% postpyloric placement in this case series is comparable with success rates of studies completed in non‐LVAD patient populations.…”

Successful Identification of Anatomical Markers and Placement of Feeding Tubes in Critically Ill Patients via Camera‐Assisted Technology with Real‐Time Video Guidance

“…Risks of tube misplacement include pneumothorax, vocal cord injury (nasogastric tube syndrome), bronchopleural fistula, aspiration pneumonia, perforation of the membranous trachea or pleural parenchyma, hydrothorax, mediastinitis atelectasis, plural effusions, and death. 7 Inadvertent insertion of enteral FTs into the tracheopulmonary system during placement is not predictable from clinical signs and auscultation in highrisk patients with the following associated factors: altered mental status, preexisting endotracheal tube, critical illness, older adults, and abdominal distention. 8 In the high-risk patient, alternatives to blind FT insertion are needed to improve patient safety.…”