Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Strong Memorial Hospital, Rochester, New York, USA.
JPEN J Parenter Enteral Nutr. 2011 Sep;35(5):636-42. doi: 10.1177/0148607110386047. Epub 2011 Aug 15.
An electromagnetic tube placement device (ETPD) monitors tip position of feeding tubes (FT) during placement in the digestive tract. It helps to avoid airway misplacement and permits positioning into the small bowel (SB). This study compares the overall agreement between FT tip location as determined by an ETPD vs an abdominal radiograph of the kidneys, ureter, and bladder (KUB).
Using an ETPD, A nurse placed postpyloric FTs in ICU patients. We included all patients in whom the ETPD was used for FT placement. Data were prospectively recorded for 255 days on the rate of successful postpyloric placement, ETPD estimated tip location, and KUB location.
860 tubes were placed in 616 patients, 719 (83.6%) of which recorded for ETPD and KUB. According to the KUB, 81% of tubes were in the SB; however, ETPD suggested 89% were beyond the pylorus. There was moderate agreement beyond what could be attributed to chance between KUB and ETPD tip locations (475 [66.1%], κ score 0.62 [95% confidence interval 0.58-0.67]). More tubes by KUB were distal (134[18.6%]) vs proximal (110[15.3%]) to the suspected location by ETPD (P < .0001. Tubes in or distal to the second half of the duodenum, according to ETPD were rarely in the stomach (<1%). No tubes were proximal to the stomach or placed into the airway.
The strong agreement between KUB and ETPD, when tubes were believed to be in the second part of the duodenum or beyond, suggests that KUB is necessary only when the FT tip is suspected to be in the proximal duodenum.
电磁管放置装置（ETPD）可在将饲管（FT）放置在消化道期间监测管尖位置。它有助于避免气道放置错误，并允许将管尖定位到小肠（SB）。本研究比较了 ETPD 与腹部肾脏、输尿管和膀胱（KUB）射线照相确定的 FT 尖端位置之间的总体一致性。
使用 ETPD，护士将胃后 FT 放置在 ICU 患者中。我们纳入了所有使用 ETPD 进行 FT 放置的患者。在 255 天的时间里，前瞻性地记录了成功胃后放置率、ETPD 估计尖端位置和 KUB 位置的数据。
在 616 名患者中放置了 860 个管，其中 719 个（83.6%）记录了 ETPD 和 KUB。根据 KUB，81%的管在 SB 中；然而，ETPD 提示 89%的管超出了幽门。KUB 和 ETPD 尖端位置之间存在中度一致性，超出了可能归因于机会的范围（475 [66.1%]，κ 评分 0.62 [95%置信区间 0.58-0.67]）。根据 KUB，更多的管位于 ETPD 可疑位置的远端（134[18.6%]）而不是近端（110[15.3%]）（P <.0001）。根据 ETPD，位于十二指肠后半部或更远的管很少位于胃中（<1%）。没有管位于胃的近端或放置在气道中。
当管被认为在十二指肠的第二部分或更远时，KUB 和 ETPD 之间的强一致性表明，只有当 FT 尖端被怀疑在十二指肠近端时，才需要进行 KUB。
