Evaluation of Cost Related to Placement of Post-pyloric Feeding Tubes in Critically Ill Pediatric Patients

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Darwin, Lisa
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Critically ill pediatric patients are often exposed to radiation by way of diagnostic imaging throughout their intensive care unit stay. Each diagnostic image increases the patient’s risk for radiation related malignancies later on in life. Pediatric Intensive Care Unit (PICU) patients often suffer from gastric feeding intolerance in the setting of an acute illness, putting their nutritional status at risk. Often times, the need for post-pyloric feeding tubes often arises. There is no formal protocol to promote accuracy for blind placement of post-pyloric feeding tubes; therefore, additional diagnostic imaging is often required to confirm proper position following blind placement.|An alternative to placing post-pyloric feeding tubes without utilizing abdominal radiography at the bedside is the commercially available CORTRAK*2 device. It is an electromagnetic device that is FDA-approved to confirm placement of the enteral feeding tube without obtaining radiographic confirmation, thereby avoiding radiation exposure and any additional costs associated with the imaging. The purpose of this cost analysis was to determine return on investment and elaborate on cost to both the patient and a Midwestern PICU when considering use of the CORTRAK*2 against current practices for blind placement of post-pyloric feeding tubes.|Additional abdominal radiographic studies increase cost to the patient with each study that is utilized to confirm post-pyloric feeding tube placement. In twelve months’ time, this PICU placed 32 post-pyloric feeding tubes, while utilizing over 150 abdominal x-rays or fluoroscopy encounters to achieve confirmation of placement. The cost to the patient of confirming proper placement has been estimated at $2,597 per placement. Use of the CORTRAK*2 is estimated to allow bedside clinicians to successfully place post-pyloric feeding tubes with as much as 50% less abdominal radiation, thereby decreasing cost to the patient by at least 50%.
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