CORTRAK 2 Enteral Access System for placing nasoenteral feeding tubes

Introduction

Enteral feeding is the delivery of a nutritionally complete feed directly into the stomach or small intestine using a feeding tube. Tubes can be inserted through the abdominal wall (percutaneous) or through the nose (nasoenteral). Percutaneous feeding tubes are generally only considered if long-term feeding (4 weeks or more) is needed. Nasoenteral tubes, used for short-term feeding, can deliver feeds directly into the stomach (nasogastric [NG]), jejunum (nasojejunal [NJ]) or duodenum (nasoduodenal [ND]). The latter 2 types are also known as post-pyloric placement.

NG feeding is the most common method used, and an estimated 271,000 NG tubes are supplied to the NHS annually (Macmillan Cancer Support 2013; Great Ormond Street Hospital 2014, National Patient Safety Agency Quarterly Data Summary 2008). The actual number is likely to be higher than this estimate as multi-packs may have been considered as single tubes.

Inserting feeding tubes is a common clinical procedure with well-recognised risks. Incorrectly placed NG tubes are relatively common and if undetected can result in significant complications. Between September 2005 and March 2011, the National Patient Safety Agency in the UK recorded 21 deaths and 79 cases of harm relating to NG feeding tubes being placed into the lower bronchial tree rather than the digestive tract. All nasoenteral tube placements carry further risk of pneumothorax, nose bleeds, bronchopleural fistula, aspiration pneumonia and vocal cord injury (Metheny et al. 2007, Roberts et al. 2007). In addition, once placement has been confirmed, nasoenteral tubes are often secured to the nose or cheek with tape. If this tape is not secure, or the patient has an episode of vigorous movement or vomiting, there is a risk that the tube can migrate, for example from the jejunum into the stomach. Nasoenteral tube placement is therefore frequently reviewed (often on a daily basis), using the centimetre markings printed on the tubes, to ensure migration has not occurred. People at increased risk of incorrect placement or migration of nasoenteral tubes include those who are intubated or ventilated, and those with decreased levels of consciousness, vocal cord dysfunction or dysphagia (National Patient Safety Agency 2011, Roberts et al. 2007).

Improving the accuracy of nasoenteral feeding tube placement may lower the risk of complications associated with the procedure.