H.22 Simplifying tube feed positioning

Food is an essential component for life. Feeding, the process of eating food, is a complex sequence of events, which requires the proper function and coordination of multiple muscles located in our mouth, jaw and neck.

There are many reasons that can lead to someone having feeding limitations and caloric restriction. To name a few, difficulty with swallowing, decreased appetite due to systemic illnesses (e.g. cancer) or other causes that affect the organs and muscles involved in swallowing and eating, all can lead to problems with food consumption.

The above scenarios are very common, especially in patients who are hospitalized. The solution to this is enteral nutrition or “tube feeding”. Tube feeding is applicable to all ages, from infants to adults. There are multiple types of tubes. The first type of tube is inserted through the nose into the stomach (nasogastric tube- NG) or small intestine (nasoenteral tube). Other options include placing a tube directly through the skin into the stomach (Gastrostomy tube) or small intestine (jejunostomy tube).

In the US alone, more than 250,000 patients receive tube feeding in US hospitals. The most common tube placed in the hospital setting is the nasogastric tube. Placement of a nasogastric tube is usually performed by a healthcare professional. However, following placement, there is a protocol to confirm the placement which includes an abdominal x-ray (or kidney-ureter-bladder x-ray- KUB) to visualize the tip of the tube and confirm its positioning within the stomach.

This process of Nasogastric tube placement has certain limitations:
1) performing a KUB usually takes time, thus delaying the use of the tube for medication and food delivery and delaying care advancement
2) additional radiation exposure for patients
3) Cost for additional imaging. The average cost for a KUB is $300. So since every single patient with tube feed placement, requires a KUB, the total cost for our healthcare system for confirmatory KUBs is roughly $75,000,000
4) Many times, tubes are found to be malpositioned on initial x-rays, needing repositioning/advancement of the tube and follow up repeat X-rays. This leads to even more radiation and cost.

It is evident that there is a need to simplify tube feed placement, for both improved patient safety (faster access to treatment and less radiation exposure) and decreased cost to our healthcare system (less imaging studies) for such a common procedure.

This project aims to find simpler and sophisticated solutions to sufficiently identify proper nasogastric tube placement without the need for additional imaging (KUB).