ABSTRACT
BACKGROUND: Early enteral nutrition has been shown to decrease complications and improve patient outcomes. Post pyloric feeding is recommended for patients with gastric intolerance or at high risk for aspiration. Feeding tube placement can be challenging and pose risk of pulmonary complications. Reliance on radiographic confirmation for feeding tube placement exposes the patient to radiation. Electromagnetic placement device (EMPD) may offer a method to minimize pulmonary complications, increase successful placement, and decrease radiation exposure to the patient. OBJECTIVE: The purpose of this study was to evaluate the safety and efficacy of using EMPD verification, instead of routine abdominal radiographic confirmation, for small-bore feeding tube placement. RESULTS: Variables evaluated were adverse events, utilization of radiographs for confirmation, and success rate of feeding tube placement in the ordered location. Two time frames were reviewed. In a 1-year period, 3754 small-bore feeding tubes were placed using EMPD, with zero adverse events noted. Radiographic confirmation was utilized in 0%-29.2% of the EMPD placed tubes. Successful placement of feeding tubes using EMPD ranged from 94%-99.6%. During a 5-year period, 7081 EMPD feeding tubes were evaluated. One adverse event, pneumothorax, occurred during the placement of these 7081 tubes, for a rate of 0.014%. CONCLUSION: Feeding tube placement confirmation is safe and efficacious via EMPD providing an effective method of feeding tube placement with a success rate >94% into the desired location. EMPD is an accurate verification method of distal tip location, eliminating the need for routine abdominal radiographic confirmation.
Subject(s)
Electromagnetic Phenomena , Enteral Nutrition/adverse effects , Intubation, Gastrointestinal/adverse effects , Pneumothorax/prevention & control , Respiratory Aspiration/prevention & control , Clinical Competence , Enteral Nutrition/instrumentation , Enteral Nutrition/nursing , Hospitals, Community , Hospitals, Teaching , Humans , Intestine, Small/diagnostic imaging , Intubation, Gastrointestinal/instrumentation , Intubation, Gastrointestinal/nursing , Patient Safety , Pneumothorax/epidemiology , Pneumothorax/etiology , Practice Patterns, Nurses' , Practice Patterns, Physicians' , Radiography, Abdominal/adverse effects , Respiratory Aspiration/epidemiology , Respiratory Aspiration/etiology , Retrospective Studies , Risk , United States/epidemiologyABSTRACT
BACKGROUND: Use of an electromagnetic placement device (EMPD) facilitates placement of feeding tubes at the bedside. Standard practice for verification of feeding tube placement is via radiographic confirmation. The purpose of this research study was to assess the accuracy of placement of small-bore feeding tubes (SBFTs) as determined by EMPD interpretation compared with that of abdominal radiograph verification by a radiologist. METHODS: This multicenter prospective study enrolled patients requiring bedside feeding tube placement. SBFTs were placed by an experienced investigator using the EMPD. Two abdominal radiographs were then obtained: one after initial SBFT placement and an additional radiograph after injection of contrast. Documentation of location based on clinician interpretation using the EMPD was then compared with radiologist interpretation. RESULTS: The final sample size was 194 patients, including 18 pediatric patients. Patient age ranged from 12 days to 102 years. Median time for tube placement was 12 minutes. Of the 194 patients, only 1 patient had data showing discrepancies between the original EMPD verification and the final abdominal radiograph interpretation, providing a 99.5% agreement. No patient experienced complications during SBFT placement, and 15 patients had inadvertent airway placement that was avoided with the use of the EMPD. CONCLUSIONS: There was a high percentage of agreement between EMPD and radiologic interpretation after contrast injection. The EMPD aided in avoiding inadvertent airway placement, with no patient complications. This device can be used safely at the bedside to facilitate placement of feeding tubes, leading to the delivery of early enteral nutrition.
Subject(s)
Enteral Nutrition/instrumentation , Radiography, Abdominal/instrumentation , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Electromagnetic Phenomena , Female , Humans , Infant , Infant, Newborn , Intubation, Gastrointestinal/instrumentation , Male , Middle Aged , Prospective Studies , Young AdultSubject(s)
Conscious Sedation , Drug Monitoring/methods , Electroencephalography/methods , Awareness/drug effects , Conscious Sedation/adverse effects , Conscious Sedation/nursing , Drug Monitoring/instrumentation , Drug Monitoring/nursing , Electroencephalography/instrumentation , Electroencephalography/nursing , Humans , Nursing Assessment/methods , Outcome Assessment, Health Care , Patient Selection , Wakefulness/drug effectsABSTRACT
Assessment, monitoring, and prevention of pressure ulcers in the hospitalized patient are required standards of care. The annual nosocomial pressure ulcer (NPU) rates for the adult intensive care units at our facility had trended up to 33% from 14% over a 13-month period. Our performance improvement team decided to track 5 variables that may have contributed to the increased incidence of NPU. Weekly skin care rounds were conducted to collect data, educate staff, and reinforce skin care policy and standards of care. Data analysis revealed 3 areas that required further emphasis with nursing staff: daily assessment with the Braden Scale, prevention of NPU beginning on the day of hospital admission, and the effect of sedation on patient mobility. Implementation of appropriate interventions targeted to specific Braden subscales needs to be included in the plan of care.
