What Do I Need to Know About Feeding Tubes? Assessing the Effect of a Multi-modal Educational Effort on Internal Medicine Residentsʼ Competence in Discussing Feeding Tube Placement

2017 ◽  
Vol 112 ◽  
pp. S624-S625
Author(s):  
Andrea Betesh ◽  
Dana Zalkin ◽  
Peter S. Liang ◽  
Michael H. Perskin ◽  
Lisa B. Malter
Keyword(s):  
Internal Medicine ◽  
Feeding Tube ◽  
Tube Placement ◽  
Feeding Tubes ◽  
Educational Effort ◽  
Feeding Tube Placement

Rapid Placement of Transpyloric Feeding Tubes: A Comparison of pH-assisted and Standard Insertion Techniques in Children

PEDIATRICS ◽  
1996 ◽  
Vol 98 (2) ◽  
pp. 242-248
Author(s):  
Brian Krafte-Jacobs ◽  
Melody Persinger ◽  
Jeannean Carver ◽  
Lori Moore ◽  
Richard Brilli
Keyword(s):  
Hospital Costs ◽  
Caloric Intake ◽  
Feeding Tube ◽  
Cost Comparison ◽  
Tube Placement ◽  
Critically Ill Children ◽  
Standard Group ◽  
Feeding Tubes ◽  
Feeding Tube Placement ◽  
Placement Technique

Objective. To compare transpyloric feeding tube placement using a pH-assisted placement technique versus a standard placement technique in pediatric patients requiring enteral nutrition. Methods. Critically ill children younger than 4 years were prospectively and randomly assigned to either a pH-assisted or a standard feeding tube placement group. Identical pH-assisted feeding tubes were used in both groups; however, feeding tubes in the standard group were not attached to a portable pH meter. Successful transpyloric placement was confirmed by radiography before beginning feedings. If placement was not successful, a second placement attempt was made after metoclopramide administration. Information regarding tube placement success, number of radiographs, time to initiaction of feedings, and daily caloric intake was collected. A cost comparison between the two groups was performed. Results. Thirty-four patients were enrolled in the pH-assisted group, and 34 were enrolled in the standard feeding tube group. Ninety-seven percent of patients in the pH-assisted group had successful placement after the first attempt, compared with 53% of patients in the standard group. The average time to successful placement of pH-assisted feeding tubes was 6 minutes. All patients in the pH-assisted group had successful placement after the second attempt, compared with 78% of patients in the standard group. A pH of greater than 5.6 accurately predicted transpyloric placement in 97% (33 of 34) of individuals in the pH-assisted group. Children in the pH-assisted group required significantly fewer radiographs than those in the standard group. Hospital costs were $114 per patient in the pH-assisted group and $135 per patient in the standard group. Conclusions. Our findings indicate that bedside transpyloric placement of pH-assisted feeding tubes can be accomplished rapidly and with a high success rate. This method is associated with decreased radiation exposure and economic savings when compared with a standard placement technique.

scholarly journals Erythromycin for Promoting the Postpyloric Placement of Feeding Tubes: A Systematic Review and Meta-Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Qing-Jun Jiang ◽  
Cai-Feng Jiang ◽  
Qi-Tong Chen ◽  
Jian Shi ◽  
Bin Shi
Keyword(s):  
Systematic Review ◽  
Adverse Effects ◽  
Success Rate ◽  
Meta Analysis ◽  
Feeding Tube ◽  
Tube Placement ◽  
Intravenous Route ◽  
Tube Insertion ◽  
Feeding Tubes ◽  
Feeding Tube Placement

Background. Critically ill patients can benefit from enteral nutrition with postpyloric feeding tubes, but the low success rate limits its wide use. Erythromycin could elevate the success rate of tube insertion, but its clinical efficiency still remains controversial. Methods. Included studies must be RCTs which assessed the success rate of postpyloric feeding tube insertion using erythromycin. Results. 284 patients were enrolled in six studies. Meta-analysis showed that erythromycin significantly increases the rate of successful postpyloric feeding tube placement (RR 1.45, 95% CI (1.12, 1.86)) and did not increase the risk of adverse effects (RR 2.15, 95% CI (0.20, 22.82)). Subgroup analysis showed that unweighted feeding tubes (RR 1.47, 95% CI (1.03, 2.11)) could significantly increase the success rate. Country of study, intravenous route of erythromycin, and year of participant enrollment did not influence these results. Conclusions. Erythromycin significantly increases the success rate of postpyloric feeding tube placement. This suggests that erythromycin can be used as an auxiliary method to improve the success rate of bedside insertion.

