H. R. Shadid1, M. Keckeisen1, A. Zarrinpar1 1David Geffen School Of Medicine, University Of California At Los Angeles,Liver Transplant Unit,Los Angeles, CA, USA
Introduction:
Enteral feeding in critically ill patients has been shown to be beneficial, but reliable placement of feeding tubes into a post-pyloric position remains a challenge. The standard of care involves blind placement, followed by abdominal radiographs to confirm post pyloric placement. Multiple attempts and radiographs are frequently needed and placement may require costly endoscopy or fluoroscopy. Lung placement remains a serious adverse event. The Cortrak 2 device allows 3D real-time tracking of the feeding tube tip position during placement, which may lead to reduced complications, use of radiography and fluoroscopy, and costs.
Methods:
We employed the Cortrak 2 device for feeding tube placements on 13 consecutive patients requiring enteral nutrition in a surgical ICU at a tertiary care center. Patients undergoing feeding tube placements in the preceding 7 months served as historical controls. Data was collected for the control group in a retrospective chart review while data for the intervention group was collected prospectively. Outcome variables included: time from initial radiograph to final confirmation of post-pyloric position, the number of abdominal radiographs performed prior to confirmation, need for fluoroscopy, placement location of each attempt (stomach, proximal duodenum [D1, D2], distal duodenum [D3, D4], and jejunum), and lung placements. Cost analysis was performed to evaluate the cost effectiveness of the device.
Results:
There were 28 patients and 63 placements for the control group and 13 patients and 26 placements for the Cortrak group. Other than patient height, there were no significant differences between the two groups in terms of age, sex, weight, BMI, hiatal hernias, or previous esophageal/gastric operations. The use of Cortrak led to decrease in time from initial radiograph to final confirmation (1813 minutes +/- 3276 v 304 minutes +/- 667, p=0.02), decrease in the number of radiographs (2.44 +/- 1.80 v 1.45 +/- 0.857, p=0.007). There was also a decrease in need for fluoroscopic insertions (11 insertions/28 patients, 17.5% v 0/13, 0%, p=0.023) and lung insertions (2/28 v 0/13, p=0.36). There were 2, 11, 10, and 3 stomach, proximal duo, distal duo, and jejunal placements compared with 9, 36, 10, and 8 in the control group (p=0.40, 0.21, 0.020, 0.88). Placements using the Cortrak device led to lower costs per patient despite Cortrak tubes being more expensive ($731 v $412, p=0.0078).
Conclusion:
In high-acuity intensive care units, use of the Cortrak device allows reliable post-pyloric enteral feeding tube placement with fewer radiographs, decreased need for fluoroscopy, and fewer lung insertions compared to blind insertion. This would result in earlier establishment of feeding and lower total costs.
