Blind bedside placement of postpyloric feeding tubes by registered dietitians: Success rates, outcomes, and cost effectiveness

摘要

Background: The purpose of this study was to evaluate the success rate, outcomes, and cost-effectiveness of blind bedside placement of postpyloric feeding tubes by registered dietitians. Feeding tubes placed by a physician using fluoroscopy were used to benchmark certain study parameters. Materials and Methods: Patients who underwent postpyloric feeding tube insertion between June 1, 2007, and May 31, 2011, were included in the study. Medical charts were reviewed for the time span between physician order and procedure documentation, bedside feeding tube tip location, number of radiographic images to confirm placement of tubes placed at the bedside, physician clearance to use the feeding tube when applicable, and reported complications. Patient charges for each procedure were also compared. Results: Data were collected on 729 patient encounters, with 285 encounters per study group and 159 encounters excluded for incomplete documentation. The average time span to bedside procedure completion was 3.7 hours compared with an average of 4.2 hours for insertion using fluoroscopy. Dietitians achieved postpyloric access 73% of the time, and an additional 16.8% of bedside tubes were deemed appropriate for use for gastric feeding. The majority of bedside insertion encounters required 1 abdominal radiograph to confirm placement, and no reported complications were associated with either technique. A 66% reduction in patient charges was associated with bedside tube insertion. Conclusion: Based on this sample, blind bedside postpyloric feeding tube insertion by registered dietitians may be a safe, cost-effective method for achieving short-term feeding tube access in the hospitalized patient.