Evaluation of Feeding Tube Migration in Critical Care Patients

BACKGROUND: Small-bore feeding tubes are often used to provide nutrition and medications to critically ill patients. Ensuring a proper distal location of the feeding tube is important to minimize aspiration risk and promote absorption of nutrients. Current guidelines call for routine verification of feeding tube location every 4 hours, yet no validated methods are available to routinely perform this bedside assessment. OBJECTIVE: To assess distal migration of the tip of small-bore feeding tubes over time in critically ill adults and to identify factors affecting migration. A secondary aim was to evaluate the effect of endotracheal tube extubation on feeding tube migration. METHODS: A prospective, repeated-measures cohort study was performed in 2 intensive care units. An electromagnetic placement device was used daily to assess distal feeding tube location for up to 5 days. RESULTS: Clinically significant feeding tube migration occurred in 6 of 108 patients (5.6%). No distal feeding tubes were displaced into the esophagus. The primary factor associated with retrograde feeding tube migration (clinically and statistically significant) was the patient pulling on the tube. Endotracheal intubation was another factor identified, but that factor's association with retrograde migration was not statistically significant. CONCLUSIONS: The study findings offer additional evidence that may challenge the practice of routinely verifying feeding tube location every 4 hours. Verification every 24 hours may be adequate for patients if migration is not suspected and if patient factors, such as pulling on the feeding tube, are not present.