Use of Electromagnetic Device to Insert Postpyloric Feeding Tubes in a Pediatric Intensive Care Unit

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Abstract

EBR

Evidence-Based Review on pp 255-256

Background

The preferred route for providing nutrition in the pediatric intensive care unit is enteral. Placement of postpyloric feeding tubes using an electromagnetic-tipped stylet that emits a signal detected by a device held over the patient's abdomen is effective in adult intensive care units, but has not been well studied in pediatric units.

Objectives

To determine the effectiveness of the electromagnetic device in reducing the numbers of radiation exposures, intrahospital transports, tubes used, and tube placement attempts in the pediatric intensive care unit.

Methods

Data from a historical control group were compared with data from a prospective intervention group of patients less than 18 years of age and weighing at least 3 kg who required a postpyloric feeding tube in a 23-bed pediatric intensive care unit. Primary outcome was number of radiation exposures. Independent-samples Student t tests were used to compare the 2 study groups for mean equality; Pearson χ2 tests were used to compare categorical data. Statistical testing was 2-sided, and P less than .05 was considered statistically significant.

Results

Of 73 children (30 in control group, 43 in intervention group), those in the intervention group had a higher success rate at tube placement (P = .009) and fewer radiation exposures (P = .006), intrahospital transports (P = .004), and tubes used (P < .001).

Conclusions

Successful placement of postpyloric feeding tubes by nurse practitioners was safely enhanced using an electromagnetic device. Establishing users' expertise with the device before studying outcomes may improve effectiveness.

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