Placement Of Nasoenteric Feeding Tubes Research Articles

Role of registered dietitians in nasoenteric feeding tube placement.

Provision of enteral nutrition (EN) in hospitalized patients is an integral part of clinical care. For various reasons, including but not limited to delayed enteral access placement and EN initiation, it is becoming more prevalent for registered dietitians (RDs) to place feeding tubes in various clinical settings. Although numerous RDs have expanded their practice by learning this skill, many remain hesitant about adding feeding tube placement to their scope of responsibilities. Feeding tube placement is within RDs' scope of practice. The recently updated Accreditation Council for Education in Nutrition and Dietetics (ACEND) standards is requiring dietetic interns to learn the process and assist in placing feeding tubes. This will help promote the inclusion of this practice and open doors for future advancement in the scope of practice for RDs. This review will provide an overview of feeding tube placement methods, evidence-based techniques, training, competencies, and barriers to accepting this practice in dietetics.

Dietitian Led Nasoenteric Feeding Tube (NEFT) Placement in a Community Hospital Setting

Dietitian Led Nasoenteric Feeding Tube (NEFT) Placement in a Community Hospital Setting

What is the efficacy and safety of electromagnetic-guided placement of postpyloric nasoenteral feeding tubes compared to endoscopic-guided placement?

What is the efficacy and safety of electromagnetic-guided placement of postpyloric nasoenteral feeding tubes compared to endoscopic-guided placement?

Enteral Nutrition Simulation Workshop Enhances Knowledge and Skills of Graduate Nutrition Students

Registered dietitian nutritionists are integral to the health care team, especially in delivering and managing parenteral or enteral nutrition (EN). 1 Corrigan ML Bobo E Rollins C Mogensen KM. Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: revised 2021 standards of practice and standards of professional performance for registered dietitian nutritionists (competent, proficient, and expert) in nutrition support. Nutr Clin Pract. 2021; 36: 1126-1143 Google Scholar The training and education of future registered dietitian nutritionists are necessary to promote and advance the skill set of the practitioner. The Accreditation Council for Education in Nutrition and Dietetics (ACEND) is the accrediting agency for nutrition and dietetics education programs which provides the required standards and learning elements that train students to become dietitians. 2 ACEND. Future Education Model Standards and Templates v2022.https://www.eatrightpro.org/acend/accreditation-standards-fees-and-policies/future-education-model-standards-and-templates-v2022. Accessed December 22, 2022. Google Scholar The ACEND standards require learning activities in the curriculum to ensure the full scope of the competencies is met. 2 ACEND. Future Education Model Standards and Templates v2022.https://www.eatrightpro.org/acend/accreditation-standards-fees-and-policies/future-education-model-standards-and-templates-v2022. Accessed December 22, 2022. Google Scholar In 2022, ACEND added required elements and learning experiences for all nutrition and dietetics programs. The ACEND Accreditation Standards for Nutrition and Dietetics Graduate Degree Programs (Future Education Model) 2 ACEND. Future Education Model Standards and Templates v2022.https://www.eatrightpro.org/acend/accreditation-standards-fees-and-policies/future-education-model-standards-and-templates-v2022. Accessed December 22, 2022. Google Scholar specify faculty must prepare students to become competent in this skill: “Element 3.2e-3: Explain the steps involved and observe the placement of nasogastric (NG) or nasoenteric feeding tubes; if available, assist in the process of placing NG or nasoenteric feeding tubes.” 2 ACEND. Future Education Model Standards and Templates v2022.https://www.eatrightpro.org/acend/accreditation-standards-fees-and-policies/future-education-model-standards-and-templates-v2022. Accessed December 22, 2022. Google Scholar

Electromagnetic-guided versus endoscopic-guided postpyloric placement of nasoenteral feeding tubes.