scholarly journals A Novel Technique for Post-pyloric Feeding Tube Placement in Critically Ill Patients: A Pilot Study

2005 ◽  
Vol 33 (2) ◽  
pp. 229-234 ◽  
Author(s):  
R. J. Young ◽  
M. J. Chapman ◽  
R. Fraser ◽  
R. Vozzo ◽  
D. P. Chorley ◽  
...  
Keyword(s):  
Gastric Emptying ◽  
Pilot Study ◽  
Real Time ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Feeding Tube ◽  
Insertion Time ◽  
Tube Placement ◽  
Feeding Tubes ◽  
Feeding Tube Placement

Delivery of enteral nutrition in critically ill patients is often hampered by gastric stasis necessitating direct feeding into the small intestine. Current techniques for placement of post-pyloric feeding catheters are complex, time consuming or both, and improvements in feeding tube placement techniques are required. The Cathlocator™ is a novel device that permits real time localisation of the end of feeding tubes via detection of a magnetic field generated by a small electric current in a coil incorporated in the tip of the tube. We performed a pilot study evaluating the feasibility of the Cathlocator™ system to guide and evaluate the placement of (1) nasoduodenal feeding tubes, and (2) nasogastric drainage tubes in critically ill patients with feed intolerance due to slow gastric emptying. A prospective study of eight critically ill patients was undertaken in the intensive care unit of a tertiary hospital. The Cathlocator™ was used to (1) guide the positioning of the tubes post-pylorically and (2) determine whether nasogastric and nasoduodenal tubes were placed correctly. Tube tip position was compared with data obtained by radiology. Data are expressed as median (range). Duodenal tube placement was successful in 7 of 8 patients (insertion time 12.6 min (5.3–34.4)). All nasogastric tube placements were successful (insertion time 3.4 min (0.6–10.0)). The Cathlocator™ accurately determined the position of both tubes without complication in all cases. The Cathlocator™ allows placement and location of an enteral feeding tube in real time in critically ill patients with slow gastric emptying. These findings warrant further studies into the application of this technique for placement of post-pyloric feeding tubes.

scholarly journals Esophagojejunostomy Feeding Tube Placement in 5 Dogs with Pancreatitis and Anorexia

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Forrest Cummings ◽  
Catherine A. Daley
Keyword(s):  
Veterinary Medicine ◽  
Enteral Feeding ◽  
Feeding Tube ◽  
Tube Placement ◽  
Loose Stool ◽  
Neurologic Diseases ◽  
Feeding Tubes ◽  
Patient Discomfort ◽  
Enteral Feeding Tube ◽  
Feeding Tube Placement

Enteral feeding tube placement has been described in veterinary medicine for several years. Indications include oral, esophageal, gastrointestinal, pancreatic, hepatic, and neurologic diseases. In this paper, endoscopically assisted placement of an esophagojejunostomy (EJ) feeding tube in dogs with pancreatitis and prolonged anorexia is described. To the author’s knowledge there are no published reports of this procedure. Esophagojejunostomy feeding tubes provide an alternative to other forms of postgastric feeding tube placement (e.g., nasojejunal, gastrojejunostomy, and jejunostomy tubes) without the associated complications of patient discomfort, sneezing, epistaxis, and peritonitis. Tube occlusion, transient vomiting and loose stool were the most commonly reported complications.

scholarly journals Methods Used by Critical Care Nurses to Verify Feeding Tube Placement in Clinical Practice

2015 ◽  
Vol 35 (1) ◽  
pp. e1-e7 ◽  
Author(s):  
Annette M. Bourgault ◽  
Janie Heath ◽  
Vallire Hooper ◽  
Mary Lou Sole ◽  
Elizabeth G. Nesmith
Keyword(s):  
Critical Care ◽  
American Association ◽  
Feeding Tube ◽  
Critical Care Nurses ◽  
Tube Placement ◽  
Evidence Based ◽  
Clinical Practices ◽  
Feeding Tubes ◽  
Verification Methods ◽  
Feeding Tube Placement

BACKGROUNDThe American Association of Critical-Care Nurses practice alert on verification of feeding tube placement makes evidence-based practice recommendations to guide nursing management of adult patients with blindly inserted feeding tubes. Many bedside verification methods do not allow detection of improper positioning of a feeding tube within the gastrointestinal tract, thereby increasing aspiration risk.OBJECTIVESTo determine how the expected practices from the American Association of Critical-Care Nurses practice alert were implemented by critical care nurses.METHODSThis study was part of a larger national, online survey that was completed by 370 critical care nurses. Descriptive statistics were used to analyze the data.RESULTSSeventy-eight percent of nurses used a variety of methods to verify initial placement of feeding tubes, although 14% were unaware that tube position should be confirmed every 4 hours. Despite the inaccuracy of auscultation methods, only 12% of nurses avoided this practice all of the time.CONCLUSIONSImplementation of expected clinical practices from this guideline varied. Nurses are encouraged to implement expected practices from this evidence-based, peer reviewed practice alert to minimize risk for patient harm.

