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

Abstract

Technology advances have made it possible to prolong life for patients with heart failure who are not transplant candidates or while awaiting transplant. Many different cardiac devices are available that can be used as a bridge to transplant (temporary support) or as a destination therapy (permanent support). Placement of these devices can cause complications that, if not addressed, could negatively impact the nutrition status of patients. Placement of nasointestinal feeding tubes using an electromagnetic sensor-guided enteral access system (EMS-EAS) has been difficult in patients with implantable devices because of the potential for interference with the EMS-EAS and the left ventricular assist device (LVAD). The purpose of this paper was to report the results using a modified method to place nasointestinal tubes in patients with LVADs by elevating the receiver off the xiphoid process. There were 42 feeding tube placements in 25 patients. Results showed a 69% success rate of placement into the small bowel, 13 unsuccessful placements, and no adverse or sentinel events associated with tube placement using this method. Results indicated the modified method is a safe approach to help expedite feeding tube placement in a nutritionally compromised patient. The success rate is comparable with non-LVAD patient populations requiring nasointestinal tube placement via EMS-EAS. To our knowledge, this is the first published case series addressing a modified method for nasointestinal tube placement in patients with LVAD. More research is needed to determine ideal separation distances or other techniques to improve the success rate in this patient population.

Major Predictors of Incidence of Congestive Heart Failure and the Responsive Character of Enteral Nutrition: Meta-Analysis

“…Only patients with EN, associated or not with oral diet therapy can recover the catabolism generated by CHF [ 20 , 21 ]. Other studies corroborate the early onset in stable myocardiopathic patients, around 24 - 48 h after cardiac decompensation [ 2 , 3 , 22 ].…”

“…Enteral diet may be infused continuously or intermittently. Studies have shown that patients who are more debilitated and less active accept diet better via a continuous probe, slowly and for a longer period, even in patients with heart disease [ 2 , 6 , 7 ]. According to the authors, continuous infusion should be decreased if the probability of gastric distension, diarrhea, pulmonary aspiration and metabolic abnormalities exits.…”

“…However, a major disadvantage of these favorable nutritional studies in CHF is the fact that they were all performed in the era before modern standard treatment with angiotensin-converting enzyme inhibitors and beta-blockers [ 2 ]. There is evidence that angiotensin-converting enzyme inhibitors prevent weight loss [ 5 ].…”

“…Congestive heart failure (CHF) is a serious and growing public health problem worldwide, being the final common pathway of most heart diseases [ 1 , 2 ]. Although the scientific and technological advances and the better socioeconomic conditions have allowed the increase of the longevity of the general population and of the cardiac patients, there has been an increase in the incidence of CHF in the world [ 2 - 4 ]. Approximately 23 million people are carriers of this disease and two million new cases are diagnosed each year.…”

“…The presence of malnutrition is an important predictor of survival reduction in patients with CHF regardless of important variables such as age, functional class and ejection fraction [ 2 , 10 , 11 ]. Thus, it becomes imperative to EN in an attempt to treat or mitigate the comorbidities of CHF.…”