For people who are malnourished and unable to consume food by mouth, nasoenteral feeding tubes are commonly used for the administration of liquid food and drugs. Postpyloric placement is when the tip of the feeding tube is placed beyond the pylorus, in the small intestine. Endoscopic-guided placement of postpyloric feeding tubes is the most common approach. Usually, an endoscopist and two or more medical professionals perform this procedure using a guidewire technique. The position of the tube is then confirmed with fluoroscopy or radiography, which requires moving people undergoing the procedure to the radiology department. Alternatively, electromagnetic-guided placement of postpyloric nasoenteral feeding tubes can be performed by a single trained nurse, at the bedside and with less equipment than endoscopic-guided placement. Hence, electromagnetic-guided placement may represent a promising alternative to endoscopic-guided placement, especially in settings where endoscopy and radiographic facilities are unavailable or difficult to access. To assess the efficacy and safety of electromagnetic-guided placement of postpyloric nasoenteral feeding tubes compared to endoscopic-guided placement. We searched the Cochrane Library, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform, and OpenGrey until February 2021. We screened the reference lists of relevant review articlesand current treatment guidelines for further literature. We contacted the study authors for missing data. We included randomised trials comparing electromagnetic-guided placement with endoscopic-guided placement of nasoenteral feeding tubes. We excluded prospective cohort studies, retrospective cohort studies, (nested) case-control studies, cross-sectional studies, and case series or case reports. Two review authors independently assessed the methodological quality of potentially eligible trials and extracted data from the included trials. The primary outcomes were technical success in insertion and aspiration pneumonitis. The secondary outcomes were the time for postpyloric placement of nasoenteral feeding tubes, direct healthcare costs, and adverse events. We performed a random-effects meta-analysis. We calculated risk ratios (RRs) with 95% confidence intervals (CIs) for dichotomous outcomes and mean differences (MDs) with 95% CIs for continuous outcomes. We evaluated the certainty of evidence based on the GRADE approach. We identified four randomised controlled trials with 541 participants which met our inclusion criteria. All trials had methodological limitations, and lack of blinding of participants and investigators was a major source of bias. We had 'some concerns' for the overall risk of bias in all trials. Electromagnetic-guided postpyloric placement of nasoenteral feeding tubes may result in little to no difference in technical success in insertion compared to endoscopic-guided placement (RR 1.09, 95% CI 0.88 to 1.35; I2 = 81%; low-certainty evidence). Electromagnetic-guided placement may result in a difference in the proportion of participants with aspiration pneumonitis compared to endoscopic-guided placement, but these results are unclear (RR 0.24, 95% CI 0.03 to 2.18; I2 = 0%; low-certainty evidence). Electromagnetic-guided placement may result in little to no difference in the time for postpyloric placement of nasoenteral feeding tubes compared to endoscopic-guided placement (MD 4.06 minutes, 95% CI -0.47 to 8.59; I2 = 97%; low-certainty evidence). Electromagnetic-guided placement likely reduces direct healthcare costs compared to endoscopic-guided placement (MD -127.69 US dollars, 95% CI -135.71 to -119.67; moderate-certainty evidence). Electromagnetic-guided placement likely results in little to no difference in adverse events compared with endoscopic-guided placement (RR 0.78, 95% CI 0.41 to 1.49; moderate-certainty evidence). We found low-certainty evidence that electromagnetic-guided placement at the bedside results in little to no difference in technical success in insertion and aspiration pneumonitis, compared to endoscopic-guided placement. The heterogeneity of the healthcare professionals who performed the procedures and the small sample sizes limited our confidence in the evidence. Future research should be based on large studies with well-defined endpoints to potentially elucidate the differences between these two procedures.

Development of a Competency Model for Placement and Verification of Nasogastric and Nasoenteric Feeding Tubes for Adult Hospitalized Patients

Nasogastric/nasoenteric (NG/NE) feeding tube placements are associated with adverse events and, without proper training, can lead to devastating and significant patient harm related to misplacement. Safe feeding tube placement practices and verification are critical. There are many procedures and techniques for placement and verification; this paper provides an overview and update of techniques to guide practitioners in making clinical decisions. Regardless of placement technique and verification practices employed, it is essential that training and competency are maintained and documented for all clinicians placing NG/NE feeding tubes. This paper has been approved by the American Society for Parenteral and Enteral Nutrition (ASPEN) Board of Directors.

Factors associated with fluoroscopy-guided placement of nasoenteral feeding tubes.

Feeding by nasoenteral tube (NET) is safe and effective for supporting the nutrition needs of patients with inadequate oral intake. However, during insertion of the NET with fluoroscopic guidance, both the professional staff and patients are exposed to radiation. To improve the success rate of NET placement and minimize radiation exposure, this retrospective study evaluated potential factors associated with successful fluoroscopy-guided NET placement and short total fluoroscopy time (TFT) among Chinese patients. An assessment was conducted among patients (n = 348) who received NET placement by physicians under fluoroscopic guidance. Multivariate logistic regression models and linear models were used to validate factors that affected the success of placement and TFT. NET was placed successfully in 319 patients (91.7%), with a median TFT of 6.1 (interquartile range [IQR], 4.9-9.9) minutes. The median TFT of patients with unsuccessful placement was 15.4 (IQR, 12.7-20.9) minutes. Factors associated with successful placement included lack of upper gastrointestinal (GI) surgery history and normal peristalsis of the upper GI tract (P ≤ .015). The TFT was significantly influenced by upper GI surgery history and characteristics of the upper GI tract (P ≤ .025). The professional title or experience of the operators had no association with successful NET placement or TFT. NET placement under fluoroscopic guidance had a high success rate. Factors that are crucial for planning the approach include a history of upper GI surgery, the dynamic status of the upper GI tract, and features of the upper GI tract.

