Introduction: Accurate verification of nasogastric and post-pyloric feeding tube placement is essential to patient safety. Radiographic imaging has long been considered the “gold standard” in determining feeding tube location. Since the early 2000s, emerging technologies have enabled more timely and accurate bedside placement, compared to the blind placement of feeding tubes. Dietitians competent in small-bore feeding tube placements at a midwestern 550-bed urban hospital studied the feasibility of utilizing electromagnetic technology to safely place and accurately verify feeding tubes without requiring a routine x-ray image. Methods: Observational and comparative data was collected when first considering x-ray free verification of feeding tube placements. Expert trained staff, defined as dietitians who have placed ≥50 post-pyloric feeding tubes using electromagnetic technology, tracked 101 tube placements and compared bedside interpretation with x-ray dictation. Results: Of the 101 feeding tubes placed, electromagnetic interpretation correlated with x-ray dictation in 98% of cases. In the remaining 2%, repeat imaging confirmed accurate post-pyloric, validating the initial bedside assessment. The initial x-ray images were not able to differentiate between the descent of the tube into the small bowel versus a coil in the stomach. With this data, committee approvals were obtained, and institutional policies were updated to allow for expert trained staff to confirm feeding tube placements without x-ray. Since implementing the new protocol, over 130 additional tubes have been placed using electromagnetic interpretation alone, with no reported adverse safety events. Conclusions: These findings highlight that, with rigorous training and ongoing auditing, electromagnetic technology offers a safe, efficient, and radiation-free alternative for feed tube placement verification.
Ender et al. (Sun,) studied this question.