Electromagnetic versus blind guidance of a postpyloric feeding tube in critically ill children

Abstract

BACKGROUND AND OBJECTIVES: Postpyloric feeding tube placement is a time-consuming procedure associated with multiple attempts and radiation exposure. Our objective with this study is to compare the time, attempts, and radiation exposure using the electromagnetic versus blind method to place a postpyloric feeding tube in critically ill children. Our hypothesis is that using electromagnetic guidance decreases the procedure time, number of x-rays, and number of attempts, compared to the blind method. METHODS: Eleven pediatric nurses participated in a randomized controlled intention-to-treat study at an academic pediatric medical, surgical, and congenital cardiac ICU. University of Texas Health Epidemiology and Biostatistics generated a randomization sequence with sealed envelopes. A standard (2-sided) F-test of association between the electromagnetic and blind method yielded 40 subjects with 86% power. Data were analyzed with Fisher’s exact test for categorical variables and the Wilcoxon rank test for continuous variables, with data documented as median (interquartile range [IQR]). RESULTS: We randomly assigned 52 patients to either the electromagnetic (n = 28) or blind method (n = 24). The number of attempts and radiographs was at a median of 2 (IQR: 1–2.25) using the blind method, compared to the electromagnetic method at a median of 1 (IQR: 1.0–1.0; P = .001). Successful guidance was 96.4% with the electromagnetic method, compared to only 66.7% with the blind technique (P = .008). The total time required was 2.5 minutes (IQR: 2.0–7.25) with the electromagnetic method, compared to 19 minutes (IQR: 9.25–27.0) for the blind method (P = .001). CONCLUSIONS: Electromagnetic guidance is a superior, faster, and overall safer method to place a postpyloric feeding tube in critically ill children.