Feeding Tube Insertion Research Articles

Cortical hemodynamic activity and pain perception during insertion of feeding tubes in preterm neonates: a randomized controlled cross-over trial.

The present study evaluated the pain perception in preterm neonates during insertion of orogastric (OG) vs. nasogastric (NG) tube by measuring the cerebral regional oxygen saturation (crSO2) and premature infant pain profile-revised (PIPP-R) score. Randomized controlled cross-over trial. Fifty infants of mean (SD) gestational age of 31.54(2) and 31.64(2.2) weeks, birth weight of 1362(354) and 1507(365) grams were randomized into OG/NG (n = 25) and NG/OG (n = 25) sequences. Mean post-menstrual age at assessment was 33(2.8) and 33(1.5) weeks, and thedifference between two interventions was 1.08(0.5) and 1.12(0.5) days in OG-NG and NG-OG, respectively. Mean crSO2(%) during insertion was significantly lower with NG compared to OGroute. Mean PIPP-R score, heart rate variability, time to normalize crSO2, and the duration of cry were also significantly higher with NG insertion. Compared to OG, NG route of feeding tube insertion was associated with higher fluctuations in crSO2 and higher PIPP-R scores. CTRI/2020/03/023728.

The Need for Valid and Reliable Methods to Determine Feeding Tube Insertion Length and Verify Placement in Neonates to Improve Safe Nursing Care.

Disclosure: The author has disclosed that she has no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Each author has indicated that he or she has met the journalʼs requirements for Authorship.

How to insert a naso-enteric tube using an ultrathin scope.

Although not a technically challenging procedure, the correct insertion of a naso-enteric feeding tube is an important skill for the surgeon. The described technique has been refined over two decades, and is well tolerated, reliable and reproducible.

Surgical feeding tube insertion, the literature review and the actual procedure

Surgical feeding tube insertion, the literature review and the actual procedure

Opioid therapy vs. multimodal analgesia in head and neck Cancer (OPTIMAL-HN): study protocol for a randomized clinical trial

BackgroundRadiation-induced mucositis (RIM) pain confers substantial morbidity for head and neck cancer (HNC) patients undergoing radiotherapy alone (RT) or chemoradiotherapy (CRT), often reducing treatment compliance. However, no standard currently exists for the treatment of RIM, and high dose opioid therapy, with its associated side effects and increased risk for chronic opioid use, remains the cornerstone of HNC pain management. The goal of this randomized clinical trial is to compare multimodal analgesia using analgesic medications with different mechanisms of action, to the institutional standard of opioid analgesia alone, in order to ascertain the optimal analgesic regimen for the management of RIM pain in HNC patients.MethodsIn this open-label, single-institution, non-inferiority, randomized clinical trial, sixty-two patients with mucosal head and neck malignancies treated with curative-intent radiation will be randomized in a 1:1 ratio, stratified by RT or CRT, between Arm 1: opioid analgesia alone as per the institutional standard, or Arm 2: multimodal analgesia using Pregabalin, Acetaminophen, and Naproxen, in addition to opioids, if required. The primary endpoint is the average 11-Numeric Rating Scale (11-NRS) score for pain during the last week of radiation treatment. Secondary endpoints include: average weekly opioid use, duration of opioid requirement, average daily 11-NRS score for pain, average weekly opioids dispensed, quality of life, hospitalizations for analgesic medication-induced complications, time to feeding tube insertion, weight loss, toxicity, treatment interruptions, and death within 3 months of completing RT treatment. Patients are eligible once analgesia is required for moderate 4/10 pain.DiscussionThis study will assess the efficacy and safety of multimodal analgesia and its impact on opioid requirements, clinical outcomes, and quality of life, as a potential new standard treatment for RIM pain in HNC patients undergoing definitive RT or CRT.Trial registrationClinicalTrials.gov Identifier: NCT04221165. Date of registration: January 9, 2020. Appendix 2 reports the World Health Organization trial registration dataset.

