Replaceable Jejunal Feeding Tubes in Severely Ill Children

Long-term enteral nutrition in chronically ill, malnourished children represents a clinical challenge if adequate feeding via nasogastric or gastrostomy tubes fails. We evaluated the usefulness and complications of a new type of surgical jejunostomy that allows for easier positioning and replacement of the jejunal feeding tube in children. We surgically inserted replaceable jejunal feeding tubes (RJFT) connected to a guide thread which exited through a separate tiny opening of the abdominal wall. In a retrospective case series, we assessed the effectiveness and complications of this technique in severely ill children suffering from malnutrition and complex disorders. Three surgical complications occurred, and these were addressed by reoperation. Four children died from their severe chronic disorders within the study period. The RJFT permitted continuous enteral feeding and facilitated easy replacement of the tube. After the postoperative period, jejunal feeding by RJFT resulted in adequate weight gain. This feeding access represents an option for children in whom sufficient enteral nutrition by nasogastric tubes or gastrostomy proved impossible. Further studies are required to investigate the safety and effectiveness of this surgical technique in a larger case series.

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Fatal Complications of Nasogastric Tube Misplacement in Two Dogs

Journal of the American Animal Hospital Association ◽

10.5326/jaaha-ms-7104 ◽

2021 ◽

Author(s):

Jenniffer Rodriguez-Diaz ◽

Julia P. Sumner ◽

Meredith Miller

Keyword(s):

Risk Factors ◽

Case Report ◽

Enteral Nutrition ◽

Case Reports ◽

Case Series ◽

Feeding Tube ◽

Tracheobronchial Tree ◽

Human Medicine ◽

Feeding Tubes ◽

Fatal Complications

ABSTRACT Provision of enteral nutrition via the use of nasoenteric feeding tubes is a commonly used method in both veterinary and human medicine. Although case reports in human medicine have identified fatalities due to misplacement of nasogastric (NG) tubes into the tracheobronchial tree and subsequent pneumothorax, there are no case reports, to our knowledge, of fatalities in veterinary patients. This case report describes two fatalities caused by misplaced NG tubes in intubated patients (one intraoperative, one postoperative). This report highlights risk factors for feeding tube complications and methods to prevent future fatalities such as two-view radiography, two-step insertion, capnography, laryngoscopic-assisted placement, and palpation of the NG tube in the stomach. The recent fatalities discussed within this case series demonstrate that deaths as a result of NG tubes misplaced into the tracheobronchial tree occur in veterinary patients, and measures should be taken to prevent this complication.

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The Placement of Post-pyloric Feeding Tubes Using DRX-Revolution Mobile X-Ray System in an ICU. A Case Series

The Journal of Critical Care Medicine ◽

10.1515/jccm-2016-0022 ◽

2016 ◽

Vol 2 (3) ◽

pp. 131-134

Author(s):

Leonid Koyfman ◽

Andrei Schwartz ◽

Yair Benjamin ◽

Alexander Smolikov ◽

Moti Klein ◽

...

Keyword(s):

Enteral Nutrition ◽

Critically Ill ◽

Enteral Feeding ◽

Nasogastric Tube ◽

Critically Ill Patients ◽

Case Series ◽

Feeding Tube ◽

Nasogastric Feeding ◽

X Ray ◽

Feeding Tubes

Abstract Enteral nutrition is crucial for ensuring that critically ill patients have a proper intake of food, water, and medicine. Methods to ensure this requirement should be initiated as early as possible. The use of PPF has several advantages compared to the use of a nasogastric feeding tube. In the present paper, the cases of three critically ill patients with a nonfunctional gastrointestinal system on admission to ICU, are detailed. Enteral feeding through a nasogastric tube by prokinetic agent therapy had been unsuccessful. The bedside placement of a post-pyloric feeding tube by the DRX-Revolution X-ray system is described.

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Evaluation of Delivery of Enteral Nutrition in Critically Ill Patients Receiving Mechanical Ventilation

American Journal of Critical Care ◽

10.4037/ajcc2008.17.1.53 ◽

2008 ◽

Vol 17 (1) ◽

pp. 53-61 ◽

Cited By ~ 71

Author(s):

Debra O’Meara ◽

Eduardo Mireles-Cabodevila ◽

Fran Frame ◽

A. Christine Hummell ◽

Jeffrey Hammel ◽

...

