A team-based protocol and electromagnetic technology eliminate feeding tube placement complications

Matthew Koopman, Kenneth A. Kudsk, Molly J. Szotkowski, Susan M. Rees

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Objective: To examine whether feeding tube placement into high-risk patients using a team-based protocol and electromagnetic tube tracking reduces complications associated with blind tube placement and to evaluate safety of blind tube placement in alert, low-risk patients. Background: Approximately 1•2million feeding tubes with stylets are placed annually in the US. Serious complications during placement exceed the rates of retained sponges and wrong site surgery. Several suggested solutions to the problem have been proposed but none completely eliminate the serious complications and many are neither cost-effective nor practical. Methods: In a retrospective, single center study, we compared complications after bedside feeding tube placement using a blind technique in 2005 to a hospital protocol mandating tube placement in high-risk patients by a Tube Team in 2007 using electromagnetic tracking. Outcome variables included airway placement, pneumothorax, death, and radiology resource utilization. Results: The Tube Team protocol eliminated airway tube placement (0 of 1154 vs. 20 of 1822, P < 0.001), pneumothorax (0/715 vs. 11/1822, P = 0.009), and all mortality whereas improving placement (83.9% success vs. 60.5%, P<0.001) in high-risk patients compared to the 2005 study. The number of X-rays obtained per tube (1.07 +/- 0.01 vs. 1.49 +/- 0.026, P < 0.001) and need for fluoroscopy (2.1% vs. 10.9%, P < 0.001) significantly dropped with the Tube Team. A final comparison was made to low-risk patients considered acceptable for blind tube placement in 2007 due to their alertness and ability to cooperate and provide feedback during tube placement. Although no mortality occurred during blind placement in low risk, alert patients, blind placement resulted in significantly increased airway placement (3/143, p = 0.001) and pneumothorax (2 of 143, P = 0.01) compared to the Tube Team protocol. Most patients who would have required fluoroscopic placement of feeding tube due to failed blind technique had successful placement by the Team avoiding fluoroscopy. Conclusion: Feeding tube placement by a dedicated team using electromagnetic tracking eliminates the morbidity and mortality of this common hospital procedure. Blind placement is not acceptable in awake, alert patients.

Original languageEnglish (US)
Pages (from-to)297-302
Number of pages6
JournalAnnals of surgery
Volume253
Issue number2
DOIs
StatePublished - Feb 1 2011
Externally publishedYes

Fingerprint

Electromagnetic Phenomena
Enteral Nutrition
Technology
Pneumothorax
Fluoroscopy
Medical Errors
Mortality
Porifera
Hospital Mortality
Radiology
X-Rays
Morbidity
Safety
Costs and Cost Analysis

ASJC Scopus subject areas

  • Surgery

Cite this

A team-based protocol and electromagnetic technology eliminate feeding tube placement complications. / Koopman, Matthew; Kudsk, Kenneth A.; Szotkowski, Molly J.; Rees, Susan M.

In: Annals of surgery, Vol. 253, No. 2, 01.02.2011, p. 297-302.

Research output: Contribution to journalArticle

Koopman, Matthew ; Kudsk, Kenneth A. ; Szotkowski, Molly J. ; Rees, Susan M. / A team-based protocol and electromagnetic technology eliminate feeding tube placement complications. In: Annals of surgery. 2011 ; Vol. 253, No. 2. pp. 297-302.
@article{aef72dfe7a4f4a009bb45b7b29e22fe0,
title = "A team-based protocol and electromagnetic technology eliminate feeding tube placement complications",
abstract = "Objective: To examine whether feeding tube placement into high-risk patients using a team-based protocol and electromagnetic tube tracking reduces complications associated with blind tube placement and to evaluate safety of blind tube placement in alert, low-risk patients. Background: Approximately 1•2million feeding tubes with stylets are placed annually in the US. Serious complications during placement exceed the rates of retained sponges and wrong site surgery. Several suggested solutions to the problem have been proposed but none completely eliminate the serious complications and many are neither cost-effective nor practical. Methods: In a retrospective, single center study, we compared complications after bedside feeding tube placement using a blind technique in 2005 to a hospital protocol mandating tube placement in high-risk patients by a Tube Team in 2007 using electromagnetic tracking. Outcome variables included airway placement, pneumothorax, death, and radiology resource utilization. Results: The Tube Team protocol eliminated airway tube placement (0 of 1154 vs. 20 of 1822, P < 0.001), pneumothorax (0/715 vs. 11/1822, P = 0.009), and all mortality whereas improving placement (83.9{\%} success vs. 60.5{\%}, P<0.001) in high-risk patients compared to the 2005 study. The number of X-rays obtained per tube (1.07 +/- 0.01 vs. 1.49 +/- 0.026, P < 0.001) and need for fluoroscopy (2.1{\%} vs. 10.9{\%}, P < 0.001) significantly dropped with the Tube Team. A final comparison was made to low-risk patients considered acceptable for blind tube placement in 2007 due to their alertness and ability to cooperate and provide feedback during tube placement. Although no mortality occurred during blind placement in low risk, alert patients, blind placement resulted in significantly increased airway placement (3/143, p = 0.001) and pneumothorax (2 of 143, P = 0.01) compared to the Tube Team protocol. Most patients who would have required fluoroscopic placement of feeding tube due to failed blind technique had successful placement by the Team avoiding fluoroscopy. Conclusion: Feeding tube placement by a dedicated team using electromagnetic tracking eliminates the morbidity and mortality of this common hospital procedure. Blind placement is not acceptable in awake, alert patients.",
author = "Matthew Koopman and Kudsk, {Kenneth A.} and Szotkowski, {Molly J.} and Rees, {Susan M.}",
year = "2011",
month = "2",
day = "1",
doi = "10.1097/SLA.0b013e318208f550",
language = "English (US)",
volume = "253",
pages = "297--302",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - A team-based protocol and electromagnetic technology eliminate feeding tube placement complications

AU - Koopman, Matthew

AU - Kudsk, Kenneth A.