In-Hospital Utilization and Outcomes of Palliative Care Consultation in Patients With Advanced Heart Failure Complicated by Cardiogenic Shock Requiring Mechanical Circulatory Support

Prior studies have shown that the early inclusion of palliative care (PC) specialist is associated with better end-of-life experiences. The National Inpatient Sample Database was queried from 2012 to 2017 for relevant of ICD)-9 and -10 procedural and diagnostic codes to identify patients above 18 years with advanced heart failure (HF) admitted with cardiogenic shock (CS) requiring mechanical circulatory support (MCS). Baseline characteristics, utilization trends and invasive procedures and complications were compared among patients evaluated by PC and those who were not. There were 65,230 patients hospitalized for advanced HF complicated by CS requiring MCS, of these a PC consult was placed in in 9,200 patients (14.1%) and trended upward from 9.4 to 16.8%, between 2012 to 2017. The majority of patients, (37.3%) from the total population died in hospital. In reference to patients who were discharged alive, PC consultation was associated with a lower incidence of invasive procedures such as mechanical ventilation, pacemaker implantation, defibrillator implantation, insertion of percutaneous feeding tubes and tracheostomies performed (p <0.05 for all) whereas complications such as major bleeding, septic shock, transfusion of any blood product were comparable between both cohorts (nonsignificant p value for all). On the other hand, in those patients who died in hospital PC was associated with a lower incidence of pacemaker implantation, defibrillator implantation and insertion of percutaneous feeding tubes (p <0.05 for all). Despite the high morbidity and mortality associated with advanced HF patients with CS requiring MCS, the overall prevalence of PC consultation is exceedingly low. When utilized, the incidence of invasive procedures was lower. This study highlights the underutilization of PC services in this patient population, precluding any perceived benefit in end-of-life experiences.

Ultrasonography-guided post-pyloric feeding tube insertion in medical intensive care unit patients.

In this study, we investigated placement rate, complication rate and time spent of successful post-pyloric enteral feeding (PPEF) tube insertion procedure guided by ultrasonography (USG). The patients who required enteral nutrition and who admitted to medical intensive care unit (MICU) of Gazi University Hospital were included to this single-center, prospective, cohort study. It was aimed to insert the enteral feeding tube into the proximal duodenum as the post-pyloric area by ultrasonography guidance. During the PPEF tube insertion procedure, the linear probe was used to display the proximal esophagus and the convex probe was used to display the post-pyloric area, antrum and pyloric channel. 33 patients were included in this study. The median age was 68 [IQR 52-79] years. There were 17 (51.5%) woman and 22 (66.7%) intubated patients. The enteral feeding tube was successfully passed into the post-pyloric area in 29 (87.9%) patients with this technique. The median time of successful feeding tube insertion was 14 [IQR 10-25] min. The median level of the enteral feeding tube was 74 [IQR 70-76] cm. in successful placement. There was no significant difference in insertion time according to gender (female vs male; 10 [IQR 8-20] min. vs 17 [IQR 12-25] min., p = 0.052) and endotracheal intubation status (intubated vs non-intubated; 14 [IQR 10-25] min. vs 12 [IQR 10-25] min., p = 0.985). Only one complication was seen during study (self-limiting epistaxis in one patient). PPEF tube insertion under USG guidance could ensure the initiation of enteral feeding safely and rapidly without exposure to radiation in ICU patients.

Ultrasound-Guided Postpyloric Feeding Tube Placement in Critically Ill Pediatric Patients.

Various methods to insert postpyloric feeding tubes at the bedside have been reported, but the optimal method remains controversial. The objective of this study was to evaluate the effect of ultrasound-guided postpyloric feeding tube placement in critically ill children. Single-center retrospective observational study. PICU of tertiary children's hospital. Children under the age of 16 who underwent postpyloric feeding tube placement in our PICU between September 2017 and August 2019. None. A total of 115 patients were included in this study: 30 patients underwent ultrasound-guided postpyloric feeding tube placement and 85 patients underwent blind postpyloric feeding tube placement; the insertion attempts were 32 and 93, respectively. There were no significant differences in patient demographics between the ultrasound-guided group and the blind group. The first-pass success rate of the ultrasound-guided group was higher than that of the blind group (94% [30/32] vs 57% [53/93]; p < 0.001). The median insertion time in the ultrasound-guided group with successful postpyloric feeding tube insertion was 18 minutes (interquartile range, 15-25; range, 8-45; n = 21). There were no complications or adverse events during the placement. In this single-center study, ultrasound-guided postpyloric feeding tube placement was feasible and a significantly high first-pass success rate was observed for critically ill children. Additional investigation with a larger pool of operators and randomized controlled patient assignment is required.

