Evaluation of a bedside technique for post-pyloric placement of feeding catheters

Abstract

Objectives: To establish the success rate, time taken and expertise required to place a feeding catheter into the small intestine using a device that permits real-time localisation of the catheter through detection of an electromagnetic field. Design: Prospective observational study. Setting: A tertiary, mixed medical–surgical, adult intensive care unit, between February 2008 and February 2009. Participants: 60 attempts at postpyloric intubation by eight clinicians (consultant and trainee intensivists and a dietitian) in 57 critically ill patients who were undergoing mechanical ventilation and were receiving, or suitable to receive, enteral nutrition. Main outcome measures: Patients were classified into an initial group (10 patients), who had the catheter placed by a single clinician to establish the most effective technique, and a subsequent group (50 patients), who had the catheter placed by any of the eight clinicians. Catheter position was confirmed on abdominal x-ray by an independent radiologist. Results: Postpyloric catheter placement was successful in 56/60 attempts (93%), in 54/57 patients (95%), with a median time to placement of 7.2min (interquartile range [IQR], 4.3–12.5min). In the initial group, placement was successful in 7/10 attempts (70%), with a median time to placement of 20.8min (IQR, 9.5–32.3 min), compared with 49/50 attempts (98%) and a median time of 5.9 min (IQR, 3.9–11.9min) in the subsequent group (P = 0.003). Conclusions: An electromagnetically guided device enabled reliable and rapid bedside placement of small-intestinal feeding catheters. Proficiency with the technique was quickly developed and successfully disseminated to a range of clinicians.