EMPD in Predicting

Feeding Tube
Placement
Heather LaPoint, RN, BSN, CCRN
MSN Candidate
University of Central Florida
Department of Nursing

PICO
In adult ICU patients, are
electromagnetic placement devices
(EMPD), compared with abdominal
radiographs, more accurate in
predicting small-bowel feeding tube
placement?

Significance &
Background

Need to provide nutrition early

Safety and accuracy

Insertion techniques

Sacred Cows vs. EMPD

Sacred Cows

EMPD in Action

CORTRAK

Methods

Literature found in Academic Search Premier,

Medline, and CINAHL

Cochran Database of Systematic Reviews yielded

no results

Search terms: adult, ICU, intensive care unit,

electromagnetic tube placement device,
electromagnet, magnet*, CORTRAK, abdominal
radiograph, x-ray, feed*, small-bowel, enteral
feeding tube, and enteral nutrition.

Cortrak is a brand name discovered in multiple

studies.

Methods
Inclusion

adult critical care

patients

enteral feeding tubes

comparison of
verification of placement
with radiograph

tube was placed with

EMPD

Exclusion

EMPD efficacy
without control
group represented
by radiology
verification

articles educating
to insertion
technique only and
lacked comparison
of insertion
techniques

Methods/Findings

27 studies discovered, 9 included

7 Prospective Analysis (Level II)

2 Retrospective Analysis (Level III)

2254 Adult ICU patients

Germany, Ireland, United Kingdom,

United States

Findings
Effect on Accuracy

All 9 studies demonstrate improved efficacy in

placement with EMPD method of insertion

Speed of accurate insertion with EMPD lends to less

delay in nutrition. Delays decreased by 2-22 hours
(p = 0.003)

Insert in 4-20 min., 1 attempt, 80-100% accurate

(p<0.0001)

(Gray et al., 2007; Hemington-Gorse et al., 2011; Kaffarnik et al., 2013, Taylor et al., 2014)

Findings
Patient Safety

6 studies demonstrate increased safety with

EMPD use

EMPD preempted trauma in 7-10% of patients

with 100% success (p = 0.005)

Adverse events unassociated with EMPD

(Powers et al., 2011; Taylor et al., 2014)

Findings
Financial Stewardship

5 studies note a reduction in cost associated with

tube insertion using EMPD equipment

Lack of need for radiology with EMPD can save

upwards of $6400 per patient per attempt at
tube insertion (p = 0.0001)

Blindly inserted tubes required an average of

twice as many X-rays, doubling costs (p =
0.0001)
(Dolan et al., 2012; Gray et al., 2007; Hemington-Gorse et al., 2010)

Findings
Limitations

Small sample sizes

Limited generalizability to adult critical care patients

Obese patients excluded Kearns et al. (2001)

Control group sample disproportionately small Gray et

al. (2007)

Bias introduced during data collection when

performed by insertion team

Recommendations

EMPD is the more accurate method of

verification and insertion of small-bowel
feeding tube

Advocate for EMPD clinically for increased

time to nutrition

Educate to the technique and efficacy

Research long-term benefits

Strength of Recommendation = A

Recommendations

EMPD is the more safe method of

insertion and verification for small-bowel
feeding tubes

Educate to proper use of technology to

reduce patient harm and increase
efficacy in practice

Educate to the benefit of this method of

insertion versus traditional methods

Strength of Recommendation = A

Recommendations

EMPD is the more fiscally responsible

method of tube insertion over time

Provide cost analysis to obtain

equipment clinically and academically

Assist in grant writing

Strength of Recommendation = A

Conclusion

EMPD predicts small-bowel feeding tubes

more accurately, more safely, and less cost
prohibitively than traditional insertion
methods with radiology verification.

Nurse Educators can confidently advocate

for this alternative technique and educate
to its use both in the clinical and academic
environments.

Educators should be prepared to aid in longterm benefit studies and curriculum

inclusion.