Small-Bore Feeding Tube Insertion Using an Electromagnetic Guidance System (CORTRAK®)
The CORTRAK® system uses electromagnetic technology to enhance the safety of bedside placement of small-bore nasoenteric feeding tubes. The guidance system directs feeding tube placement by tracking the relative location of the tube as it proceeds down the alimentary tract. This visual guidance aids in avoiding intubation of the pulmonary system and facilitates postpyloric placement of feeding tubes.1,5,8,12,15
PREREQUISITE NURSING KNOWLEDGE
• Knowledge of upper respiratory and gastrointestinal anatomy and physiology is necessary.
• Proficiency is needed in physical assessment skills for lungs and abdomen.
• Clinical and technical competence is necessary in placement of small-bore feeding tubes and in use of the CORTRAK® (Corpak MedSystems, Wheeling, IL) device, based on institutional policies.
• Recognition is needed of risk factors associated with placement errors during insertion of small-bore feeding tubes: endotracheal intubation, advanced age, altered level of consciousness, and diminished reflexes for airway protection.14
• The benefits of enteral nutrition for the critically ill, including indications for postpyloric placement, should be understood.6
EQUIPMENT
• CORTRAK® feeding tube placement device (Fig 132-1)
• CORTRAK® feeding tube with transmitting stylet
• 50-mL or larger catheter-tipped or Luer-Lok/slip syringe
• Water (tap water or sterile water based on institutional policy)
• Additional personal protective equipment, including gown and goggles
• Viscous lidocaine (optional)
PATIENT AND FAMILY EDUCATION
• Explain the essential role adequate nutritional status plays in promoting wound healing and recovery from illness. 
Rationale: Explanation may elicit cooperation and allay patient anxiety.
• Explain why a feeding tube is needed to ensure adequate nutritional intake. 
Rationale: Explanation may elicit cooperation and facilitate tube insertion.
• Outline the steps in the procedure and the patient’s role during feeding tube insertion (e.g., position, swallowing as instructed). 
Rationale: Patient cooperation may facilitate insertion.
• Describe the typical sensations experienced during feeding tube insertion. 
Rationale: Explanation may alleviate anxiety and promote patient cooperation.
• Inform patient and family of the need for postinsertion radiograph. 
Rationale: Information may provide reassurance regarding expected course of events.
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