Goggans Margaret, Pickard Sharon, West Alina Nico, Shah Samir, Kimura Dai
1 Department of Nutrition Therapy, Le Bonheur Children's Hospital, Memphis, Tennessee, USA.
2 College of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Nutr Clin Pract. 2017 Apr;32(2):233-237. doi: 10.1177/0884533616682683. Epub 2016 Dec 19.
Transpyloric feeding tubes (TPT) are often recommended in critically ill children. Blind tube placement, however, can be difficult, be time-consuming, and incur multiple radiation exposures. An electromagnetic device (EMD) is available for confirmation of successful placement of TPTs. We conducted a retrospective cohort study to evaluate the efficacy of an EMD for TPT placement in children and determine its impact on placement success, radiation exposure, confirmation time, and cost for tube placement compared with traditional blind TPT placement.
Retrospective data were collected in patients receiving a TPT before (pre-EMD group) and after implementation of an EMD (EMD group).
Need for radiographic exposure decreased significantly in the EMD group (n = 40) compared with the pre-EMD group (n = 38) (0.6 vs 1.6 x-rays, P < .001). TPTs were placed and confirmed without abdominal x-ray in 21 of 40 patients in the EMD group. There were no serious adverse events such as misplacement into the lung or pneumothorax or perforation injury of the stomach. Successful tube confirmation took a significantly shorter time in the EMD group than in the pre-EMD group (1.45 vs 4.59 hours, P < .0001). There was an estimated cost savings of $245.10 per placement associated with decreased x-ray and fluoroscopy.
The use of an EMD in children significantly decreased radiation exposure and confirmation time while maintaining TPT placement success. The use of an EMD can potentially offer large cost savings. Elimination of abdominal x-ray with EMD during TPT placement was achieved without any serious complications in approximately half of the children.
经幽门喂养管（TPT）常用于危重症儿童。然而，盲目放置喂养管可能困难、耗时，且会导致多次辐射暴露。有一种电磁装置（EMD）可用于确认TPT是否成功放置。我们进行了一项回顾性队列研究，以评估EMD在儿童TPT放置中的效果，并确定与传统盲目放置TPT相比，其对放置成功率、辐射暴露、确认时间和放置成本的影响。
收集在实施EMD之前（EMD前组）和之后（EMD组）接受TPT的患者的回顾性数据。
与EMD前组（n = 38）相比，EMD组（n = 40）对放射影像学检查的需求显著降低（0.6次X线检查对1.6次X线检查，P <.001）。EMD组40例患者中有21例在未进行腹部X线检查的情况下放置并确认了TPT。未发生严重不良事件，如误置入肺部、气胸或胃穿孔损伤。EMD组成功确认导管的时间明显短于EMD前组（1.45小时对4.59小时，P <.0001）。估计每次放置节省成本245.10美元，这与减少的X线检查和荧光镜检查有关。
在儿童中使用EMD可显著减少辐射暴露和确认时间，同时保持TPT放置成功率。使用EMD可能会大幅节省成本。在大约一半的儿童中，使用EMD在TPT放置期间无需进行腹部X线检查，且未出现任何严重并发症。
