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Wang H, Huang C, Yang Y, Kong L, Zheng X, Shan X. Cost-effectiveness analysis of nasojejunal tube feeding for the prevention of pneumonia in critically ill adults. JPEN J Parenter Enteral Nutr 2021; 46:1167-1175. [PMID: 34751960 DOI: 10.1002/jpen.2302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Nasojejunal tube (NJT) feeding has demonstrated value in reducing pneumonia in critically ill adults who require enteral nutritional (EN) support. This study discusses whether EN support via nasojejunal tube (NJT) feeding is more cost-effective than nasogastric tube (NGT) feeding in reducing pneumonia. METHODS A decision tree model was created. The analysis was based on data from a health care provider in China. Model inputs were derived from published data. The endpoints included incremental cost per pneumonia infection avoided, incremental cost-effectiveness ratio (ICER), net monetary benefit (NMB) and incremental net monetary benefit (INMB) associated with prevention of pneumonia. The uncertainty was assessed through one-way and probabilistic sensitivity analysis. RESULTS The base case analysis showed that EN support via NJT feeding resulted in 0.7453 quality-adjusted life years (QALYs) at a cost of $3018.83 compared to NGT feeding, which resulted in 0.7354 QALYs at a cost of $4788.76. NJT feeding was better than NGT feeding, providing an INMB of $2,075.09 and an ICER of $-178,813.96 per QALY gained, and the cost per pneumonia infection prevented was $16,808.51. The probabilistic sensitivity analysis indicated that NJT feeding was more cost-effective in 83.4% of the cases, with a cost below the WTP threshold. The NMB and INMB estimation for different WTP thresholds also indicated that NJT feeding is the optimal strategy. CONCLUSIONS EN support via NJT feeding was a more cost-effective strategy than NGT feeding in preventing pneumonia in critically ill adults. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Hongmei Wang
- Department of Pharmacy, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Chun Huang
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yang Yang
- Operating Room, VIP Department, Jinshan Hospital, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 401122, China
| | - Lingxi Kong
- Department of Pharmacy, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xiaoying Zheng
- Department of Pharmacy, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xuefeng Shan
- Department of Pharmacy, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
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Powers J, Brown B, Lyman B, Escuro AA, Linford L, Gorsuch K, Mogensen KM, Engelbrecht J, Chaney A, McGinnis C, Quatrara BA, Leonard J, Guenter P. Development of a Competency Model for Placement and Verification of Nasogastric and Nasoenteric Feeding Tubes for Adult Hospitalized Patients. Nutr Clin Pract 2021; 36:517-533. [PMID: 34021623 DOI: 10.1002/ncp.10671] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 03/23/2021] [Accepted: 04/04/2021] [Indexed: 01/15/2023] Open
Abstract
Nasogastric/nasoenteric (NG/NE) feeding tube placements are associated with adverse events and, without proper training, can lead to devastating and significant patient harm related to misplacement. Safe feeding tube placement practices and verification are critical. There are many procedures and techniques for placement and verification; this paper provides an overview and update of techniques to guide practitioners in making clinical decisions. Regardless of placement technique and verification practices employed, it is essential that training and competency are maintained and documented for all clinicians placing NG/NE feeding tubes. This paper has been approved by the American Society for Parenteral and Enteral Nutrition (ASPEN) Board of Directors.