Electromagnetic guided versus endoscopic guided postpyloric placement of nasoenteral feeding tubes

Electromagnetic guided versus endoscopic guided postpyloric placement of nasoenteral feeding tubes

S0579 The Utility of Obtaining Abdominal Radiograph to Confirm Nasoenteric Feeding Tube Placement by Endoscopy

INTRODUCTION: Enteral feeding is the preferred method of nutrition support in patients unable to maintain volitional intake given its low cost, preservation of gut integrity, and lower infection rate as compared to parenteral nutrition. At our institution, nasoenteric tubes are either placed by nutrition support nurses who are trained to use electromagnetically visualized enteral system or placed by endoscopy either by gastroenterology or general surgery. We aimed to validate feeding tube placement by endoscopy using abdominal x- rays and to determine the risk factors associated with a mal-positioned feeding tube. METHODS: In this retrospective observational study, all patients who underwent nasoenteric feeding tube placement by endoscopy during the year 2019 at Cleveland Clinic were identified using electronic medical records. Data was collected on indication for feeding tube, location (inpatient vs. outpatient), feeding tube tip position on endoscopy report and x-ray report (obtained within 24 hours post-placement), demographics, BMI, medications, comorbidities including gastroparesis, ileus, post-op GI surgery, and post-op non-GI surgery. RESULTS: A total of 308 patients were included in the final analysis. The mean age was 58.9 years, 53.9% were females and 77.3% were white. Majority of the feeding tubes were placed in outpatient or ambulatory setting compared to inpatient (208 vs 100). The main indication for feeding tube placement was dysphagia (24.4%) followed by malnutrition (14.9%), nausea and vomiting (8.4%), and gastroparesis (8.1%). Feeding tube tip location by endoscopy was in the proximal or distal duodenum 61% of the time and in the proximal jejunum 26.3%. Tip location on abdominal film was 22% in the jejunum, 22.1% in the stomach, 15.6% in the third and fourtpart of the duodenum, and 14.6% in first or second part of the duodenum. Endoscopy and x-ray were 75% of the time in agreement. Some of the factors associated with EGD and x-ray discrepancy include younger age, male gender, greater BMI, longer endoscopy duration and having a fellow present during the case although none are statistically significant (P > 0.05). CONCLUSION: The tip of nasoenteric feeding tube may migrate during or post procedure. Therefore, abdominal films should remain the gold standard to confirm tip position in nasoenteric feeding tube placed by endoscopy.

Correction: Electromagnetic-Guided Bedside Placement of Nasoenteral Feeding Tubes by Nurses Is Non-Inferior to Endoscopic Placement by Gastroenterologists: A Multicenter Randomized Controlled Trial.

Gerritsen, Arja MD, PhD; de Rooij, Thijs BSc; Dijkgraaf, Marcel G. PhD; Busch, Olivier R. MD, PhD; Bergman, Jacques J. MD, PhD; Ubbink, Dirk T. MD, PhD; van Duijvendijk, Peter MD, PhD; Erkelens, Willemien G. MD; Klos, Mariël RN; Kruyt, Philip M. MD; Bac, Dirk Jan MD, PhD; Rosman, Camiel MD, PhD; Tan, Adriaan C. MD, PhD; Molenaar, Quintus I. MD, PhD; Monkelbaan, Jan F. MD; Mathus-Vliegen, Elisabeth M. MD, PhD; Besselink, Marc G. MD, MSc, PhD; Collabolators

Bedside electromagnetic-guided placement of nasoenteral feeding tubes among critically Ill patients: A single-centre randomized controlled trial

PurposeWe aimed to compare the effectiveness of EM-guided and endoscopic nasoenteral feeding tube placement among critically ill patients. Materials and methodsWe performed a single-center, randomized controlled trial among 161 adult patients admitted to intensive care units (ICUs) requiring nasoenteral feeding. Patients were randomly assigned to EM-guided or endoscopic nasoenteral feeding tube placement (1:1). The primary end point was the total success rate of correct jejunal placement. ResultsThis was achieved in 74/81 and 76/80 patients who underwent EM-guided and endoscopic jejunal tube placements, respectively (91.4% vs. 95%; relative risk, 0.556; [CI], 0.156–1.980; P = 0.360). The EM-guided group had more placement attempts, longer placement time, and shorter inserted nasal intestinal tube length. However, they had shorter total placement procedure duration and physician's order–tube placement and order–start of feeding intervals. The EM-guided group had higher discomfort level and recommendation scores and lesser patient costs. This trial is registered at Chinese Clinical Trials Registry (ChiCTR-IOR-17011737). ConclusionBedside EM-guided placement is as fast, safe, and successful as endoscopic placement and may be considered the preferred technique in critically ill patients.