Superior Mesenteric Artery Syndrome: A Single-institution Experience

Background: Superior mesenteric artery syndrome (SMAS) is a rare disease in adult. SMAS is characterized by acute, or, more commonly, chronic nonspecific symptoms due to duodenal obstruction and severe malnutrition with reduced arterio-mesenteric angle and distance. Surgical treatment may be necessary in most cases with chronic symptoms or when conservative treatment fails in SMAS. Methods: A retrospective chart review was performed on patients who underwent operation for SMAS from January 2008 to August 2020 in Cardinal Tien Hospital. Patients’ clinical presentations, surgical intervention, and outcomes. Results: Data from a total of 14 patients diagnosed with SMAS were analyzed, of which seven were diagnosed with SMAS by abdominal computed tomography and upper gastrointestinal series with water-soluble barium contrast. Six of the confirmed cases underwent surgery, namely, gastric decompression using a nasogastric tube, and correction of electrolyte imbalance. The nasoduodenal tube was placed through the obstructed duodenum to provide a high-nutrient fluid supplement. After conservative treatment failure, the patients underwent surgery. Of the six patients, four underwent duodenojejunostomy, one underwent a mini-laparotomy duodenojejunostomy bypass, and the last one underwent Roux-en-Y duodenojejunal bypass with duodenal feeding tube insertion. Conclusion: Patients with SMAS should initially be treated conservative. Surgical intervention should be considered in patients in whom conservative treatments were not effective. Complete resolution of all symptoms may not always be guaranteed after surgical intervention. Laparoscopy is currently widely used. In well-selected patients, minimally invasive or mini-laparotomy duodenojejunostomy is a safe and effective treatment for SMAS. The main advantages of mini-laparotomy duodenojejunostomy over other surgical approaches include half-length surgical incision and a shorter operative time. Duodenojejunostomy is rapidly becoming the standard procedure of this condition, and it has excellent outcomes comparable with those of open surgery.

Endotracheal tube as a conduit for difficult gastric feeding tube insertion in a tracheostomized patient.

Endotracheal tube as a conduit for difficult gastric feeding tube insertion in a tracheostomized patient.

Healthcare resource utilization following unilateral versus bilateral radiation therapy for oropharyngeal carcinoma

PurposeTo describe differences in healthcare resource utilization between patients treated with bilateral vs. unilateral neck radiation therapy (RT) for lateralized oropharyngeal cancer. MethodsA propensity score matching strategy was used to identify two otherwise clinically similar cohorts of tonsillar cancer patients treated with either bilateral or unilateral neck RT. Cohorts were matched based on similar propensity scores for age, sex, ECOG performance status, pack-year smoking history, cT-category, cN-category, HPV-status, and use of concurrent chemotherapy. Short term (from start of RT to 3 months following end of RT) resource utilization included: 1) outpatient supportive care visits, 2) hospital admission, and 3) interventions (feeding tube insertion and outpatient intravenous hydration). Long-term resource utilization included feeding tube dependency at 1-year. ResultsAmong 559 patients with tonsillar cancer treated between 2004–2017, propensity score matching identified a unilateral neck RT cohort (n = 81) and bilateral neck RT cohort (n = 81) with similar clinical and treatment characteristics. Bilateral neck RT was associated with a higher likelihood of hospitalization (33% vs 12%, p < 0.01), outpatient IV hydration (33% vs 17%, p = 0.03), and feeding tube insertion (33% vs 10%, p < 0.001); a greater number of total days of hospitalization (110 vs 47 days, p < 0.01) and outpatient IV hydration (135 vs 72 days, p = 0.02); and higher total number of supportive clinic visits (1226 vs 1053 days, p = 0.04). In the long-term, bilateral RT was associated with higher rate of feeding tube dependency at 1-year (7% vs 0%, p < 0.001). ConclusionBilateral RT for tonsillar cancer resulted in significant increase in health resource utilization.

National Survey of Feeding Tube Verification Practices: An Urgent Call for Auscultation Deimplementation.

