Successful Placement of Nasointestinal Feeding Tubes Using an Electromagnetic Sensor-Guided Enteral Access System in Patients With Left Ventricular Assist Devices

: Technology advances have made it possible to prolong life for patients with heart failure who are not transplant candidates or while awaiting transplant. Many different cardiac devices are available that can be used as a bridge to transplant (temporary support) or as a destination therapy (permanent support). Placement of these devices can cause complications that, if not addressed, could negatively impact the nutrition status of patients. Placement of nasointestinal feeding tubes using an electromagnetic sensor-guided enteral access system (EMS-EAS) has been difficult in patients with implantable devices because of the potential for interference with the EMS-EAS and the left ventricular assist device (LVAD). The purpose of this paper was to report the results using a modified method to place nasointestinal tubes in patients with LVADs by elevating the receiver off the xiphoid process. There were 42 feeding tube placements in 25 patients. Results showed a 69% success rate of placement into the small bowel, 13 unsuccessful placements, and no adverse or sentinel events associated with tube placement using this method. Results indicated the modified method is a safe approach to help expedite feeding tube placement in a nutritionally compromised patient. The success rate is comparable with non-LVAD patient populations requiring nasointestinal tube placement via EMS-EAS. To our knowledge, this is the first published case series addressing a modified method for nasointestinal tube placement in patients with LVAD. More research is needed to determine ideal separation distances or other techniques to improve the success rate in this patient population.