Keyword(s):

Mechanical Ventilation ◽

Enteral Nutrition ◽

Critically Ill ◽

Critically Ill Patients ◽

Feeding Tube ◽

Feeding Tubes ◽

Academic Center ◽

Specific Step ◽

Feeding Process ◽

Medical Intensive Care

Background Published reports consistently describe incomplete delivery of prescribed enteral nutrition. Which specific step in the process delays or interferes with the administration of a full dose of nutrients is unclear. Objectives To assess factors associated with interruptions in enteral nutrition in critically ill patients receiving mechanical ventilation. Methods An observational prospective study of 59 consecutive patients who required mechanical ventilation and were receiving enteral nutrition was done in an 18-bed medical intensive care unit of an academic center. Data were collected prospectively on standardized forms. Steps involved in the feeding process from admission to discharge were recorded, each step was timed, and delivery of nutrition was quantified. Results Patients received approximately 50% (mean, 1106.3; SD, 885.9 Cal) of the prescribed caloric needs. Enteral nutrition was interrupted 27.3% of the available time. A mean of 1.13 interruptions occurred per patient per day; enteral nutrition was interrupted a mean of 6 (SD, 0.9) hours per patient each day. Prolonged interruptions were mainly associated with problems related to small-bore feeding tubes (25.5%), increased residual volumes (13.3%), weaning (11.7%), and other reasons (22.8%). Placement and confirmation of placement of the small-bore feeding tube were significant causes of incomplete delivery of nutrients on the day of admission. Conclusions Delivery of enteral nutrition in critically ill patients receiving mechanical ventilation is interrupted by practices embedded in the care of these patients. Evaluation of the process reveals areas to improve the delivery of enteral nutrition.

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Characterization of Fungal Colonization of Indwelling Esophagostomy Tubes

Case Reports in Veterinary Medicine ◽

10.1155/2019/8153468 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Shelly J. Olin ◽

David A. Bemis ◽

John R. Dunlap ◽

Jacqueline C. Whittemore

Keyword(s):

Structural Integrity ◽

Case Series ◽

Morphological Characteristics ◽

Surface Characteristics ◽

Feeding Tube ◽

Fungal Colonization ◽

Feeding Tubes ◽

Normal Microbiota ◽

Tube Exchange ◽

The Impact

Fungal colonization of feeding tubes occurs rapidly in people, resulting in decreased structural integrity and complications such as luminal obstruction and tube failure. Esophagostomy tubes (E-tubes) are commonly used in dogs and cats for enteral support, but data are lacking regarding colonizing fungi and the impact of colonization on tube integrity. In this study, esophagostomy tubes were collected in lieu of disposal from dogs and cats undergoing feeding tube exchange. Fungi were isolated with culture and identified using morphological characteristics. Scanning electron microscopy was used to evaluate the surface characteristics of the tubes. Two silicone and one polyurethane E-tube were evaluated. Fungi associated with the normal microbiota, including Candida sp. and Penicillium sp., as well as environmental fungi were identified. This case series represents the first documentation of fungal colonization of silicone and polyurethane E-tubes in dogs and cats. Additionally, this is the first report to document degenerative changes in a silicone E-tube.

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Evaluation of the Safety of Early Compared to Late Enteral Nutrition in Canine Septic Peritonitis

Journal of the American Animal Hospital Association ◽

10.5326/jaaha-ms-6513 ◽

2017 ◽

Vol 53 (2) ◽

pp. 90-95 ◽

Cited By ~ 3

Author(s):

Jamie Elizabeth Hoffberg ◽

Amy Koenigshof

Keyword(s):

Enteral Nutrition ◽

Case Series ◽

Early Enteral Nutrition ◽

Retrospective Case ◽

Gastrointestinal Complications ◽

Additional Risk ◽

Significant Difference ◽

Septic Peritonitis ◽

Potential Benefits ◽

Postoperative Feeding

ABSTRACT Septic peritonitis is a relatively common condition in the veterinary intensive care unit, with a classically high mortality rate. Early enteral nutrition (EEN) in critically ill humans can lead to improved outcome. This study was performed to determine the safety of early postoperative feeding in canine septic peritonitis. In this retrospective case series, 56 dogs were identified. Sixteen dogs received EEN, defined as nutrition within 24 hr of surgery; 27 received late enteral nutrition (LEN) defined as nutrition more than 24 hours following surgery; and 13 dogs had no enteral nutrition in hospital (NEN). Signalment, physical examination findings, and occurrence of pre-admission vomiting, regurgitation, and length of anorexia were the same amongst all groups. There was no significant difference in the number of gastrointestinal complications postoperatively between the EEN, LEN, and NEN groups or in the occurrence of vomiting/regurgitation postoperatively compared to preoperatively. There was no difference in the length of hospitalization between any group, although fewer dogs in the NEN group survived compared to the EEN/LEN combined group (46% [6/13] versus 81% [37/40]). This study indicates it is safe to initiate EEN without additional risk of gastrointestinal complications. Prospective studies are needed to evaluate the potential benefits of EEN in dogs with septic peritonitis.

