S0587 Bedside Postpyloric Placement Under Direct Visualization: The Next Generation

INTRODUCTION: Roughly 1 2M feeding tubes are placed annually in the US, most of which are placed without direct visualization The current state within our Network is blind bedside placement with x-ray confirmation The cost of blind placement is $1 46M annually, with potential additional cost due to complications (airway placement, pneumothorax, death), delayed nutrition/administration of medications, and cost of x-ray We identified 3 adverse events which occurred over a 3-year time period with blind placement, resulting in 2 deaths and 1 lung placement Sub-specialty departments have expressed frustration for lack of a "tubes service" in an effort to provide more timely nutrition in a safe manner as well as avoid need for x-rays METHODS: In an effort to improve quality of care to patients, optimize time to tube placement, and ensure accurate placement eliminating need for x-rays, an enteral nutrition platform was implemented with GI fellow training and placement of NG and post-pyloric tubes under direct visualization without the use of endoscopy The inpatient service received consults for failed bedside NG placements via a specific EPIC order set Each fellow was required to participate in a demo on proper device use and per form 2 live placements with industry and lead physician providing atelbow assistance The Program Director developed an instruction sheet which was made a part of the curriculum, Figure 1 with the first 50 placements to be confirmed by x-ray RESULTS: The service began in February 2020 and 10 consults had been received thus far The GI fellows achieved a 100% success using tube with direct visualization X-ray confirmed proper placement with no adverse events Average time from consult to placement was 10 hours and time from consult to use was less than 24 hours, Figure 2 Xinying et al reported time from consult to blind placement was an average of ;21 hours Given the COVID-19 pandemic, fellow training was halted and 2 competent fellows continued to place tubes eliminating the need for transport and x-ray during that critical time CONCLUSION: The tube service was well accepted in our hospital An initial cost/benefit analysis shows a potential $840 20 in savings per patient (Table 1) with decreased need for x-rays, elimination of adverse events as direct visual capability, earlier time to feeding and decreased length of stay Further cost/benefit will be analyzed as we expand throughout our very large health system