Introduction Nasojejunal tube (NJT) feeding provides a less costly and possibly safer alternative to parenteral nutrition (PN) in many settings including acute pancreatitis. However it is frequently underused due to reliance of NJT placement on radiological or endoscopic guidance, attendant delays and frequent mechanical complications including tube displacements and blockages. The Cortrak® electromagnetic imaging system allows bedside placement of NJT, is minimally invasive and avoids the need for radiological or endoscopic guidance.
We introduced a Nutrition Clinical Nurse Specialist (CNS)-delivered Cortrak® service at our hospital, as part of a Nutrition Support Service in which which all patients referred for PN or NJT feeding were reviewed by a member of the Nutrition Support Team and suitable patients identified proactively. Bedside NJT placement by the Nutrition CNS was followed by immediate verbal and written communication of tube aftercare instructions to ward staff after placement. An electronic referral system for Cortrak® NJT placement was implemented.
Method Prospective data were collected on indications, placement success, procedure time and complications over a 10 month period between April 2014 and February 2015. Patients with surgically altered upper gastrointestinal tract anatomy were excluded. Successful placement was determined by inspection of Cortrak® NJT insertion traces, supplemented by abdominal x-ray in a minority of cases (n = 4) where jejunal tip position on Cortrak tracing was considered equivocal.
Results 66 referrals for bedside NJ tube placement in adult patients were received, of which 16 (24%) were deemed unsuitable on clinical grounds. The most common reason for rejecting referrals was suitability for provision of adequate nutrition via oral or nasogastric routes (7/16, 44%). Of 35 patients suitable for NJT feeding, 20 (57%) had previously been receiving PN or had been referred for PN. 50 insertions were attempted on 35 patients, with successful NJT placement in 42 out of 50 (84%). The median procedure time was 15 min (range 3 to 60). There were no procedure related complications. Involuntary extubation occurred for 5 tubes (12%), and tube blockage in 1 (2.4%).
Conclusion A Nutrition CNS-delivered bedside NJT insertion service has several benefits. Our data demonstrate high rates of conversion of nutrition support from PN to enteral and avoidance of inappropriate NJT insertion in 24% of cases. Cortrak ® NJT placement was successful in 84% of cases, similar to other series. The incidence of NJT blockage was low (2.4%) and may reflect better communication of tube aftercare instructions to ward staff made possible by a CNS placing tubes on the ward.
Disclosure of interest None Declared.
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