Abstract
Title:
Single centre evaluation of nasojejunal feeding tube placement by nurses using the
Cortrak® electromagnetic imaging system.
Authors:
Geesing J.M.J., Kuper J.Z., Postema-Stiksma M.S., Hoekstra-Wilts M., Noordhoff H.R.,
Koornstra J.J., Dijkstra, G.
Institution(s):
University Medical Centre Groningen
Text abstract:
The Cortrak® electromagnetic imaging system for placement of nasojejunal feeding
tubes is minimal invasive and does not need X-ray. Therefore it is a promising alternative
for endoscopic or radiologic placement. Furthermore, bedside placement can be
performed by nurses, thereby reducing costs and workload for endoscopic teams. First
results were promising with a success rate of 78-89%, dependant on the condition of the
patient.
The purpose of this study is to evaluate the learning curve, results and costs of bedside
placement of Cortrak® nasojejunal feeding tubes by nurses in a Dutch university
hospital.
Three nurses with interest in enteral nutrition were trained in a two day course and had
one day instruction in the hospital by an experienced nurse. From March 2011 till
December 2012 all patients in which an endoscopic jejunal feeding tube was requested
during working hours were screened for Cortrak® placement. Patients with surgically
changed anatomy of the upper gastrointestinal tract, signs of stenosis, rupture, varices or
Zenker’s diverticula of the esophagus or greatly enhanced bleeding risk were excluded. If
the reason for placement was gastric paresis, especially on the intensive care units, nurses
could request a single dose of erythromycin 250 mg IV before or during placement. Time
of procedure, success rate with or without erythromycin, time of procedure and success
rate confirmed by X-ray was recorded. Costs were evaluated according to the in-hospital
fees. Reduction in costs was calculated by difference in price between endoscopic and
Cortrak® placement minus the extra costs of the Cortrak® method if it failed.
Cortrak® placement was attempted in 342 cases of which 98 (29%) were on intensive
care units. The success rate confirmed by X-ray (discordance in one) was 160 out of 165
(97%), success rate based on electromagnetic imaging alone was 132 out of 177, giving
in total a success rate of 85 %. On IC units the success rate was lower (76 vs 90%) and
mean duration of procedure was longer (25 vs 18 min). With the use of erythromycin
(n=27) success rate on IC-units improved to 89%. Success rates were equal in 2011 and
2012, showing no clear learning curve. Cortrak® feeding tube placement being €210
cheaper than endoscopic placement reduced costs with €51070.
In conclusion, placement of the Cortrak® nasojejunal feeding tube by nurses is a safe,
minimal invasive, cost effective method with high success rate (90% outside IC-units and
in 76% of IC-patients). Erythromycin improves success rates on IC units. We therefore
recommend this electromagnetic imaging system for routine nasojejunal tube placement.