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EM-guided nasoenteral feeding tube placement by nurses comparably effective to endoscopic placement
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Electromagnetic-guided bedside placement of nasoenteral feeding tubes in surgical patients by nurses was found to be comparably effective to endoscopic placement by gastroenterologists in a randomized controlled trial.
“Previously, non-comparative studies have suggested that success rates and complications of the EM-guided technique are similar to those of endoscopic tube placement, but these studies lack data on patient-reported outcomes and costs,” researchers wrote. “Moreover, studies in surgical patients, especially those with an altered upper gastrointestinal anatomy after surgery, are scarce.”
They therefore conducted a non-inferiority trial in which 154 adult patients in five Dutch hospitals were randomly assigned to undergo EM-guided bedside nasoenteral feeding tube placement by a trained endoscopy nurse or nutrition team member (n = 80) or endoscopic nasoenteral feeding tube placement by a trained gastroenterologist or supervised trainee in the endoscopy department (n = 74). The need for reinsertion served as the primary endpoint, and the researchers prespecified a 10% non-inferiority margin.
Tube reinsertion was required by 36% of the EM-guided group and by 42% of the endoscopic group (absolute risk difference, –6%; upper limit of one-sided 95% CI, 7%; P for non-inferiority = .022). Success and complication rates were similar.
Discomfort level was higher in the EM-guided group (median visual analogue scale score, 3.9 vs. 2; P = .009), but EM-guided placement received higher recommendation scores (median, 8.2 vs. 5.5; P = .008). Furthermore, time to start of feeding was 424 minutes in the EM-guided group compared with 535 minutes in the endoscopic group (P = .001).
“EM-guided bedside placement of nasoenteral feeding tubes by nurses was non-inferior to endoscopic placement by gastroenterologists in terms of effectiveness in surgical patients while offering advantages in logistics and may therefore be considered the preferred technique for nasoenteral feeding tube placement,” the researchers concluded. – by Adam Leitenberger
Disclosures: One of the researchers reports training honoraria from Duomed-Medicor outside the submitted work.
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