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Electromagnetic sensing devices as a cost-effective and safer option for bedside placement of postpyloric feeding tubes.

I read with interest the recent work reported by Cone et al on fluoroscopic placement of nasoduodenal feeding tubes. They are to be congratulated on their successful placement rates and improvement in patient safety through reduction in fluoroscopy-related radiation exposure by staff training and the use of thresholds for fluoroscopy time. They also discussed the use of novel techniques for postpyloric tube placement but unfortunately failed to refer to the use of electromagnetic sensing devices. We recently audited the Cortrak (Corpak MedSystems, Chicago) bedside placement system for nasogastric and postpyloric feeding tubes after the first 14 months of implementation in our institution. An electromagnetic transmitting guide wire is inserted into the tube preinsertion. A receiving disc tracks “real-time” passage of the tube, which is visualized by a monitor. Thirty-nine tube placements were attempted, with 69% of postpyloric referrals resulting in successful placement. This placement rate is in excess of “blind” bedside techniques reported in the literature. X-ray confirmation was required in only 22% of all postpyloric placements. Placement costs were 180 US dollars (USD) per tube. Potential cost savings for reduced need of x-ray and parenteral nutrition were calculated at 3310 USD and 9930 USD, respectively. Analysis against endoscopic placement, often considered a standard for postpyloric tube placement, indicated a cost avoidance of more than 33,130 USD. Our findings demonstrate benefit to our healthcare organization not only through these cost savings but also reduced clinical risk through less exposure to x-ray, avoidance of the metabolic and infective complications of parenteral nutrition, and avoidance of the risks of hemorrhage, perforation, and sedationrelated effects associated with an endoscopic procedure. A prospective data collection system is planned, and we intend to reaudit at 3 years to evaluate whether success rates improve even further with continued experience.