Clinical Research: Nonfluoroscopic, Postpyloric Feeding Tube Placement: Number and Cost of Plain Films for Determining Position

Abstract

After nonfluoroscopic placement (NFP) of a feeding tube, a conventional radiograph is obtained to determine the location of the catheter tip. At our institution, ideal position for enteral feeding is the distal duodenum or beyond, and multiple radiographs may be needed to confirm migration to this location. Acquiring the number of films needed to achieve this goal may be time consuming and costly. The aim of this project was to determine the relative charge of NFP, on the basis of successful placement confirmed radiographically, to that of fluoroscopic placement. We determined the number of films needed and the relative charge of NFP in 257 patients (157 men, 100 women; mean age, 60. years) over a 4‐month period. At our institution, the relative charge factor of a single abdominal film us. fluoroscopic feeding tube placement was 0.54. Results showed that on the first radiograph, the tip of the feeding tube was in the duodenum or jejunum in 95 (37%) of 257 patients and in the stomach or esophagus in the remaining 162 patients. Additional films were obtained for 143 patients, for a combined total of 458 (mean, 3.2 films per patient in this group). Therefore the relative charge for NFP in patients who needed just one film was half that of our fluoroscopic charge; however, the cost of conventional radiographs was nearly twice (1.73) that of the fluoroscopic method in patients who underwent NFP if multiple films were needed. These results suggest that failure 'of NFP after several films are obtained warrants consideration of fluoroscopic placement