Bryant Vera, Phang Jean, Abrams Kevin
Vera Bryant is an acute care nurse practitioner in the neuroscience department at Baptist Hospital of Miami, Miami, Florida. Jean Phang is a quality assurance nurse at Baptist Hospital of Miami. Kevin Abrams is medical director of the radiology department at Baptist Hospital of Miami.
Am J Crit Care. 2015 Nov;24(6):525-30. doi: 10.4037/ajcc2015493.
Clinicians are unsure if radiography is needed to confirm correct positioning of feeding tubes inserted with assistance from an electromagnetic system.
To compare radiographic reports of feeding tube placement with images generated by an electromagnetic feeding tube placement device.
The medical records of 200 consecutive patients who had feeding tubes inserted with assistance from an electromagnetic feeding tube placement device were reviewed retrospectively. Radiographic reports of tube site were compared with images generated by the device.
Radiographic evidence of tube sites was available in 188 cases: 184 tubes were located in portions of the gastrointestinal tract. Ninety of the 188 tubes were situated in the optimal site (distal duodenum or jejunum) radiographically. Images generated by the electromagnetic device were available in 176 cases; of these, 52 tubes appeared to end in the expected left lower quadrant. Tubes shown on radiographs to be in other sites also occasionally appeared to end in the left lower quadrant. Nurses using the device did not recognize 4 of the 188 tubes (2.1%) that were inadvertently placed in the lung. No consistent pattern of quadrant distribution was found for tubes positioned in the stomach or proximal duodenum.
Images generated by the electromagnetic tube placement device provided inconsistent results regarding tube location. A small percentage of seriously malpositioned tubes were not detected by using the electromagnetic device. These findings do not support eliminating radiographs to confirm correct tube placement following use of an electromagnetic tube placement device.
临床医生不确定在电磁系统辅助下插入饲管后是否需要进行放射检查来确认饲管的正确位置。
比较饲管放置的放射学报告与电磁饲管放置设备生成的图像。
回顾性分析连续200例在电磁饲管放置设备辅助下插入饲管的患者的病历。将饲管位置的放射学报告与该设备生成的图像进行比较。
188例有饲管位置的放射学证据：184根饲管位于胃肠道的不同部位。188根饲管中有90根在放射学上位于最佳位置（十二指肠远端或空肠）。电磁设备生成的图像有176例可用；其中，52根饲管似乎在预期的左下腹终止。放射照片显示位于其他部位的饲管偶尔也似乎在左下腹终止。使用该设备的护士未识别出188根饲管中有4根（2.1%）无意中置入了肺部。位于胃或十二指肠近端的饲管未发现一致的象限分布模式。
电磁饲管放置设备生成的图像在饲管位置方面提供的结果不一致。使用电磁设备未检测到一小部分严重错位的饲管。这些发现不支持在使用电磁饲管放置设备后不进行放射检查来确认饲管的正确放置。
