Cortrak® duodenal tube placements: A solution for more patients? A preliminary survey to the introduction of electromagnetic-guided placement of naso-duodenal feeding tubes

• Published in: Clinical nutrition ESPEN Vol. 29; pp. 133 - 136
• Main Authors: Arjaans, W, Ouwehand, M, Bouma, G, van der Meulen, T, de van der Schueren, M.A.E
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-02-2019
• Subjects: Adult; Aged; Cortrak; Duodenal feeding tube; Education, Nursing; Electromagnetic guidance; Electromagnetic Phenomena; Endoscopes; Enteral Nutrition - methods; Female; Gastroenterology and Hepatology; Humans; Intubation, Gastrointestinal - methods; Male; Middle Aged; Nasoenteral tubes; Nurses; Retrospective Studies; Surveys and Questionnaires; Tube feeding; Nasoenteral tubes; Electromagnetic guidance; Cortrak; Duodenal feeding tube; Tube feeding
• ISSN: 2405-4577; 2405-4577
• DOI: 10.1016/j.clnesp.2018.11.006

Summary Rationale The Cortrak® feeding tube, an electromagnetic (EM) guided feeding tube which is placed by a trained nurse at the patient's bedside, is reported to be a safe, patient friendly and cost effective answer to the disadvantages of endoscopic placement of naso-duodenal feeding tubes. However, this procedure requires a learning curve and regular practice. This study aims to evaluate whether introducing Cortrak® feeding tube placement would be profitable in a tertiary referral academic hospital. Methods We re-evaluated all endoscopically placed post-pyloric feeding tubes in the years 2012–2013. Taking into consideration training for nurses to learn how to place Cortrak® feeding tubes, strict inclusion criteria were formulated for the initial retrospective analysis: age 18 years or older, normal GI anatomy and non-ICU admitted patients. As a secondary analysis we also evaluated ICU patients (age >18 and normal upper GI tract). Results Patient records of 487 duodenal feeding tube placements in 331 patients were evaluated; 125 non-ICU placements (in 90 patients) and 84 ICU placements (in 75 ICU patients) fulfilled the inclusion criteria. Main reasons for exclusion were: abnormalities of the upper GI tract (n = 176) and endoscopy for diagnostic reasons (n = 74). Main indications for placements were gastroparesis (37%) or insufficient food intake (20%). For secondary analysis, 84 placements in 75 ICU patients were re-evaluated, with main indication gastroparesis (62%). Conclusion In our hospital, at least one quarter of the duodenal tube placements would qualify for Cortrak® placement in the initial phase. Once routine has been built up and also ICU patients could be considered, half or more patients requiring a naso-duodenal feeding tube would qualify for Cortrak® placement, adding up to 3 placements per week. The findings of this study may help to decide on the profitability of introducing this method in our own hospital. The next step will be to perform a cost-benefit analysis to study whether implementing Cortrak® in practice is cost-effective and feasible.