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Affiliation(s)
- Jan Powers
- Parkview Health System, Fort Wayne, Indiana, USA
| | - Britta Brown
- Nutrition Services Hennepin Healthcare Minneapolis, Minneapolis, Minnesota, USA
| | - Beth Lyman
- Nutrition Support Consultant, Smithville, Missouri, USA
| | - Arlene A Escuro
- Center for Human Nutrition, Digestive Disease and Surgery Institute Cleveland Clinic, Cleveland, Ohio, USA
| | - Lorraine Linford
- Nutrition Support/Vascular Team, Intermountain Healthcare Medical Center Murray, Salt Lake City, Utah, USA
| | - Kim Gorsuch
- Interventional GI and Pulmonology, Gastroenterology and Nutrition Support Clinic, Comprehensive Care and Research Center, Chicago, Zion, Illinois, USA
| | - Kris M Mogensen
- Department of Nutrition, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | | | - Amanda Chaney
- Department of Transplant, College of Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Carol McGinnis
- Sanford USD Medical Center, Sioux Falls, South Dakota, USA
| | - Beth A Quatrara
- Center of Interprofessional Collaborations School of Nursing, University of Virginia Charlottesville, Charlottesville, Virginia, USA
| | - Jennifer Leonard
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri, USA
| | - Peggi Guenter
- Clinical Practice, Quality, and Advocacy, American Society for Parenteral and Enteral Nutrition, Silver Spring, Maryland, USA
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Gentry Wilkerson R, Pustavoitau A, Carolan H, Benner N, Fischer C, Sheets DJ, Wang PI, Tropello S. Percutaneous Ultrasound Gastrostomy: A Novel Device and Bedside Procedure for Gastrostomy Tube Insertion Using Magnetic and Ultrasound Guidance. J Med Device 2019. [DOI: 10.1115/1.4042866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
This paper describes a novel percutaneous ultrasound gastrostomy (PUG) procedure and the CoapTech point-of-care ultrasound magnet-aligned gastrostomy (PUMA-G) device, which were developed to allow the placement of gastrostomy tubes by physicians across a variety of specialties, using ultrasound equipment found in many nonspecialized medical locations while consuming fewer resources. The current practice for the placement of gastrostomy tubes requires highly specialized equipment and trained physicians, which can delay the performance of the procedure or make it inaccessible in some locations. The PUMA-G device consists of an orogastric catheter with a balloon that encloses a magnetic bar at its distal end and an external, handheld magnet. The orogastric tube is passed through the mouth or the nose and into the stomach. The external magnet is then used to maneuver the balloon to the desired location in the stomach, with feedback and guidance from real-time ultrasound visualization. The novelty of this approach is the use of magnets to create the static compressive force needed for coaptation, in which the stomach is pushed flush against the abdominal wall, allowing ultrasound visualization of the entire gastrostomy tract (skin to stomach), safe cutaneous puncture, and guidewire-assisted placement of the gastrostomy tube. The development of the PUMA-G device has been aided by benchtop and simulation testing in addition to canine and human cadaver studies. The PUMA-G device was used successfully in 29 of 30 cadaver tests, with the one failure attributed to operator error and not the device. Further testing in live patients will assess the safety of the procedure, the speed with which it can be completed, the cost savings, and other benefits the device might offer over the existing gastrostomy procedures.
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Affiliation(s)
- R. Gentry Wilkerson
- Department of Emergency Medicine, School of Medicine, University of Maryland, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201 e-mail:
| | - Aliaksei Pustavoitau
- Department of Anesthesiology and Critical Care Medicine, School of Medicine, Johns Hopkins University, 600 North Wolfe Street, Meyer 297, Baltimore, MD 21287 e-mail:
| | - Howard Carolan
- Armstrong Institute for Patient Safety and Quality, School of Medicine, Johns Hopkins University, 750 East Pratt Street, 15th Floor, Baltimore, MD 21202 e-mail:
| | - Nolan Benner
- School of Engineering, Johns Hopkins University, Baltimore, MD 21218 e-mail:
| | - Clark Fischer
- School of Engineering, Johns Hopkins University, Baltimore, MD 21218 e-mail:
| | - Daniel J. Sheets
- Department of Emergency Medicine, School of Medicine, University of Maryland, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201 e-mail:
| | - Peggy I. Wang
- CoapTech, 8 Market Place Suite 804, Baltimore, MD 21202 e-mail:
| | - Steven Tropello
- Department of Emergency Medicine, School of Medicine, University of Maryland, 110 South Paca Street, 6th Floor, Suite 200, Baltimore, MD 21201 e-mail:
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Carter M, Roberts S, Carson JA. Small-Bowel Feeding Tube Placement at Bedside: Electronic Medical Device Placement and X-Ray Agreement. Nutr Clin Pract 2018. [DOI: 10.1002/ncp.10072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Michaelann Carter
- Nutrition Services Department at Baylor University Medical Center; Dallas Texas USA
- Department of Clinical Nutrition; University of Texas Southwestern Medical Center; Dallas Texas USA
| | - Susan Roberts
- Nutrition Services Department at Baylor University Medical Center; Dallas Texas USA
| | - Jo Ann Carson
- Department of Clinical Nutrition; University of Texas Southwestern Medical Center; Dallas Texas USA
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