The feasibility of electromagnetic sensing aided post pyloric feeding tube placement (CORTRAK) in patients with thrombocytopenia with or without anticoagulation on the intensive care unit.
CEAS
anticoagulation
cancer patients
enteral nutrition
feeding tube
thrombocytopenia
Journal
JPEN. Journal of parenteral and enteral nutrition
ISSN: 1941-2444
Titre abrégé: JPEN J Parenter Enteral Nutr
Pays: United States
ID NLM: 7804134
Informations de publication
Date de publication:
07 2022
07 2022
Historique:
revised:
17
09
2021
received:
07
07
2021
accepted:
28
09
2021
pubmed:
5
10
2021
medline:
14
7
2022
entrez:
4
10
2021
Statut:
ppublish
Résumé
The successful initiation of enteral nutrition is frequently hampered by various complications occurring in patients treated in the intensive care unit (ICU). Successful placement of a nasojejunal tube by CORTRAK enteral access system (CEAS) has been reported to be a simple bedside tool for placing the postpyloric (PP) feeding tube. We evaluated the efficacy and side effects using CEAS to establish EN in patients with critical illness, thrombocytopenia, and/or anticoagulation. Fifty-six mechanically ventilated patients were analyzed. Twenty-four of them underwent prior hematopoietic stem cell transplantation (SCT). Sixteen patients received extracorporeal membrane oxygenation treatment because of acute respiratory distress syndrome. The median platelet count at PP placement was 26 g/L (range, 4-106 g/L); 16 patients received therapeutic anticoagulation (activated partial thromboplastin time, 50-70 s). CEAS-assisted placement of a PP nasojejunal tube was performed successfully in all patients. The most frequent adverse event was epistaxis in 27 patients (48.2%), which was mostly mild (Common Terminology Criteria for Adverse Events grade 1, n = 21 [77.8%], and grade 2, n = 6). A significant association between a low platelet count and bleeding complications was observed (P < 0.001). Performed by an experienced operator, CEAS is a simple, rapidly available, and effective bedside tool for safely placing PP feeding tubes for EN in patients with thrombocytopenia, even when showing an otherwise-caused coagulopathy in the ICU. Higher-grade bleeding complications were not observed despite their obvious correlation to thrombocytopenia. A prospective study is in preparation.
Sections du résumé
BACKGROUND
The successful initiation of enteral nutrition is frequently hampered by various complications occurring in patients treated in the intensive care unit (ICU). Successful placement of a nasojejunal tube by CORTRAK enteral access system (CEAS) has been reported to be a simple bedside tool for placing the postpyloric (PP) feeding tube.
METHODS
We evaluated the efficacy and side effects using CEAS to establish EN in patients with critical illness, thrombocytopenia, and/or anticoagulation.
RESULTS
Fifty-six mechanically ventilated patients were analyzed. Twenty-four of them underwent prior hematopoietic stem cell transplantation (SCT). Sixteen patients received extracorporeal membrane oxygenation treatment because of acute respiratory distress syndrome. The median platelet count at PP placement was 26 g/L (range, 4-106 g/L); 16 patients received therapeutic anticoagulation (activated partial thromboplastin time, 50-70 s). CEAS-assisted placement of a PP nasojejunal tube was performed successfully in all patients. The most frequent adverse event was epistaxis in 27 patients (48.2%), which was mostly mild (Common Terminology Criteria for Adverse Events grade 1, n = 21 [77.8%], and grade 2, n = 6). A significant association between a low platelet count and bleeding complications was observed (P < 0.001).
CONCLUSION
Performed by an experienced operator, CEAS is a simple, rapidly available, and effective bedside tool for safely placing PP feeding tubes for EN in patients with thrombocytopenia, even when showing an otherwise-caused coagulopathy in the ICU. Higher-grade bleeding complications were not observed despite their obvious correlation to thrombocytopenia. A prospective study is in preparation.
Substances chimiques
Anticoagulants
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1183-1190Informations de copyright
© 2021 The Authors. Journal of Parenteral and Enteral Nutrition published by Wiley Periodicals LLC on behalf of American Society for Parenteral and Enteral Nutrition.
Références
Reintam Blaser A, Starkopf J, Alhazzani W, et al. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med. 2017;43(3):380-398.
van Zanten ARH. How to improve worldwide early enteral nutrition performance in intensive care units? Crit Care. 2018;22(1):315.
Zama D, Gori D, Muratore E, et al. Enteral versus parenteral nutrition as nutritional support after allogeneic hematopoietic stem cell transplantation: a systematic review and meta-analysis. Transplant Cell Ther. 2021;27(2):180.e1-180.e8.
McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2016;40(2):159-211.
Singer P, Blaser AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38(1):48-79.
