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.

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.

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.

Bedside Electromagnetic-Guided Feeding Tube Placement: An Improvement Over Traditional Placement Technique?

2007 ◽  
Vol 22 (4) ◽  
pp. 436-444 ◽  
Author(s):  
Rebecca Gray ◽  
Cameo Tynan ◽  
Lisa Reed ◽  
Jeanette Hasse ◽  
Mary Kramlich ◽  
...  
Keyword(s):  
Feeding Tube ◽  
Tube Placement ◽  
Feeding Tube Placement ◽  
Placement Technique
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