Electromagnetic Versus Blind Guidance of a Postpyloric Feeding Tube in Critically Ill Children

Abstract

BACKGROUND AND OBJECTIVES: Postpyloric feeding tube placement is a time-consuming procedure associated with multiple attempts and radiation exposure. Our objective with this study is to compare the time, attempts, and radiation exposure using the electromagnetic versus blind method to place a postpyloric feeding tube in critically ill children. Our hypothesis is that using electromagnetic guidance decreases the procedure time, number of x-rays, and number of attempts, compared to the blind method.METHODS: Eleven pediatric nurses participated in a randomized controlled intention-to-treat study at an academic pediatric medical, surgical, and congenital cardiac ICU. University of Texas Health Epidemiology and Biostatistics generated a randomization sequence with sealed envelopes. A standard (2-sided) F-test of association between the electromagnetic and blind method yielded 40 subjects with 86% power. Data were analyzed with Fisher's exact test for categorical variables and the Wilcoxon rank test for continuous variables, with data documented as median (interquartile range [IQR]). RESULTS:We randomly assigned 52 patients to either the electromagnetic (n = 28) or blind method (n = 24). The number of attempts and radiographs was at a median of 2 (IQR: 1-2.25) using the blind method, compared to the electromagnetic method at a median of 1 (IQR: 1.0-1.0; P = .001). Successful guidance was 96.4% with the electromagnetic method, compared to only 66.7% with the blind technique (P = .008). The total time required was 2.5 minutes (IQR: 2.0-7.25) with the electromagnetic method, compared to 19 minutes (IQR: 9.25-27.0) for the blind method (P = .001).CONCLUSIONS: Electromagnetic guidance is a superior, faster, and overall safer method to place a postpyloric feeding tube in critically ill children.

Application of visual placement of a nasojejunal indwelling feeding tube in intensive care unit patients receiving mechanical ventilation

“…Although X-ray examination is used to determine the tube position, children and pregnant women may face the risk of radiation overexposure ( 17 ). It has been reported that the use of magnetic navigation ( 18 ) and B-ultrasound assistance ( 19 ) can improve the success rates of blind intubation, but the two techniques require more manpower and material resources, and require expensive equipment and long-term experiences.…”

Gastrointestinal Tube Insertion Techniques in Critical Patients: Scoping Review

“…The study verified a success rate of 96.4% for the electromagnetic technique and 66.7% for the conventional technique. Regarding time, electromagnetic insertion had an average duration of 2.5 minutes, while "blindly", 19 minutes, in addition, the electromagnetic method presented a reduced need to confirm the positioning by radiography examination 44 .…”

Challenges and advances in nutrition for the critically ill child

“…Recent studies have therefore focused on efficient and timely placement of postpyloric tubes [35][36][37]. Success rates in postpyloric tube placement on firsttime attempt using blind-bedside placement, electromagnetic-guidance and pH guided devices vary, with some studies reporting success rates of greater than 80% with any one of these techniques [38][39][40]. Point-of-care ultrasound has now also been utilized for postpyloric tube placement with an 87-94% success rate in critically ill children, making ultrasound a promising tool for timely postpyloric tube placement [41,42].…”