1229 Resident Education in the Placement and Confirmation of Feeding Tubes

Abstract

INTRODUCTION: Nasogastric feeding tube (FT) placement is often done by trainees without uniform education. Serious complications can occur if FT are improperly inserted. This study assesses trainee education in FT insertion to identify knowledge-gaps and a need for standardized training. METHODS: A 16- item, web-based E-questionnaire was distributed to 149 Internal Medicine, Medicine-Pediatrics, Family Medicine, Obstetrics and Gynecology, General Surgery and Neurology residents at a university medical center and a community-based teaching hospital near Chicago, IL. Results were collected and analyzed through the web-based platform. The study was exempted from institutional review. RESULTS: One hundred seventeen residents responded (78.5% response rate). Most were Internal Medicine residents (66.1%) in postgraduate year 1 (37.8%). 76.1% of survey respondents received training in residency and 59.8% in medical school. The majority of survey respondents (94.9%) learned by bedside demonstration. The second most common training method was simulator training, but this was reported by only 29.9%. Most survey respondents felt they had adequate training (74.1%); however, only 50% felt very confident in their ability. Most residents reported requirements between 0 and <10 supervised placements before being certified by their institution. Almost a third (32.8%) of respondents were unaware of the requirements for certification, and surprisingly 23.3% reported that none were required. Most indicated that residents or fellows placed the majority of FT at their institutions. Almost all respondents (96.6%) were able to correctly identify abdominal Xray as the gold standard to confirm correct FT placement. Though 47% stated they were responsible for certifying proper positioning of FT, only 62.6% of responders reported they received instruction in Xray interpretation, and only 36.8% were able to correctly answer a question regarding radiographic landmarks of properly-placed tubes. CONCLUSION: Our study is the first to survey American medical residents regarding their knowledge, training, and comfort in placing FT. While the data indicate residents generally feel they receive adequate training, only half reported being very confident in this skill, and training in Xray interpretation was inadequate. This suggests a role for standardized training in placement and confirmation of FT to improve patient safety and resident education.