Blind bedside postpyloric placement of spiral tube as rescue therapy in critically ill patients: a prospective, tricentric, observational study

Abstract

BackgroundVarious special techniques for blind bedside transpyloric tube placement have been introduced into clinical practice. However, transpyloric spiral tube placement facilitated by a blind bedside method has not yet been reported. The objective of this prospective study was to evaluate the safety and efficiency of blind bedside postpyloric placement of a spiral tube as a rescue therapy subsequent to failed spontaneous transpyloric migration in critically ill patients.MethodsThis prospective, tricentric, observational study was conducted in the intensive care units (ICUs) of three tertiary hospitals. A total of 127 consecutive patients with failed spontaneous transpyloric spiral tube migration despite using prokinetic agents and still required enteral nutrition for more than 3 days were included. The spiral tube was inserted postpylorically using the blind bedside technique. All patients received metoclopramide intravenously prior to tube insertion. The exact tube tip position was determined by radiography. The primary efficacy endpoint was the success rate of postpyloric spiral tube placement. Secondary efficacy endpoints were success rate of a spiral tube placed in the third portion of the duodenum (D3) or beyond, success rate of placement in the proximal jejunum, time to insertion, length of insertion, and number of attempts. Safety endpoints were metoclopramide-related and major adverse tube-associated events.ResultsIn 81.9% of patients, the spiral feeding tubes were placed postpylorically; of these, 55.1% were placed in D3 or beyond and 33.9% were placed in the proximal jejunum, with a median time to insertion of 14 min and an average number of attempts of 1.4. The mean length of insertion was 95.6 cm. The adverse event incidence was 26.0%, and no serious adverse event was observed.ConclusionsBlind bedside postpyloric placement of a spiral tube, as a rescue therapy subsequent to failed spontaneous transpyloric migration in critically ill patients, is safe and effective. This technique may facilitate the early initiation of postpyloric feeding in the ICU.Trial registrationChinese Clinical Trial Registry, ChiCTR-OPN-16008206. Registered on 1 April 2016.

A novel method of blind bedside placement of postpyloric tubes

“…We read with great interest the recent report on blind bedside postpyloric placement by Lv et al [ 1 ]. Their methods were proven to be safe and effective in intensive care units.…”

Is metoclopramide beneficial for the post-pyloric placement of nasoenteric tubes? A systematic review and meta-analysis of randomized controlled trials

“…Recently, a novel NET with a spiral tip for post-pyloric placement in the assistance of prokinetic agents has emerged as a promising approach [18,[34][35][36], as demonstrated by the subgroup results strati ed by spiral or straight tube tip. In previous studies, Lai et al demonstrated that a spiral NET in conjunction with metoclopramide is preferable to a straight NET for post-pyloric placement [37].…”

The choice of a postpyloric tube and the patient’s position in our procedure: A response

“…In a recent letter published in Critical Care [1], Sun and colleagues argued that the choice of a postpyloric tube and the patient’s position with regard to spiral nasojejunal feeding tube insertion in a previously published study [2] required further improvement.…”

“…We are willing to make a comparison between the two positions in future work and optimize the method of remedial spiral feeding tube insertion. One position is described in the authors’ work [1], another position is described in our previous published work [2]. …”

“…Blind bedside postpyloric placement of the spiral tube as rescue therapy is implemented after a failed transpyloric migration [2]. The expected success rate is more than 90% using this strategy.…”