Trainee booklet: Selection, insertion and ongoing safe use of nasogastric (NG) tubes in adults with the Cortrak™ 2 Enteral Access System (EAS™).Redhill: Avanos Medical; 2018

Bourgault AM, Aguirre L, Ibrahim J. Cortrak-assisted feeding tube insertion: A comprehensive review of adverse events in the MAUDE Database. Am J Crit Care.. 2017; 26:(2)149-156

Bryant V, Phang J, Abrams K. Verifying placement of small-bore feeding tubes: electromagnetic device images versus abdominal radiographs. Am J Crit Care.. 2015; 24:(6)525-530

A position paper on nasogastric safety: llll to put patient safety first. 2020. (accessed 3 November 2020)

Blind bedside placement of feeding tubes: Treatment or threat?. 2011. (accessed 2 November 2020)

McCutcheon KP, Whittet WL, Kirsten JL, Fuchs JL. Feeding tube insertion and placement confirmation using electromagnetic guidance: A team review. J. Parentr. Entr. Nutr.. 42:247-54

Metheny NA, Meert KL. Update on effectiveness of an electromagnetic feeding tube-placement device in detecting respiratory placements. Am J Crit Care.. 2017; 26:(2)157-161

Taylor SJ, Allan K, Clemente R, Brazier S. Cortrak tube placement part 1: Confirming by quadrant may be unsafe. Br J Nurs.. 2017a; 26:(13)751-755

Taylor SJ, Allan K, Clemente R, Brazier S. Cortrak tube placement part 2: guidance to avoid misplacement is inadequate. Br J Nurs.. 2017b; 26:(15)876-881

Taylor SJ, Allan K, Clemente R. Undetected Cortrak tube misplacements in the UK 2010-17: an audit of trace interpretation. Intensive Crit Care Nurs.. 2019; 55

Taylor SJ, Manara A, Brown J, Allan K, Clemente R, Toher D. Cortrak feeding tube placement: interpretation agreement of the ‘GI flexure’ system versus X-ray. Br J Nurs.. 2020; 29:(12)662-668

Cortrak feeding tube placement: accuracy of the ‘GI flexure system’ versus manufacturer guidance

26 November 2020
Volume 29 · Issue 21


Electromagnetic (EM) guided enteral tube placement may reduce lung misplacement to almost zero in expert centres, but more than 60 undetected misplacements had occurred by 2016 resulting in major morbidity or death. Aim: Determine the accuracy of manufacturer guidance in trace interpretation against what is referred to as the ‘GI flexure system’. Methods: The authors prospectively observed the accuracy of the ‘GI flexure system’ of trace interpretation against manufacturer guidance in primary nasointestinal (NI) tube placements. Findings: Contrary to manufacturer guidance, 33% of traces deviated >5 cm from the sagittal midline and 26.5% were oesophageal when entering the lower left quadrant, incorrectly indicating lung and gastric placement, respectively. Conversely, the GI flexure system identified ≥99.4% of GI traces when they reached the gastric body flexure; 100% at the superior duodenal flexure. All lung misplacements were identified by the absence of GI flexures. Conclusion: Current manufacturer guidance should be updated to the GI flexure system of interpretation.

The rate of complications caused by undetected lung misplacement of feeding tubes is relatively small (estimated at 0.01%) (Jones, 2020) when compared with the relatively common major complications caused by lung misplacement that is detected (0.5%) (Krenitsky, 2011). Based on the number of tubes used, an estimated 4000 complications due to identified lung misplacement can be expected annually in the UK (Krenitsky, 2011). Guided tube placement has the potential to almost eliminate these complications by pre-empting deep lung placement of the tube. One method, Cortrak, facilitates this by tracing the path of an electromagnet at the tip of the tube guide-wire, warning in real-time of potential deviation into the lung.

Unfortunately, up to the end of February 2016 there were 54 adverse events reported on the Manufacturer and User Facility Device Experience (MAUDE) database in the USA; 98% were lung misplacements, undetected by Cortrak operators, commonly resulting in pneumothorax (77%), pneumonitis (21%) and death (17%) (Bourgault et al, 2017). In a parallel report of MAUDE events, 17 of 25 events resulted in pneumothorax, despite only six being fed (Metheny and Meert, 2017). These data show that, unless misplacement is detected before the tube has advanced deeply into the lung, pneumothorax, pneumonitis and death are possible. Failure to detect lung misplacement has been reported to be as high as 2.1% with Cortrak (Bryant et al, 2015), similar to the 1.4% seen in blind placement (Krenitsky, 2011), and was thought to be due to inadequate training.

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content