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Post-pyloric feeding is recommended in critically ill patients with gastrointestinal intolerance. However, traditional placement methods are logistically difficult and carry potential risks. The authors retrospectively compared the position of post-pyloric feeding tubes (PPFTs) using an electromagnetic device that demonstrated by X-ray and analysed the complication rates, proportion of lung placements avoided and the time taken to establish enteral feeding. Forty placements in 37 mechanically ventilated patients were analysed; there was a success rate of 87.5%. Sensitivity and specificity were 77% (95% CI 59.9-89.6%) and 100% (95% CI 48.0-100%). Five lung placements were identified in real time and therefore avoided. The mean (SD) time from PPFT placement to X-ray was 134 minutes (± 139 minutes) and, to feeding, 276 minutes (± 213 minutes). In conclusion, placement of PPFT using an electromagnetic device carries a high success rate, is safe and feasible to undertake at the bedside in mechanically ventilated patients. [ABSTRACT FROM AUTHOR]

Gastric confirmation by pH is only achievable in approximately 50% of placements and X-rays are expensive and may be misinterpreted. Bedside electromagnetic (EM) guidance offers real-time confirmation. The authors determined the accuracy of guidance in predicting gastric body position from the EM trace using official Cortrak guidance (the EM trace reaches the bottom left quadrant of the anterior screen) compared with local guidance (detailed anterior-depth description of the GI flexures). X-ray, pH or an EM trace beyond the gastric body were used to independently confirm gastric position. Of 496 EM traces, 49% of tubes were in the oesophagus on entry to the lower left quadrant whereas 12% had already reached the gastric body in the upper left quadrant. Overall, predicting position by quadrant was 70% accurate whereas differentiating the pre-gastro-oesophageal junction (pre-GOJ) from the gastric body flexure was 100% accurate. Confirming gastric position by the anterior trace quadrant appears to be unsafe whereas expert differentiation of the pre-GOJ and gastric body flexures was reliable. The authors invite Corpak Medsystems (now owned by Halyard Health) to update its guidance in view of these findings. [ABSTRACT FROM AUTHOR]

Around 5% of hospital patients require enteral tube feeding, yet its efficacy and costs are poorly understood. The authors examined radio-opacity, reason for repeat X-ray and overall cost in consecutive patients having tubes confirmed by X-ray when using polyvinylchloride (PVC) Ryles tubes versus CORFLO® (CORTRAK Medsystems) polyurethane tubes (PUTs); and confirmation method and reason for tube loss over an enteral episode. Despite higher PUT cost, because more Ryles tubes required re-X-ray ± radiocontrast injection (0% compared with 26%, p=0.029), overall cost was almost identical (Corflo: £54.2 vs Ryles: £54.6). Confirmation of tube position by X-ray remains more common than pH (51% compared with 45%) and tube loss is mostly as a result of inadvertent patient removal (54%). These studies show that: a) when using X-ray confirmation, PUTs and PVC Ryles tube cost is similar; b) despite pH being taught as first-line confirmation, X-ray remains the most common method therefore PUT use may further reduce cost when staff and outcome costs are included. In addition, more reliable and repeatable bedside confirmation methods are required; c) most tube loss is potentially preventable by use of nasal bridles. Larger studies are required to establish baseline data on problems and costeffectiveness of enteral tube feeding before intervention trials. [ABSTRACT FROM AUTHOR]