AU - Szotkowski, Molly J.

AU - Rees, Susan M.

PY - 2011/2/1

Y1 - 2011/2/1

N2 - Objective: To examine whether feeding tube placement into high-risk patients using a team-based protocol and electromagnetic tube tracking reduces complications associated with blind tube placement and to evaluate safety of blind tube placement in alert, low-risk patients. Background: Approximately 1•2million feeding tubes with stylets are placed annually in the US. Serious complications during placement exceed the rates of retained sponges and wrong site surgery. Several suggested solutions to the problem have been proposed but none completely eliminate the serious complications and many are neither cost-effective nor practical. Methods: In a retrospective, single center study, we compared complications after bedside feeding tube placement using a blind technique in 2005 to a hospital protocol mandating tube placement in high-risk patients by a Tube Team in 2007 using electromagnetic tracking. Outcome variables included airway placement, pneumothorax, death, and radiology resource utilization. Results: The Tube Team protocol eliminated airway tube placement (0 of 1154 vs. 20 of 1822, P < 0.001), pneumothorax (0/715 vs. 11/1822, P = 0.009), and all mortality whereas improving placement (83.9% success vs. 60.5%, P<0.001) in high-risk patients compared to the 2005 study. The number of X-rays obtained per tube (1.07 +/- 0.01 vs. 1.49 +/- 0.026, P < 0.001) and need for fluoroscopy (2.1% vs. 10.9%, P < 0.001) significantly dropped with the Tube Team. A final comparison was made to low-risk patients considered acceptable for blind tube placement in 2007 due to their alertness and ability to cooperate and provide feedback during tube placement. Although no mortality occurred during blind placement in low risk, alert patients, blind placement resulted in significantly increased airway placement (3/143, p = 0.001) and pneumothorax (2 of 143, P = 0.01) compared to the Tube Team protocol. Most patients who would have required fluoroscopic placement of feeding tube due to failed blind technique had successful placement by the Team avoiding fluoroscopy. Conclusion: Feeding tube placement by a dedicated team using electromagnetic tracking eliminates the morbidity and mortality of this common hospital procedure. Blind placement is not acceptable in awake, alert patients.

AB - Objective: To examine whether feeding tube placement into high-risk patients using a team-based protocol and electromagnetic tube tracking reduces complications associated with blind tube placement and to evaluate safety of blind tube placement in alert, low-risk patients. Background: Approximately 1•2million feeding tubes with stylets are placed annually in the US. Serious complications during placement exceed the rates of retained sponges and wrong site surgery. Several suggested solutions to the problem have been proposed but none completely eliminate the serious complications and many are neither cost-effective nor practical. Methods: In a retrospective, single center study, we compared complications after bedside feeding tube placement using a blind technique in 2005 to a hospital protocol mandating tube placement in high-risk patients by a Tube Team in 2007 using electromagnetic tracking. Outcome variables included airway placement, pneumothorax, death, and radiology resource utilization. Results: The Tube Team protocol eliminated airway tube placement (0 of 1154 vs. 20 of 1822, P < 0.001), pneumothorax (0/715 vs. 11/1822, P = 0.009), and all mortality whereas improving placement (83.9% success vs. 60.5%, P<0.001) in high-risk patients compared to the 2005 study. The number of X-rays obtained per tube (1.07 +/- 0.01 vs. 1.49 +/- 0.026, P < 0.001) and need for fluoroscopy (2.1% vs. 10.9%, P < 0.001) significantly dropped with the Tube Team. A final comparison was made to low-risk patients considered acceptable for blind tube placement in 2007 due to their alertness and ability to cooperate and provide feedback during tube placement. Although no mortality occurred during blind placement in low risk, alert patients, blind placement resulted in significantly increased airway placement (3/143, p = 0.001) and pneumothorax (2 of 143, P = 0.01) compared to the Tube Team protocol. Most patients who would have required fluoroscopic placement of feeding tube due to failed blind technique had successful placement by the Team avoiding fluoroscopy. Conclusion: Feeding tube placement by a dedicated team using electromagnetic tracking eliminates the morbidity and mortality of this common hospital procedure. Blind placement is not acceptable in awake, alert patients.

UR - http://www.scopus.com/inward/record.url?scp=79151481041&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79151481041&partnerID=8YFLogxK

U2 - 10.1097/SLA.0b013e318208f550

DO - 10.1097/SLA.0b013e318208f550

M3 - Article

C2 - 21135697

AN - SCOPUS:79151481041

VL - 253

SP - 297

EP - 302

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 2

ER -