Jiyong J, Tiancha H, Huiqin W, Jingfen J. Effect of gastric versus post-pyloric feeding on the incidence of pneumonia in critically ill patients: observations from traditional and Bayesian random-effects meta-analysis. Clin Nutr. 2013;32(1):8-15.
Hemington-Gorse SJ, Sheppard NN, Martin R, Shelley O, Philp B, Dziewulski P. The use of the Cortrak Enteral Access System for post-pyloric (PP) feeding tube placement in a burns intensive care unit. Burns. 2011;37(2):277-280.
Arjaans W, Ouwehand M, Bouma G, van der Meulen T, de van der Schueren MAE. Cortrak duodenal tube placements: a solution for more patients? A preliminary survey to the introduction of electromagnetic-guided placement of naso-duodenal feeding tubes. Clin Nutr ESPEN. 2019;29:133-136.
Bourgault AM, Aguirre L, Ibrahim J. Cortrak-assisted feeding tube insertion: a comprehensive review of adverse events in the MAUDE database. Am J Crit Care. 2017;26(2):149-156.
Bourgault AM, Gonzalez L, Aguirre L, Ibrahim JA. CORTRAK superuser competency assessment and training recommendations. Am J Crit Care. 2019;28(1):30-40.
Dolan AM, O'Hanlon C, O'Rourke J. An evaluation of the Cortrak enteral access system in our intensive care. Ir Med J. 2012;105(5):153-154.
Rao MM, Kallam R, Flindall I, Gatt M, Macfie J. Use of Cortrak-an electromagnetic sensing device in placement of enteral feeding tubes. Proc Nutr Soc. 2008;67(OCE):E109.
Taylor SJ, Allan K, Clemente R. Undetected Cortrak tube misplacements in the United Kingdom 2010-17: an audit of trace interpretation. Intensive Crit Care Nurs. 2019;55:102766.
Taylor SJ, Clemente R, Allan K, Brazier S. Cortrak tube placement part 2: guidance to avoid misplacement is inadequate. Br J Nurs. 2017;26(15):876-881.
Taylor SJ, Clemente R, Allan K, Brazier S. Cortrak tube placement part 1: confirming by quadrant may be unsafe. Br J Nurs. 2017;26(13):751-755.
Holzinger U, Brunner R, Miehsler W, et al. Jejunal tube placement in critically ill patients: a prospective, randomized trial comparing the endoscopic technique with the electromagnetically visualized method. Crit Care Med. 2011;39(1):73-77.
Xing J, Zhang Z, Ke L, et al. Enteral nutrition feeding in Chinese intensive care units: a cross-sectional study involving 116 hospitals. Crit Care. 2018;22(1):229.
De la Calle de la Rosa L, Bermejo de Las Heras S, Blesa A, Giner M, Arias Diaz J. Assessment of the clinical quality indicator “early enteral nutrition” in intensive care units. Nutr Hosp. 2017;34(5):1288-1291.
Doig GS, Heighes PT, Simpson F, Sweetman EA. Early enteral nutrition reduces mortality in trauma patients requiring intensive care: a meta-analysis of randomised controlled trials. Injury. 2011;42(1):50-56.
Doig GS, Heighes PT, Simpson F, Sweetman EA, Davies AR. Early enteral nutrition, provided within 24 h of injury or intensive care unit admission, significantly reduces mortality in critically ill patients: a meta-analysis of randomised controlled trials. Intensive Care Med. 2009;35(12):2018-2027.
Janssens U, Druml W. Early parenteral or enteral nutrition in intensive care patients. Results of the CALORIES trial. Med Klin Intensivmed Notfmed. 2015;110(1):65-67.
Jose IB, Leandro-Merhi VA, Aquino JLB, Mendonca JA. The diagnosis and NUTRIC score of critically ill patients in enteral nutrition are risk factors for the survival time in an intensive care unit? Nutr Hosp. 2019;36(5):1027-1036.
Kim H, Stotts NA, Froelicher ES, Engler MM, Porter C, Kwak H. Adequacy of early enteral nutrition in adult patients in the intensive care unit. J Clin Nurs. 2012;21(19-20):2860-2869.
Zhu Y, Yin H, Zhang R, Ye X, Wei J. Gastric versus postpyloric enteral nutrition in elderly patients (age >/= 75 years) on mechanical ventilation: a single-center randomized trial. Crit Care. 2018;22(1):170.
Solomon DM, Emery EZ, Kavelak HL, Pontiggia L, Hollands JM, Bingham AL. Impact of implementation of the American Society for Parenteral and Enteral Nutrition Model for parenteral nutrition order writing and review on competency, attitudes, and perceptions. Nutr Clin Pract. 2019;34(4):597-605.
McCutcheon KP, Whittet WL, Kirsten JL, Fuchs JL. Feeding tube insertion and placement confirmation using electromagnetic guidance: a team review. JPEN J Parenter Enteral Nutr. 2018;42(1):247-254.