Verifying Placement of Small-Bore Feeding Tubes: Electromagnetic Device Images Versus Abdominal Radiographs

2015 ◽  
Vol 24 (6) ◽  
pp. 525-530 ◽  
Author(s):  
Vera Bryant ◽  
Jean Phang ◽  
Kevin Abrams
Keyword(s):  
Feeding Tube ◽  
Tube Placement ◽  
Electromagnetic System ◽  
Lower Quadrant ◽  
Feeding Tubes ◽  
Left Lower Quadrant ◽  
Electromagnetic Device ◽  
Abdominal Radiographs ◽  
Feeding Tube Placement ◽  
Optimal Site

Background Clinicians are unsure if radiography is needed to confirm correct positioning of feeding tubes inserted with assistance from an electromagnetic system. Objectives To compare radiographic reports of feeding tube placement with images generated by an electromagnetic feeding tube placement device. Methods The medical records of 200 consecutive patients who had feeding tubes inserted with assistance from an electromagnetic feeding tube placement device were reviewed retrospectively. Radiographic reports of tube site were compared with images generated by the device. Results Radiographic evidence of tube sites was available in 188 cases: 184 tubes were located in portions of the gastrointestinal tract. Ninety of the 188 tubes were situated in the optimal site (distal duodenum or jejunum) radiographically. Images generated by the electromagnetic device were available in 176 cases; of these, 52 tubes appeared to end in the expected left lower quadrant. Tubes shown on radiographs to be in other sites also occasionally appeared to end in the left lower quadrant. Nurses using the device did not recognize 4 of the 188 tubes (2.1%) that were inadvertently placed in the lung. No consistent pattern of quadrant distribution was found for tubes positioned in the stomach or proximal duodenum. Conclusions Images generated by the electromagnetic tube placement device provided inconsistent results regarding tube location. A small percentage of seriously malpositioned tubes were not detected by using the electromagnetic device. These findings do not support eliminating radiographs to confirm correct tube placement following use of an electromagnetic tube placement device.

Nasogastric and Nasointestinal Feeding Tube Placement: An Integrative Review of Research

1994 ◽  
Vol 5 (2) ◽  
pp. 194-206 ◽  
Author(s):  
Barbara A. Rakel ◽  
Marita Titler ◽  
Colleen Goode ◽  
Jean Barry-Walker ◽  
Ginette Budreau ◽  
...  
Keyword(s):  
Risk Factors ◽  
Implementation Strategies ◽  
Critical Care Patient ◽  
Feeding Tube ◽  
Care Patient ◽  
Tube Placement ◽  
Feeding Tubes ◽  
Recommendations For Practice ◽  
Associated Risk Factors ◽  
Feeding Tube Placement

The authors present a review of the research on various methods for determining placement of nasogastric and nasointestinal feeding tubes. They also discuss research on associated risk factors, complications specific to critical care patient populations, and techniques for postpyloric placement. They present research consensus, recommendations for practice, and implementation strategies.

Efficacy of Feeding Tube Placement during Pancreaticoduodenectomy for Chronic Pancreatitis

2007 ◽  
Vol 73 (12) ◽  
pp. 1262-1265
Author(s):  
Thomas Schnelldorfer ◽  
David B. Adams
Keyword(s):  
Chronic Pancreatitis ◽  
Parenteral Nutrition ◽  
Hospital Stay ◽  
Total Parenteral Nutrition ◽  
Length Of Hospital Stay ◽  
Feeding Tube ◽  
Tube Placement ◽  
Duration Of Symptoms ◽  
Feeding Tubes ◽  
Feeding Tube Placement

