Gerritsen Arja, de Rooij Thijs, Dijkgraaf Marcel G, Busch Olivier R, Bergman Jacques J, Ubbink Dirk T, van Duijvendijk Peter, Erkelens G Willemien, Klos Mariël, Kruyt Philip M, Bac Dirk Jan, Rosman Camiel, Tan Adriaan C, Molenaar I Quintus, Monkelbaan Jan F, Mathus-Vliegen Elisabeth M, Besselink Marc G
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Am J Gastroenterol. 2016 Aug;111(8):1123-32. doi: 10.1038/ajg.2016.224. Epub 2016 Jun 7.
Electromagnetic (EM)-guided bedside placement of nasoenteral feeding tubes by nurses may improve efficiency and reduce patient discomfort and costs compared with endoscopic placement by gastroenterologists. However, evidence supporting this task shift from gastroenterologists to nurses is limited. We aimed to compare the effectiveness of EM-guided and endoscopic nasoenteral feeding tube placement.
We performed a multicenter randomized controlled non-inferiority trial in 154 adult patients who required nasoenteral feeding and were admitted to gastrointestinal surgical wards in five Dutch hospitals. Patients were randomly assigned (1:1) to undergo EM-guided or endoscopic nasoenteral feeding tube placement. The primary end point was the need for reinsertion of the feeding tube (e.g., after failed initial placement or owing to tube-related complications) with a prespecified non-inferiority margin of 10%.
Reinsertion was required in 29 (36%) of the 80 patients in the EM-guided group and 31 (42%) of the 74 patients in the endoscopy group (absolute risk difference -6%, upper limit of one-sided 95% confidence interval 7%; P for non-inferiority=0.022). No differences were noted in success and complication rates. In the EM-guided group, there was a reduced time to start of feeding (424 vs. 535 min, P=0.001). Although the level of discomfort was higher in the EM-guided group (Visual Analog Scale (VAS) 3.9 vs. 2.0, P=0.009), EM-guided placement received higher recommendation scores (VAS 8.2 vs. 5.5, P=0.008).
EM-guided bedside placement of nasoenteral feeding tubes by nurses was non-inferior to endoscopic placement by gastroenterologists in surgical patients and may be considered the preferred technique for nasoenteral feeding tube placement.
与胃肠病学家进行的内镜下放置相比，护士在电磁（EM）引导下在床边放置鼻肠饲管可能会提高效率、减轻患者不适并降低成本。然而，支持这项任务从胃肠病学家转移到护士的证据有限。我们旨在比较EM引导和内镜下鼻肠饲管放置的有效性。
我们在荷兰五家医院的胃肠外科病房对154名需要鼻肠饲管的成年患者进行了一项多中心随机对照非劣效性试验。患者被随机分配（1:1）接受EM引导或内镜下鼻肠饲管放置。主要终点是饲管再次插入的必要性（例如，初次放置失败后或由于与饲管相关的并发症），预设非劣效界值为10%。
EM引导组80名患者中有29名（36%）需要再次插入，内镜组74名患者中有31名（42%）需要再次插入（绝对风险差异-6%，单侧95%置信区间上限7%；非劣效性P=0.022）。成功率和并发症发生率无差异。在EM引导组，开始喂养的时间缩短（424对535分钟，P=0.001）。虽然EM引导组的不适程度较高（视觉模拟评分（VAS）3.9对2.0，P=0.009），但EM引导放置获得了更高的推荐评分（VAS 8.2对5.5，P=0.008）。
在外科患者中，护士在EM引导下在床边放置鼻肠饲管不劣于胃肠病学家进行的内镜下放置，可被视为鼻肠饲管放置的首选技术。
