Utilization of electromagnetic tube placement device to facilitate Nasojejunal Insertion in the PICU

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King, Hilary
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Purpose: The purpose of this quality improvement (QI) project was to improve patient’s outcomes of reduced radiation exposure in the PICU related to confirmation of nasojejunal feeding tube placement through the implementation of the electromagnetic-enteral access system (CORTRAK*2).|Background: Children admitted to the pediatric intensive care unit (PICU) are at risk for malnutrition and often require feeding tubes. It is estimated that one million enteral (gastric and intestinal) tubes are placed annually in adults and children across the United States to support nutrition during illness (Ellett, Croffie, Cohen, & Perkins, 2005). Inserting nasojejunal (NJ) tubes blindly can cause serious complications including respiratory distress or pneumothorax (Ellett, Croffie, Cohen, & Perkins, 2005).|Sample/Setting: The sample included pediatric patients from a 27-bed pediatric intensive care unit (PICU) in a Midwest, free standing Children’s Hospital requiring placement of a nasojejunal feeding tube.|Methods: The design for the quality improvement project was a retrospective chart review. Upon completion of the 12-week implementation period, the data was gathered through the electronic medical record and the CORTRAK*2 device. Data was entered into a spreadsheet and analyzed to evaluate for change in frequency in x-ray utilization and the accuracy of CORTRAK*2.|Results: A total of 16 NJ placements using the CORTRAK*2 were completed. Of those placements, two placements confirmed NJ placement on the CORTRAK*2 without need for an X-ray. Zero tubes were placed in the lungs using CORTRAK*2. Six out of 16 attempts resulted in NJ placement/utilization (37.5%).|Conclusion: Equivocal results on CORTRAK*2 should require an x-ray to confirm placement. Of the small study, when the CORTRAK*2 device resulted in either positive or negative, the X-ray confirmed those results to be accurate. Overall success rate of NJ tube placement was about a third, but majority of negative CORTRAK*2results did not receive an x-ray.
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