Using the Cortrak magnetic device to facilitate early enteral nutrition in critically ill patients

Introduction

Confirmation of correct nasogastric tube (NGT) positioning is required before commencement of enteral nutrition (EN). In the ICU, however, the use of sedation, 24-hour feeding and proton pump inhibitors can make the standard confirmatory methods recommended by the UK National Patient Safety Agency (UKNPSA) [1] unreliable, and result in the need for multiple chest X-rays (CXR), increased cost and feeding delay. We studied the role of the Cortrak^®(Viasys MedSystems, USA) against standard practice, and assessed the following outcomes: time required to confirm correct NGT position, time to starting feeding, and potential cost savings.

Methods

We enrolled patients admitted to our ICU who required NGT insertion for EN. A Corflow NGT with Cortrak stylet was inserted, and the position monitored using the Cortrak magnetic sensor. The Cortrak system tracks the trail of the stylet tip as it progresses towards the stomach and provides a visual representation of the NGT position on a video screen, allowing rapid determination of insertion success. The position of the NGT was also assessed using pH paper and/or CXR, as appropriate, according to the standard UKNPSA guidelines. Data were analysed using a paired t test and time-to-event analysis.

Results

Fifty-two patients were recruited and 57 insertions were analysed: 32 first insertions, and 25 reinsertions. Gastric content was successfully aspirated in 40% (23/57) of insertions, and 14% (8/57) had pH 6 or above. Forty-six CXRs were requested, with three patients requiring multiple CXRs. The Cortrak correctly confirmed the position of NGT in all 57 insertions. The time required to confirm the NGT position was significantly less with the Cortrak than with conventional methods (mean ± SE Cortrak: 9.6 ± 1.7 min; pH paper: 11.6 ± 1.7 min; CXR: 122 ± 23 min; P < 0.0001). There was a 1.5-hour delay in starting EN in the standard practice group compared with the Cortrak group (mean ± SE 3.98 ± 0.5 hours vs 2.58 ± 0.4 hours, P = 0.049). If the Cortrak results had been acted upon, 46 CXRs could have been avoided, which equates to a saving of £2,300 (€3,220).

Conclusion

The Cortrak demonstrated 100% accuracy in confirming the position of NGT in this patient series. It exposes patients to less radiation, facilitates earlier EN and is cost-effective. Consideration should therefore be given to including it into the standard UKNPSA guideline.