Malnutrition, intestinal dysmotility, and gastroparesis are frequent problems in patients with chronic pancreatitis who undergo pancreaticoduodenectomy. This has led to the practice of operative placement of enteral feeding tubes. The purpose of this study is to examine the efficacy of feeding tubes placed during pancreaticoduodenectomy in patients with chronic pancreatitis. The records of 78 consecutive patients who underwent pancreaticoduodenectomy for chronic pancreatitis were retrospectively reviewed and analyzed. Forty-nine patients who received feeding tubes at the time of operation were compared with 29 who did not have feeding tubes placed. Both groups had similar disease progress measured by duration of symptoms and preoperative nutritional status. During the observation period, there was a trend toward not using operative feeding tubes (first 6 years 84 per cent versus last 2 years 33%). The overall complication rate after pancreaticoduodenectomy was 54 per cent. Placement of a feeding tube was associated with an increase in intra-abdominal morbidity from 34 per cent to 57 per cent ( P < 0.03). None of the patients had a complication directly related to placement of the feeding tube. Eighty-eight per cent of the placed feeding tubes were used. Despite feeding tube placement, 49 per cent of patients with feeding tubes required postoperative use of total parenteral nutrition compared with 55 per cent of patients without feeding tubes ( P > 0.05). Length of hospital stay and hospital readmission during the first postoperative year were not affected by feeding tube placement. In conclusion, simultaneous feeding tube placement along with pancreatic head resection for chronic pancreatitis can be performed safely. The majority of the feeding tubes are used in postoperative care, but they do not prevent the need for total parenteral nutrition and do not shorten length of hospital stay.

Feeding Tube Placement Following Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma

2021 ◽  
pp. 019459982110203
Author(s):  
Allen L. Feng ◽  
Andrew J. Holcomb ◽  
Nicholas B. Abt ◽  
Tara E. Mokhtari ◽  
Krish Suresh ◽  
...  
Keyword(s):  
Squamous Cell Carcinoma ◽  
Logistic Regression ◽  
Robotic Surgery ◽  
Cell Carcinoma ◽  
Feeding Tube ◽  
Transoral Robotic Surgery ◽  
Tube Placement ◽  
Multiple Logistic Regression ◽  
Feeding Tubes ◽  
Feeding Tube Placement

Objective To identify factors that may predict the need for feeding tubes in patients undergoing transoral robotic surgery (TORS) in the perioperative setting. Study Design Retrospective chart review. Setting Academic tertiary center. Methods A retrospective series of patients undergoing TORS for oropharyngeal squamous cell carcinoma (OPSCC) was identified between October 2016 and November 2019 at a single tertiary academic center. Patient data were gathered, such as frailty information, tumor characteristics, and treatment, including need for adjuvant therapy. Multiple logistic regression was performed to identify factors associated with feeding tube placement following TORS. Results A total of 138 patients were included in the study. The mean age was 60.2 years (range, 37-88 years) and 81.9% were male. Overall 82.9% of patients had human papilloma virus–associated tumors, while 28.3% were current or former smokers with a smoking history ≥10 pack-years. Eleven patients (8.0%) had a nasogastric or gastrostomy tube placed at some point during their treatment. Five patients (3.6%) had feeding tubes placed perioperatively (<4 weeks after TORS), of which 3 were nasogastric tubes. Six patients (4.3%) had feeding tubes placed in the periadjuvant treatment setting for multifactorial reasons; 5 of which were gastrostomy tubes. Only 1 patient (0.7%) was gastrostomy dependent 1 year after surgery. Multiple logistic regression did not demonstrate any significant predictive variables affecting perioperative feeding tube placement following TORS for OPSCC. Conclusions Feeding tubes are seldom required after TORS for early-stage OPSCC. With appropriate multidisciplinary planning and care, patients may reliably avoid the need for feeding tube placement following TORS for OPSCC.

Endoscopically Assisted Nasojejunal Feeding Tube Placement: Technique and Results in Five Dogs

2011 ◽  
Vol 47 (4) ◽  
pp. e50-e55 ◽  
Author(s):  
Scott Ayers Campbell ◽  
Catherine A. Daley
Keyword(s):  
Medical Records ◽  
Companion Animals ◽  
Feeding Tube ◽  
Tube Placement ◽  
Feeding Tubes ◽  
Nasojejunal Feeding ◽  
Premature Removal ◽  
Feeding Tube Placement ◽  
Placement Technique

Interest in noninvasive feeding tube placement in companion animals led to the adaption of a human technique utilizing endoscopy to place nasojejunal feeding tubes. Data from medical records in which nasojejunal feeding tubes were attempted were reviewed. Feeding tubes were attempted and successfully placed in five dogs within a median of 35 min. Feeding tubes remained in place for approximately 7 days. Complications included facial irritation (5/5), sneezing (5/5), fractured facial sutures (4/5), vomiting (3/5), diarrhea (3/5), crimping of feeding tube (3/5), regurgitation (1/5), epistaxis (1/5), clogging of the feeding tube (2/5), and oral migration with premature removal of the feeding tube (1/5). The deployment technique used in this study was found to be cumbersome. Despite minor complications, endoscopy can be used to rapidly and accurately place nasoenteric feeding devices.

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