Harm events such as pneumothoraces and pneumonia continue to be associated with feeding tube insertion. Most bedside verification methods are not accurate to discriminate pulmonary from gastrointestinal system. Evidence-based clinical practice guidelines do not support auscultation of feeding tubes in adults, yet auscultation is the most common method used. Our survey assessed national feeding tube verification practices used by critical care nurses, including progress in auscultation method deimplementation, and stylet reinsertion and cleansing practices. A national survey of 408 critical care nurses was performed. The majority performed auscultation (311 of 408 [76%]) to verify feeding tube placement. In the final multivariable model, nursing education, facility type, observation of colleagues performing auscultation, and awareness of an institutional policy were associated with auscultation of feeding tubes. Thirty-five percent used enteral access devices to verify initial feeding tube placement. Stylet cleansing methods were variable; 38% of reinserted stylets were not cleansed. Minimal progress has been made in deimplementation of auscultation in the past 7 years despite passive knowledge dissemination in research articles, clinical practice guidelines, and procedure manuals. Although pH measure is used as a first-line feeding tube verification method in the United Kingdom, it is rarely used in the United States. Clinical practice guidelines should be updated to incorporate new research on enteral access systems. Tradition-based practices such as auscultation and certain stylet cleansing methods should be deimplemented. A focused interdisciplinary, multifaceted program is needed to deimplement auscultation practice for adult feeding tubes.

Feed intolerance and postpyloric feeding in the critically ill child

: Feeding intolerance (FI) is a common problem in critically ill children that results in feed interruptions impacting heavily on outcome. The lack of consistent and validated definition for FI makes difficult to know the real prevalence of this problem in these patients and precludes obtaining conclusive results on predictors and outcomes. Gastric dysmotility (GD) is the principal mechanism underlying FI. The aetiology of GD is largely unknown but many factors (vasoactive drugs, sedatives, opioids, muscle relaxation drugs, hypoperfusion) may be involved in its appearance. Future research must focus on clarifying the potential mechanisms of FI during critical illness as well as finding a proper and validate definition of FI. Several actions are used in clinical practice to reduce FI in critically ill children as prokinetic agents, change from polymeric to semi-elemental formulation and change of feed delivery method from intermittent bolus to continuous feeding. However, the evidence does not support the routine use of these methods to manage FI. Transpyloric enteral nutrition (TEN) is another option to manage FI in sick children as it has proven to be safe and well tolerated with few complications in these patients. TEN promote early nutrition and reduce the volume of gastric residues and the number of enteral nutrition interruptions increasing energy intake. Children with shock, acute kidney injury (AKI) and in the recovery of cardiac surgery may benefit from this technique. However, feeding tube insertion is difficult and it is not exempt of problems. Staff must be trained to detect and decrease complications associated with its utilization.

Does Age Impact Outcomes of Oropharyngeal squamous cell carcinoma?

It is well-established that human papilloma virus (HPV) positive (+ve) oropharyngeal (OP) squamous cell carcinoma (SCC) carries a better overall prognosis than HPV negative (-ve) tumors. We sought to investigate the impact of age upon survival endpoints for HPV +ve and -ve OP SCC as well as the differences in acute radiotherapy (RT) toxicity. We included all OP SCC cases treated definitively between 2010-2017. All cases underwent either surgery ± adjuvant RT; or definitive RT ± chemotherapy according to the multidisciplinary tumor board decision. After determining p16 status we dichotomized each HPV group by age at diagnosis into old (> or = 65 years) and young (<65 years) sub-groups. Patients' demographics, clinico-pathological data and treatment modalities were compared across age groups for both HPV sub-types. Log-rank test and Kaplan-Meier curves were utilized to measure effect of age on overall (OS), local recurrence free (LRFS) and distant metastases free (DMFS) survival for HPV +ve and -ve. For patients receiving RT we compared weight loss, feeding tube insertion, treatment breaks and hospitalization during RT as parameters for acute toxicity across age groups. We identified 217 OP SCC who fit our inclusion criteria. Seventy percent were HPV+ve, males were 82%, mean age at diagnosis was 61 years, 75% were white, 67% were ever smokers and 54% were frequent/heavy alcohol drinkers. According to AJCC 7th edition, Stages III and IVA formed 87%; however, these were regrouped as stage I (51%) and stage IVA (62%) as prevalent stages for HPV+ve and -ve respectively as per AJCC 8th version. Definitive CRT was utilized in 58% and surgery ± adjuvant therapy in 31% of the study cohort. For HPV+ve sub-group, 31% were old (n=47); whereas they constituted 40% (n=27) of HPV-ve cases. Clinicopathological and treatment characteristics were generally equivalent among age groups except that HPV +ve younger patients had more adequate surgical margins (≥5mm) (78% vs 36%; p=0.03) than old; and HPV-ve old cases had a trend towards more utilization of concomitant cetuximab (30% vs 13%; p=0.09) than younger ones. All endpoints were not significantly different between old vs young HPV+ve cases with 2-year OS and LRFS of (64% vs 59%; p=0.41 and 88% vs 87%; p=0.98 for both respectively). Similar outcomes were observed between study age groups for HPV-ve cases (p>0.05 for all endpoints). Hospitalization during RT was more frequent in old patients (44% vs 28%; p=0.03). Median weight loss during RT was 9.5% (0-22%) vs 9.3% (0-17%) for old vs young (p=0.35) and RT breaks were also non-significant (39% vs 27%, p=0.8). Feeding tubes were inserted after RT initiation in 41% of old and 36% in young (p=0.5). Older patients with OP SCC have equivalent outcomes compared to younger ones irrespective of HPV status. Optimal treatments must be offered following standard of care as determined by a multi-disciplinary group of providers.

