Madigan Army Medical Center, USA
Mary McCarthy, Ph.D., RN has been a nurse for over 30 years with 15 years of critical care/emergency nursing and 15 years of research and teaching experience. Research involves ICU care, nurse staffi ng and patient outcomes, and Soldier wellness, supported by grant funds totaling over $2 million to date. As a retired Army nurse and currently an Army nurse scientist, her passion is working in the military setting with its unique challenges to maintaining a seasoned, trained, and stable nursing workforce. In addition, patients are younger with war-related traumatic injuries requiring novel scientifi c approaches to recovery and healing.
Introduction: While there are abundant options for post-pyloric feeding tubes, the bedside electromagnetic-guided tubes have been well-received by nurses for their ease of insertion and safety profile. Nurse-driven enteral feeding protocols can decrease the time to initiation of feeding which is an important part of the best practice model for critically ill patients. Methods: As part of a larger retrospective study approved by the Institutional review board at our institution, we examined the success rate of ICU nurses inserting electromagnetic-guided tubes (CORPAK® MedSystems, Buff alo Grove, IL) into a post-pyloric location, and related complications. To evaluate the nurses decision regarding proper tube placement, stored real-time tracings were viewed. Three seasoned clinicians evaluated the tracings and compared results with the radiologists report. Results: From December 2009 to July 2013, nurses placed 36 of 74 tubes using the Cortrak® System. Th e rate of successful placement was 44%; 16 tubes were in a post-pyloric location. All other tubes were left in the gastric location (n=20). Concurrence between real-time tracing and radiologic report was 77%. Using the Cortrak® System nurses had a 100% success in avoiding inadvertent lung placement or other complications. Conclusions: Nurse turnover, inexperience, and competing priorities limit opportunities for skill acquisition. Use of an evidence based protocol, skills fairs, and hands-on experience are critical strategies for performance improvement. Th e safe and rapid placement that can be accomplished using the Cortrak® system results in early initiation of feeding and attainment of nutrition goals, both of which contribute to decreased ICU mortality and length of stay.