Clinical Costs of Feeding Tube Placement
Background: Although small-bore tube placement is common, insertion can lead to serious complications. We investigated the use of radiographs, fluoroscopy, feeding tubes, and complications associated with blind feeding-tube placement. Methods: The electronic and paper records of adult patients recei...
Saved in:
Published in | JPEN. Journal of parenteral and enteral nutrition Vol. 31; no. 4; pp. 269 - 273 |
---|---|
Main Authors | , |
Format | Journal Article |
Language | English |
Published |
Silver Spring, MD
SAGE Publications
01.07.2007
ASPEN American Society for Parenteral and Enteral Nutrition |
Subjects | |
Online Access | Get full text |
Cover
Loading…
Summary: | Background: Although small-bore tube placement is common,
insertion can lead to serious complications. We investigated the use of
radiographs, fluoroscopy, feeding tubes, and complications associated with
blind feeding-tube placement. Methods: The electronic and paper
records of adult patients receiving a small-bore feeding tube in 2005 were
retrospectively reviewed for the following variables: demographics, desired
location (gastric or postpyloric), number of radiographs, number of tubes per
individual, time interval between medical prescription, tube placement and
delivery of the diet, complications, transport for fluoroscopy, and hospital
location of placement (intensive care unit vs floor).
Results: We identified 1822 tubes placed into 729 patients (male:
449, 61.6%; female: 280, 38.4%; median age: 59 years old, range 18–98).
All tubes were placed by nurses unless fluoroscopically placed in radiology or
placed after head and neck surgery in the operating room. An average of 2.5
(range 1–20) tubes was used per patient. A total of 2696 radiographs
were obtained for an average of 3.7 (range 0–32) films per patient and
1.5 (range 0–11) per feeding tube. Successful placement was higher for
intragastric (93.3%) than for postpyloric position (60.4%; p <
.001). Fluoroscopy was needed in 18.6% of the patients, mostly for postpyloric
insertion (p < .001). Respiratory tree misplacement occurred in 23
(3.2%) patients; 9 (1.2%) had a pneumothorax and 4 (0.5%) died. Patients with
a malpositioned feeding tube underwent more tube insertions (6.8 ± 5.4;
range 2–20) than patients without complications (2.2 ± 1.8; range
1–18; p < .001). Conclusions: The incidence of
airway misplacement of feeding tubes (3.2%) at a major tertiary referral
university hospital was alarming. Mandatory radiographs may eliminate the risk
of respiratory administration of feedings but not misplacements. The
associated costs of radiographs, unsuccessful placements, fluoroscopy, and
complications are significant. A solution to this problem will require focused
attention and development of specific protocols, possibly using new
technologies.
Although small-bore tubes are commonly used, their insertion can lead to serious complications. A mandatory radiograph may eliminate the risk of respiratory administration of feedings but not misplacements. |
---|---|
Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 0148-6071 1941-2444 |
DOI: | 10.1177/0148607107031004269 |