Assessing dietetics students’ change in perceived knowledge and perceived codence in feeding tube insertion using patient simulation

Assessing dietetics students’ change in perceived knowledge and perceived codence in feeding tube insertion using patient simulation

Continuity of Hospital Care and Feeding Tube Use in Cognitively Impaired Hospitalized Persons.

Hospitalists are increasingly the attending physician for hospitalized patients, and the scheduling of their shifts can affect patient continuity. For dementia patients, the impact is unknown. Longitudinal study using physician billing claims between 2000 and 2014 to examine the association of continuity of care with the insertion of a feeding tube (FT). US hospitals. Between 2000 and 2014, 166,056 hospitalizations of patients with a prior nursing home stay, advanced cognitive impairment, and impairments in four or more activities of daily living (mean age = 84.2 years; 30.4% male; 81.0% white). Continuity of care measured at the hospital level with the Sequential Continuity Index (SECON; range = 0 to 100; higher score indicates higher continuity). Rates of a hospitalist acting as the attending physician increased from 9.6% in 2000 to 22.6% in 2010, whereas a primary care physician with a predominant outpatient focus acting as the attending physician decreased from 50.3% in 2000 to 12.6% in 2014. Post-2010, a mixture of physician specialties increased from 55.5% to 66.4% with a reduction in hospitalists from 22.6% (2010) to 14.1% (2013). Continuity of care decreased over time with SECON dropping from 63.0 to 43.5. Adjusting for patient baseline risk factors, a nonlinear association was observed between SECON and FT insertion. Using cubic splines in the multivariate logistics regression model, the risk of FT insertion in hospitals where the SECON score dropped from 82 to 23 had an adjusted risk ratio (ARR) of FT insertion of 1.48 (95% confidence interval [CI] = 1.34-1.63); hospitals in which SECON dropped from 51 to 23 had an ARR of FT insertion of 1.38 (95% CI = 1.27-1.50). Hospitalized dementia patients in hospitals in which continuity of care was lower had higher rates of FT insertions. Newer models of care are needed to enhance care continuity and thus ensure treatment consistent with likely outcomes of care and goals of care. J Am Geriatr Soc 68:1852-1856, 2020.

Accuracy of the corrected nose-earlobe-xiphoid distance formula for determining nasogastric feeding tube insertion length in intensive care unit patients: A prospective observational study

BackgroundAs nasogastric feeding tube insertion is a frequently applied, non-risk-free nursing technique, a high level of evidence-based nursing care is required. Little evidence is available regarding the accurate determination of the insertion length of nasogastric feeding tubes. The method of using the nose-earlobe-xiphoid distance as measurement is inadequate and not supported by evidence. Findings from a recent randomized trial led to an alternative calculation: the corrected nose-earlobe-xiphoid distance formula: (nose-earlobe-xiphoid distance × 0.38696) + 30.37 + 6 cm. ObjectivesTo test the accuracy of the corrected nose-earlobe-xiphoid distance formula for determining the required nasogastric feeding tube insertion length in adults admitted on an intensive care unit and to investigate the probability to successfully obtain gastric aspirate for pH measurement. DesignProspective, single‐center observational study. Participants and methodsAdult intensive care unit patients in a general hospital (N = 218) needing a small-bore nasogastric feeding tube were included between March and September 2018. Correct tip positioning was defined as a tube tip located > 3 cm under the lower esophageal sphincter. Tip positioning was verified using X-ray. ResultsAll nasogastric feeding tube tips were correctly positioned > 3 cm under the lower esophageal sphincter. The chance of successfully obtaining gastric aspirate within 2 h after placement of the tube was 77.9%. ConclusionsWith all tips positioned > 3 cm in the stomach and zero tubes migrating back into the esophagus, the corrected nose-earlobe-xiphoid distance formula can be considered a more accurate method to determine nasogastric feeding tube insertion length.

