Feeding Tube Placement Made Easy: Electromagnetic Placement Systems

Enteral feeding in acute and chronic patients is an essential part of ensuring appropriate nutrition to meet the needs of the patient. Malnourished patients have poorer clinical outcomes, more complications and infections, and use more resources than well-nourished patients. Children are more susceptible than adults to malnutrition and its multiple complications; as a result, nutritional interventions are even more important in pediatric patients. Thus, in both adult and pediatric patients, every effort should be made to support normal nutritional status throughout illness (Heuschkel & Duggan, 2019).

Blind placement of post-pyloric feeding tubes is not easy. Multiple radiographs are required to determine placement and often placement is not confirmed. The weighted feeding tube may be left to move into position with peristalsis, but this is not always accomplished.

Is there a way to ensure proper placement while limiting the number of radiographs needed for placement confirmation?

Yes, with the use of electromagnetic placement systems. The system approved by the U.S. Food & Drug Administration (FDA) is the Cortrak2 Enteral Access System by Corpak Medsystems (U.S. Food & Drug Administration (FDA), 2018).

The electromagnetic placement systems are designed to aid post-pyloric feeding tube placement by showing real-time positional information as the tube is being inserted. These systems show the placement in real-time via an external monitor. When placement is confirmed via the monitor, a picture may be generated for documentation (FDA, 2019). Additionally, the feeding tube does not have to be removed if it becomes displaced from patient movement or interference. The feeding solution is turned off, the guidewire, which is approved for reinsertion, is reinserted and the feeding tube is repositioned.

Many institutions have begun to use these devices; however, they are not without risk.
The FDA reported that from 2012 to 2017 there were 51 medical device reports generated regarding the use of these devices and pneumothorax.

• 11 patients died

Mitigating risk is possible. Both the Association of Critical Care Nurses and the FDA have released white papers regarding this topic. The consensus is, if the institutional protocol permits confirmation of tip placement via the device, then:

• Only staff who have been trained using the manufacturer and are deemed competency validated or credentialed by the institution should place or reposition these tubes
• Small teams of inserters can be kept competency validated and have more consistent results than large groups.
• If there are signs of respiratory distress during or after the procedure, the tube should be removed
• An alternative tip placement verification (radiograph) is recommended if:
  • There is any difficulty inserting the tube
  • If the path of the tube appears to deviate from the expected, or if the final location is not certain
  • The patient has abnormal gastrointestinal anatomy
  • The patient is intubated or has an altered level of consciousness

(FDA, 2019).

The electromagnetic placement systems have enabled healthcare providers to insert enteral feeding tubes with confidence. Remember this is a device to help you, not to replace skill, competency, and common sense. Many of the issues reported to the FDA occurred because the provider placed too much confidence in the device, even when the procedure did not occur without difficulty.

Improving nutritional status is so important to patient outcomes. Using an assistive device to help place post-pyloric tubes is becoming standard practice. Ensure your practice and institutional protocol embraces use of the device by competency validated/credentialled staff and empowers the staff to use a radiograph to confirm placement if you have any question regarding where the tip of the catheter is or if the patient is showing signs of lung intubation by the feeding tube.

^{References
Heuschkel, R. & Duggan, C. (2019). Enteral feedings: gastric versus post-pyloric.
U.S. Department of Food and Drug Administration (FDA). Feeding Tube Placement Systems - Letter to Health Care Providers.}