Percutaneous feeding tube replacement in the ED--are confirmatory x-rays necessary?

No study to date has addressed whether confirmatory x-ray after ED percutaneous feeding tube (PFT) replacement is always necessary. We hypothesized that x-ray confirmation of PFT replacement is not necessary in patients lacking both tract immaturity and trauma to the tract during dislodgement or replacement. Therefore confirmatory x-rays could safely be avoided for these patients.

Medical records of 113 adult PFT encounters that met inclusion criteria between December 2000 and March 2004 at an urban university hospital ED seeing approximately 50,000 adult patients per year were reviewed.

Ninety-four patients (83%) presented secondary to dislodgement, and 19 patients (17%) presented secondary to malfunction. Forty-seven patients (42%) did not have confirmatory x-rays, and 66 (58%) had confirmatory x-rays. None of the patients discharged without a confirmatory x-ray returned with evidence of improper PFT placement. Of the 66 patients who had a confirmatory x-ray, 62 (94%) x-rays showed the feeding tube was in the correct location. In 4 patients, the x-ray showed either the PFT was not in the stomach or evidence of tract compromise. All of these patients had trauma to the tract and 3 of 4 were in immature tracts. There were only 19 patients of the total group of 113, however, who had neither trauma nor an immature tract.

Although uncommon, significant problems with PFT placement occur with the potential for catastrophic consequences. It appears that immaturity of the tract and trauma to the tract, either potential or actual, are the major risk factors for such complications.