Application of bronchoscope for the placement of nasoenteric feeding tube: new ideas from old ways

The novel technique of nasoenteric feeding tube (NET) placement with bronchoscope proposed by Cao et al . (1) is an interesting report and deserve in depth discussion and further study. In spite of limited case numbers, Cao et al . validate that placing nasojejunal tube with bronchoscope is safe and feasible in post esophagectomy patients.

Safety and Efficacy of Electromagnetic-Guided Bedside Placement of Nasoenteral Feeding Tubes versus Standard Placement

Although enteral feeding in critically ill patients has been shown to be beneficial, reliable postpyloric placement of feeding tubes remains a challenge. The standard of care involves blind placement, frequently requiring multiple attempts, and radiographs. To evaluate the effect of electromagnetic-guided bedside placement in reducing time to establishment of feeding, lung placement, use of radiography, and cost, we initiated a prospective trial using electromagnetic-guided bedside placement and compared them to a retrospective cohort. Fifty-three consecutive placements of nasoenteral feeding tubes were made using electromagnetic-guidance on patients requiring enteral nutrition in a surgical intensive care unit at a tertiary care center. Sixty-three placement attempts in the preceding seven months served as controls. There were no significant differences between the two groups in terms of age, sex, weight, body mass index, hiatal or ventral hernias, or previous esophageal/gastric operations. The number of radiographs needed per patient, need for fluoroscopy, radiology charge per patient for the tube placement, and time from first attempt at placement to confirmation of postpyloric location were lower for the electromagnetic-guided group. Use of electromagnetic guidance allows reliable and cost-effective postpyloric enteral feeding tube placement compared with blind insertion.

Application of bronchoscope for the placement of nasoenteric feeding tube in patients with esophagectomy: a novel technique.

Currently the available techniques for the placement of nasoenteric feeding tube (NET), utilizing transnasal gastroscope are fast and tolerable, which is known as the most popular method. However, lots of hospitals don't have this endoscopic system. Bronchoscope, which is the basic respiratory endoscope, not only has the advantages of transnasal endoscopy, but also is popular in common hospitals. We used oxygen instillation as air supply plant of the bronchoscope, which broke its application limitation in digestive tract. The aim of this study is to evaluate the feasibility and availability of the method of placing NET with the bronchoscope in patients with esophagectomy. From January 2013 to January 2016, a total of 48 patients with esophagectomy who underwent NET placement with the bronchoscope were included in our study. Information concerning age, gender, as well as background disease of the patients was collected. The success rate, procedure duration, and complications were recorded for each patient. The technique success rate reached 100%, procedure time ranged from 150 to 750 s, with an average time of 257 s. All patients tolerated well under local anesthesia, no complication of epistaxis or perforation occurred. The new technique of placing NET with the bronchoscope is fast, safe, effective, and well tolerated for patients with esophagectomy.

Does metoclopramide assist with the post-pyloric placement of naso-enteral feeding tubes?

Does metoclopramide assist with the post-pyloric placement of naso-enteral feeding tubes?

Electromagnetic-Guided Bedside Placement of Nasoenteral Feeding Tubes by Nurses Is Non-Inferior to Endoscopic Placement by Gastroenterologists: A Multicenter Randomized Controlled Trial.