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A Retrospective Case Series of Thiamine Deficiency in Non-Alcoholic Hospitalized Veterans: An Important Cause of Delirium and Falling?

Journal of Clinical Medicine ◽

10.3390/jcm10071449 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1449

Author(s):

Elisabeth Mates ◽

Deepti Alluri ◽

Tailer Artis ◽

Mark S. Riddle

Keyword(s):

Thiamine Deficiency ◽

Laboratory Data ◽

Case Series ◽

Chronically Ill ◽

Retrospective Case ◽

Inflammatory Stress ◽

Inflammatory Conditions ◽

Neuropsychiatric Manifestations ◽

Specific Symptoms ◽

Thiamine Level

Thiamine deficiency (TD) in non-alcoholic hospitalized patients causes a variety of non-specific symptoms. Studies suggest it is not rare in acutely and chronically ill individuals in high income countries and is underdiagnosed. Our aim is to demonstrate data which help define the risk factors and constellation of symptoms of TD in this population. We describe 36 cases of TD in hospitalized non-alcoholic veterans over 5 years. Clinical and laboratory data were extracted by chart review +/− 4 weeks of plasma thiamine level 7 nmol/L or less. Ninety-seven percent had two or more chronic inflammatory conditions (CICs) and 83% had one or more acute inflammatory conditions (AICs). Of possible etiologies of TD 97% had two or more of: insufficient intake, inflammatory stress, or increased losses. Seventy-five percent experienced 5% or more weight loss. Ninety-two percent had symptoms with the most common being weakness or falling (75%) followed by neuropsychiatric manifestations (72%), gastrointestinal dysfunction (53%), and ataxia (42%). We conclude that TD is underdiagnosed in this population with consequent morbidity and mortality. TD likely develops because of inflammatory stress from CIC’s compounded by AIC’s combined with decreased energy intake or increased nutrient losses.

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Evaluation of a Nasoenteral Feeding Tube With Balloon to Facilitate Placement

Critical Care Nurse ◽

10.4037/ccn2020845 ◽

2020 ◽

Vol 40 (1) ◽

pp. 37-44

Author(s):

Sabry Gabriel ◽

Richard Ackermann ◽

Samy Gabriel ◽

Caleb Ackermann ◽

Leslie Swadener-Culpepper

Keyword(s):

Critically Ill ◽

Case Series ◽

Feeding Tube ◽

Burn Patients ◽

Insertion Technique ◽

Abdominal Radiography ◽

Feeding Tubes ◽

Distal Migration ◽

Hospital Patients ◽

Nasoenteral Feeding

Background Enteral feeding is essential for critically ill, head trauma, and burn patients who are unable to swallow. Objective To evaluate a new nasoenteral feeding tube with distal tip balloon designed to facilitate post-pyloric migration and avoid misplacement in the trachea. Methods A case series was conducted in 50 critically ill patients aged 19 to 89 years receiving mechanical ventilation and requiring enteral nutrition in a teaching hospital. Patients received a soft, flexible, kink-resistant nasoenteral feeding tube with a balloon near the distal tip to enhance postpyloric migration by peristalsis. The feeding tube was inserted with a novel thread technique to reduce posterior nasopharyngeal trauma and tube misplacement. Pulse oximetry provided early detection of misplacement into the trachea. Placement was verified by abdominal radiography performed shortly after the procedure and repeated within 24 hours if needed. Results Postpyloric placement was achieved at 30 minutes in 24% of patients and by the following morning in 70% of patients. Tracheal intubation occurred in 1 patient but was recognized and corrected without injury. No tube occlusion from kinking occurred. Conclusions Early gastric or postpyloric feeding can be provided with this novel feeding tube. Its use facilitates quick bedside recognition of accidental misplacement in the trachea, reducing the chance of pneumothorax. The tip balloon reduces deeper placement into a lung and promotes distal migration into the small intestine. The design prevents occlusion from kinking, which is common with conventional feeding tubes. Nurses easily adopted the tube and insertion technique.

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