CORTRAK device in itu
Published Date: 19th July 2016
Publication Authors: Sharma N
INTRODUCTION
The cortrak enteral access system (EAS) allows real time tracking of a NG tube tip, supposedly abolishing the need for x-ray confirmation of nasogastric tube (NGT) position. With the use of an electromagnetic transmitting stylet inserted within the NG tube and a receiver unit placed over the patient's xiphisternum, a real time graph is produced on a monitor and can be printed and used as evidence of correct placement.
Horsley ITU is in the unique position of not having an onsite radiographer overnight to confirm NG placement, this was hoped to be a solution. A 'Field Safety Notice' issued in 2010 described two inadvertent lung NGT placements confirmed by the cortrak device. This led to a possible mistrust of the device and increased use of CXR led confirmation.
The cost of the cortrak NGT is £90; a standard NGT £7.50; an x-ray overnight £65 and radiographer overnight £70. The clinical importance of this survey, is one of patient safety and cost effectiveness.
OBJECTIVES
To establish: the type of NGT being inserted; the frequency of correct use of the cortrak device and CXR used to confirm placement; the reasons for confirmatory CXR and to provide recommendations on future use of cortrak device based on patient safety and cost saving.
METHODS
Over a 4 week period, patient's notes and bedsides were surveyed as were their PACS and CXR records to establish the above aims.
RESULTS
48 NGT insertions were identified. 85% of all NGT inserted were cortrak (41/48). 76% of these used electromagnetic device for insertion (31/41). 28/31 cortrak graphs were stuck in patients notes. 53% (22/41) of cortrak NGT insertions had confirmatory CXR and 77% (17/22) had evidence of magnetic device use and CXR. The commonest reason for this after 'no reason' was 'no aspirate' then 'inexperience reading graph.' No reported harm in 100% of NGT insertions.
The cortrak EAS does not feature on NPSA decision tree and is not currently recommended and therefore inadvertent misplacement when using cortrak would not be supported. 77% of cortrak NGT also had confirmatory CXRs. This shows incorrect use of an expensive piece of equipment. If these x-rays were done overnight, this also shows an overspend of £82.50 per patient. With a projected 492 NGT insertions a year at Horsley, £44.280 is currently being spent on cortrak NGT insertion compared with £3,690 with a standard NGT, not including price of CXR confirmation.
CONCLUSIONS
The cortrak device is not being used as intended and 77% of patients are also having CXRs.
RECOMMENDATIONS
1) Re - training of staff on cortrak device use and graph interpretation.
2)Creation of local protocol, especially overnight with cortrak use.
3) Return to use of standard NGT and confirm placement using aspirate or CXR in daylight hours.
OUTCOMES
The cortrak device is no longer used in HITU, with an estimated departmental saving of £50,000 a year.
Sharma, N; Nair, P. (2013). Use of the electromagnetic ng CORTRAK device in itu - A survey . Intensive Care Medicine. 39 (Issue 2 Supple), S470
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