Electromagnetic (EM)-guided bedside placement of nasoenteral feeding tubes by nurses may improve efficiency and reduce patient discomfort and costs compared with endoscopic placement by gastroenterologists. However, evidence supporting this task shift from gastroenterologists to nurses is limited. We aimed to compare the effectiveness of EM-guided and endoscopic nasoenteral feeding tube placement. We performed a multicenter randomized controlled non-inferiority trial in 154 adult patients who required nasoenteral feeding and were admitted to gastrointestinal surgical wards in five Dutch hospitals. Patients were randomly assigned (1:1) to undergo EM-guided or endoscopic nasoenteral feeding tube placement. The primary end point was the need for reinsertion of the feeding tube (e.g., after failed initial placement or owing to tube-related complications) with a prespecified non-inferiority margin of 10%. Reinsertion was required in 29 (36%) of the 80 patients in the EM-guided group and 31 (42%) of the 74 patients in the endoscopy group (absolute risk difference -6%, upper limit of one-sided 95% confidence interval 7%; P for non-inferiority=0.022). No differences were noted in success and complication rates. In the EM-guided group, there was a reduced time to start of feeding (424 vs. 535 min, P=0.001). Although the level of discomfort was higher in the EM-guided group (Visual Analog Scale (VAS) 3.9 vs. 2.0, P=0.009), EM-guided placement received higher recommendation scores (VAS 8.2 vs. 5.5, P=0.008). EM-guided bedside placement of nasoenteral feeding tubes by nurses was non-inferior to endoscopic placement by gastroenterologists in surgical patients and may be considered the preferred technique for nasoenteral feeding tube placement.

Tension Pneumothorax Caused by Feeding Tube Malposition: How could It Be Prevented?

Nasoenteric feeding tube placement is routine to ensure the enteral nutrition in critically ill patients, but pulmonary complications may be encountered when feeding tubes were placed blindly at the bedside. Herein, we present a case with tension pneumothorax caused by withdrawal of incorrect positioned feeding tube to left hemithorax and most recent approaches were revised to prevent pulmonary complications during the feeding tube placement.

Fluoroscopy-guided placement of nasoenteral tubes in children using intermittent digital pulse fluoroscopy and last image save/grab technique

To document the radiation exposure metrics, including fluoroscopic radiation time and radiation dose-area product, in children <18 years of age who undergo nasoenteral tube placement using fluoroscopic guidance with maximal dose-reduction techniques. Following institutional review board approval, the age, gender, anatomical information, immediate procedure-related complications if any, fluoroscopy time, and radiation dose-area product were collected retrospectively in all paediatric patients who underwent fluoroscopically guided nasoenteral tube placement during a 5-year period. Three paediatric radiology faculty members, a radiologist assistant, and trainee residents during their paediatric radiology rotation performed the procedures on two different digital fluoroscopic machines using radiation-minimising techniques. Median values of the fluoroscopy time and radiation dose-area product were calculated and compared to values reported in the literature using the Wilcoxon procedure. There were 41 male and 33 female patients with a median age of 4 years and 6 months. Median fluoroscopy time used for placing a nasoenteral tube was 1.25 minutes with a median radiation exposure dose-area product of 0.245 Gy·cm(2). All patients had successful placement of nasoenteral tube without immediate procedure-related complications. Fluoroscopy-guided nasoenteral feeding tube placement can be performed successfully with minimal radiation exposure without compromising procedural success.

Electromagnetic guided bedside placement of nasoenteral feeding tubes by nurses versus endoscopic placement by gastroenterologists (CORE): A randomized controlled non-inferiority multicenter trial

Electromagnetic guided bedside placement of nasoenteral feeding tubes by nurses versus endoscopic placement by gastroenterologists (CORE): A randomized controlled non-inferiority multicenter trial

Electromagnetic Sensor-Guided Enteral Access Systems: A Literature Review.

Enteral feeding is the nutritional support of choice for acutely ill patients with functional gastrointestinal tracts who are unable to swallow. Several benefits including reduced mortality and length of hospital stay have been associated with early initiation of enteral feeding. However, misplacement of conventional nasoenteric tubes is relatively common and can result in complications including pneumothorax. In addition, the need to confirm the position by X-ray can delay the start of using the tube. Eliminating these delays can help patients start feeding, and minimise the adverse impact on initiating hydration and medication. The purpose of this review was to critically examine whether electromagnetic sensor-guided enteral access systems (EMS-EAS) can help overcome the challenges of conventional nasoenteric feeding tube placement and confirmation. The Royal Society of Medicine’s library performed two searches on Medline (1946–March 2014) and Embase (1947–March 2014) covering all papers on Cortrak or electromagnetic or magnetic guidance systems for feeding tubes in adults. Results from the literature search found an agreement between the radiographic and EMS-EAS confirmation of placement. EMS-EAS virtually eliminated the risk of misplacement and pneumothorax was not reported. In addition, studies showed a small decrease in the number of X-rays with EMS-EAS and a reduced average time to start feeding compared with blind placement. This review suggests that EMS-EAS reduces several complications associated with the misplacement of nasoenteric feeding tubes, and that there could be considerable improvements in mortality, morbidity, patient experience and cost if EMS-EAS is used instead of conventional methods.