A Novel Method of Nasojejunal Feeding and Gastric Decompression Using a Double Lumen Silicone Tube for Upper Gastrointestinal Obstruction.

Provision of enteral nutrition with jejunal feeding in upper gastrointestinal obstruction is highly recommended. Access to jejunum can be obtained surgically, percutaneously, or endoscopically. Our institution routinely and preferentially utilizes a silicone nasojejunal tube that is inserted past the obstruction endoscopically. We use a custom dual channel tube that allows feeding at the distal tip and another channel 40 cm from the tip that enables decompression proximally. This is a report of our experience with this custom nasojejunal tube. This is a prospective observational study of 201 patients who underwent endoscopic nasojejunal wire-guided feeding tube insertions for obstruction of either the esophagus or the stomach including both benign and malignant pathologies between January 2015 to June 2018 in Hospital Sungai Buloh and Hospital Sultanah Aminah, Malaysia. The indications for tube insertion, insertion technique, and tube-related problems were described. The nasojejunal tube was used to establish enteral feeding in patients with obstructing tumors of the distal esophagus in 65 patients (32.3%) and gastric outlet obstruction in 72 patients (35.8%). There were 54 patients (26.9%) who required reinsertion. The most common reason for reinsertion was unintentional dislodgement, where 32 patients (15.9%) followed by tube blockage 20 patients (10.0%). Using our method of advancement under direct vision, we had only 2 cases of malposition due to severely deformed anatomy. We had no incidence of aspiration in this group of patients and overall, the patients tolerated the tube well. The novel nasojejunal feeding tube with gastric decompression function is a safe and effective method of delivery of enteral nutrition in patients with upper gastrointestinal obstruction. These tubes if inserted properly are well tolerated with almost no risk of malposition and are tolerated well even for prolonged periods of time until definitive surgery could be performed.

Pneumothoraces Prevented With Use of Electromagnetic Device to Place Feeding Tubes.

A US Food and Drug Administration safety letter warned about the risk for pneumothoraces during feeding tube insertion despite the use of electromagnetic placement devices that provide real-time visualization of feeding tube position. To systematically assess pulmonary placement and pneumothoraces in CORTRAK-assisted feeding tube insertions. CINAHL, MEDLINE, and Cochrane databases were searched for studies of CORTRAK-assisted feeding tube insertion. Thirty-two studies documenting pulmonary placement and/or complications of feeding tube insertion were found. Operators recognized pulmonary placement on insertion tracings during 202 CORTRAK-assisted feeding tube insertion procedures, resulting in the immediate withdrawal of 199 feeding tubes. One pneumothorax was identified later by radiography. Seven pulmonary placements were not recognized by CORTRAK operators at the time of feeding tube insertion, resulting in 2 pneumothoraces. The incidence of pneumothorax for CORTRAK-assisted feeding tube insertions was 0.02% (3 of 17039). Of the feeding tubes inserted into the pulmonary system - either found during or after the procedure -1.4% (3 of 209) resulted in pneumothoraces (as opposed to the 19% to 28% incidence of pneumothorax for blind feeding tube insertions. Operators recognizing pulmonary placement on CORTRAK insertion tracings may have prevented 97% (202 of 209) of feeding tubes from being inserted farther into the respiratory tract. Feeding tube insertion with an electromagnetic placement device is advantageous over blind feeding tube insertion because the operator can recognize pulmonary placement early and withdraw the feeding tube, thus decreasing the risk of pulmonary complications.

1229 Resident Education in the Placement and Confirmation of Feeding Tubes

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 &lt;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.