Small‐Bowel Feeding Tube Placement at Bedside: Electronic Medical Device Placement and X‐Ray Agreement

Carter, Michaelann; Roberts, Susan; Carson, Jo Ann S.

doi:10.1002/ncp.10072

Cited by 9 publications

(16 citation statements)

References 27 publications

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“…Our research determined that trained RDs who had the option to forgo radiographic confirmation imaging while placing small‐bore feeding tubes using the CEAS led to a 68% reduction in the number of radiographic confirmation images and a significant cost avoidance of $67,282.80 per 253 tube placements. These findings are more than the 50% reduction in radiographic confirmation imaging initially reported in our preliminary data 14 . If findings from this research are extrapolated for future cost analysis and reporting, we can assume that per 100 successful small‐bore feeding tube placements, a cost avoidance of $26,593.99 is anticipated.…”

Section: Discussionmentioning

confidence: 54%

“…These findings are more than the 50% reduction in radiographic confirmation imaging initially reported in our preliminary data. 14 If findings from this research are extrapolated for future cost analysis and reporting, we can assume that per 100 successful small-bore feeding tube placements, a cost avoidance of $26,593.99 is anticipated. There were roughly 1050 successful small-bore feeding tube placements by RDs using the CEAS at BUMC between 2017 and 2021.…”

Section: Discussionmentioning

confidence: 99%

“…In 2016, a follow‐up study examined the rate of agreement between radiographic confirmation images and CEAS images 14 . This research 14 found substantial agreement between clinician interpretation of the CEAS images and radiographic readings in 280 tube placements at BUMC, resulting in a change in institutional protocol in 2016, allowing trained clinicians to forgo radiographic verification of tube placements when using the CEAS. The following year's preliminary data showed an approximate 50% reduction in radiographic confirmation imaging.…”

Section: Introductionmentioning

confidence: 99%

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Small‐bore feeding tubes placed with an electromagnetic imaging device leads to cost avoidance and decreased time to initiation of enteral nutrition

et al. 2023

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BackgroundThe Cortrak Enteral Access System (CEAS) was previously approved by the United States Food and Drug Administration (FDA) to be used in lieu of radiographic confirmation imaging for feeding tubes placed by trained clinicians. Following an institutional protocol change in 2016, our registered dietitians had the option to forgo radiographic confirmation imaging for tubes placed using the CEAS. Our research aimed to determine the difference in the number of radiographic confirmation images for feeding tubes placed using the CEAS between preprotocol and postprotocol environments and the associated cost avoidance after the institutional policy change.MethodsWe retrospectively reviewed data from 506 tube placements (n = 253 per protocol environment) in adult patients with diverse diagnoses admitted to various in‐patient care units.ResultsThere was a significant reduction in the mean number of radiographic images per tube placement (preprotocol = 1.10 [95% CI, 1.05–1.15]; postprotocol = 0.36 [95% CI, 0.30–0.41]; P < 0.001), leading to a cost avoidance of $67,282.80 for the 253 tube placements and a potential cost avoidance of $279,236 over the 5‐year postprotocol environment. Additionally, the mean time to initiation of enteral nutrition was significantly reduced by 2.65 h in the postprotocol environment (P < 0.001).ConclusionOur findings suggest that using the CEAS can reduce the number of radiographic images, provide cost avoidance, and improve nutrition outcomes. However, updated 2022 FDA regulatory changes to the use of the CEAS for tube confirmation lead to an uncertain future for this practice because of safety concerns.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Small‐bore feeding tubes placed with an electromagnetic imaging device leads to cost avoidance and decreased time to initiation of enteral nutrition

et al. 2023

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“…An additional recent single‐center study compared NE tube tip position using EMPD technology with radiology reports in the electronic health record. Findings from this study suggest that EMPD images provide substantial agreement with x‐ray confirmation and almost perfect agreement when the tip of the tube is within the small bowel 77 …”

Section: Verification Of Feeding Tube Placementmentioning

confidence: 63%

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

Powers

Brown

Lyman³

et al. 2021

Nut in Clin Prac

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Nasogastric/nasoenteric (NG/NE) feeding tube placements are associated with adverse events and, without proper training, can lead to devastating and significant patient harm related to misplacement. Safe feeding tube placement practices and verification are critical. There are many procedures and techniques for placement and verification; this paper provides an overview and update of techniques to guide practitioners in making clinical decisions. Regardless of placement technique and verification practices employed, it is essential that training and competency are maintained and documented for all clinicians placing NG/NE feeding tubes. This paper has been approved by the American Society for Parenteral and Enteral Nutrition (ASPEN) Board of Directors.

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“…By contrast the ability to place an enteric tube under guidance requires a booking on endoscopic or radiological lists, services which are in high demand at our hospital. Delays to accessing inpatient endoscopy are acknowledged as a limiting factor on the provision of timely care, 17 and while bedside approaches to the placement of postpyloric tubes have been reported as a feasible alternative to endoscopic or radiologically options 18,19 these are yet to be integrated widely into Australian practice, with cost and clinical governance posing the primary obstacles at the present time. Although steps to overcome these barriers are being undertaken, the use of PPN in this patient cohort could potentially negate the higher costs and increased clinical risks associated with CVAD placement while providing bridging nutrition for the several days usually required to access the currently available feeding tube placement options.…”

Section: Discussionmentioning

confidence: 99%

Are we underusing peripheral parenteral nutrition? A 5‐year retrospective review of inpatient parenteral nutrition practices

et al. 2022

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Background Peripheral parenteral nutrition (PPN) represents an alternative option to central parenteral nutrition (CPN) for patients requiring short‐term parenteral nutrition (PN). We hypothesized that the use of PPN could be increased in certain patient cohorts referred for PN in our facility. Methods A retrospective observational study investigating the clinical characteristics of patients receiving PN under the nutrition support team over a 5‐year period was undertaken. Patients who received PPN were reviewed descriptively. Of the patients who received CPN, representative samples were grouped into those who received PN for ≤7 or >7–28 days (n = 100 each, randomly assigned). Clinical characteristics considered included indication, duration and referring team for PN, and nutrition status. Descriptive statistics and binary logistic regression model for predictors of PN duration of ≤7 or >7–28 days were derived. Results Only four patients received PPN for a median of 4 days, most of whom required this route because of loss of central venous access for CPN. A high proportion of patients with no enteral access received CPN for ≤7 days, whereas the majority of patients with malabsorption required >7–28 days of CPN. Being referred for PN following upper gastrointestinal surgery increased the likelihood of CPN use for >7 days (relative risk, 5.7; 95% CI, 1.7–18.9; P = 0.004). Conclusion Within our service, PN referrals for no enteral access may represent a group in whom PPN could be used in the first instance; those referred with an indication of malabsorption or following upper gastrointestinal surgery may benefit from early commencement of CPN.

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Small‐Bowel Feeding Tube Placement at Bedside: Electronic Medical Device Placement and X‐Ray Agreement

Abstract: These findings suggest that EMPD images provide substantial agreement with X-ray confirmation and almost perfect agreement when the tip of the tube is within the small bowel. This indicates that the EMPD could be used without X-ray confirmation.

Cited by 9 publications

References 27 publications

Small‐bore feeding tubes placed with an electromagnetic imaging device leads to cost avoidance and decreased time to initiation of enteral nutrition

Small‐bore feeding tubes placed with an electromagnetic imaging device leads to cost avoidance and decreased time to initiation of enteral nutrition

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

Are we underusing peripheral parenteral nutrition? A 5‐year retrospective review of inpatient parenteral nutrition practices

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