Arja Gerritsen1,2, Thijs de Rooij1, Marcel G Dijkgraaf3, Olivier R Busch1, Jacques J Bergman4, Dirk T Ubbink1, Peter van Duijvendijk5, G Willemien Erkelens6, Mariël Klos7, Philip M Kruyt8, Dirk Jan Bac9, Camiel Rosman10, Adriaan C Tan11, I Quintus Molenaar2, Jan F Monkelbaan12, Elisabeth M Mathus-Vliegent4, Marc G Besselink1. 1. Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands. 2. Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands. 3. Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands. 4. Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands. 5. Department of Surgery, Gelre Hospital, Apeldoorn, The Netherlands. 6. Department of Gastroenterology, Gelre Hospital, Apeldoorn, The Netherlands. 7. Department of Dietetics, Gelre Hospital, Apeldoorn, The Netherlands. 8. Department of Surgery, Hospital Gelderse Vallei, Ede, The Netherlands. 9. Department of Gastroenterology, Hospital Gelderse Vallei, Ede, The Netherlands. 10. Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands. 11. Department of Gastroenterology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands. 12. Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
Abstract
OBJECTIVES:Electromagnetic (EM)-guided bedside placement of nasoenteral feeding tubes by nurses may improve efficiency and reduce patient discomfort and costs compared with endoscopic placement by gastroenterologists. However, evidence supporting this task shift from gastroenterologists to nurses is limited. We aimed to compare the effectiveness of EM-guided and endoscopic nasoenteral feeding tube placement. METHODS: We performed a multicenter randomized controlled non-inferiority trial in 154 adult patients who required nasoenteral feeding and were admitted to gastrointestinal surgical wards in five Dutch hospitals. Patients were randomly assigned (1:1) to undergo EM-guided or endoscopic nasoenteral feeding tube placement. The primary end point was the need for reinsertion of the feeding tube (e.g., after failed initial placement or owing to tube-related complications) with a prespecified non-inferiority margin of 10%. RESULTS:Reinsertion was required in 29 (36%) of the 80 patients in the EM-guided group and 31 (42%) of the 74 patients in the endoscopy group (absolute risk difference -6%, upper limit of one-sided 95% confidence interval 7%; P for non-inferiority=0.022). No differences were noted in success and complication rates. In the EM-guided group, there was a reduced time to start of feeding (424 vs. 535 min, P=0.001). Although the level of discomfort was higher in the EM-guided group (Visual Analog Scale (VAS) 3.9 vs. 2.0, P=0.009), EM-guided placement received higher recommendation scores (VAS 8.2 vs. 5.5, P=0.008). CONCLUSIONS:EM-guided bedside placement of nasoenteral feeding tubes by nurses was non-inferior to endoscopic placement by gastroenterologists in surgical patients and may be considered the preferred technique for nasoenteral feeding tube placement.
RCT Entities:
OBJECTIVES: Electromagnetic (EM)-guided bedside placement of nasoenteral feeding tubes by nurses may improve efficiency and reduce patient discomfort and costs compared with endoscopic placement by gastroenterologists. However, evidence supporting this task shift from gastroenterologists to nurses is limited. We aimed to compare the effectiveness of EM-guided and endoscopic nasoenteral feeding tube placement. METHODS: We performed a multicenter randomized controlled non-inferiority trial in 154 adult patients who required nasoenteral feeding and were admitted to gastrointestinal surgical wards in five Dutch hospitals. Patients were randomly assigned (1:1) to undergo EM-guided or endoscopic nasoenteral feeding tube placement. The primary end point was the need for reinsertion of the feeding tube (e.g., after failed initial placement or owing to tube-related complications) with a prespecified non-inferiority margin of 10%. RESULTS: Reinsertion was required in 29 (36%) of the 80 patients in the EM-guided group and 31 (42%) of the 74 patients in the endoscopy group (absolute risk difference -6%, upper limit of one-sided 95% confidence interval 7%; P for non-inferiority=0.022). No differences were noted in success and complication rates. In the EM-guided group, there was a reduced time to start of feeding (424 vs. 535 min, P=0.001). Although the level of discomfort was higher in the EM-guided group (Visual Analog Scale (VAS) 3.9 vs. 2.0, P=0.009), EM-guided placement received higher recommendation scores (VAS 8.2 vs. 5.5, P=0.008). CONCLUSIONS: EM-guided bedside placement of nasoenteral feeding tubes by nurses was non-inferior to endoscopic placement by gastroenterologists in surgical patients and may be considered the preferred technique for nasoenteral feeding tube placement.
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