Evaluation of ultrasound-guided Freka-Trelumina enteral nutrition tube placement in the treatment of acute pancreatitis

Abstract

Background: Enteral nutrition should be implemented as early as possible in patients with moderate or severe acute pancreatitis. This study was designed to evaluate the feasibility and Deffectiveness of ultrasound-guided Freka-Trelumina tube placement for enteral nutrition in acute pancreatitis. Methods: Patients with severe acute pancreatitis admitted to Shengjing Hospital of China Medical University who needed Freka-Trelumina tube placement for enteral nutrition and gastrointestinal decompression were included in the current study. The relevant evaluation indicators of tube placement included the success rate of tube placement, tube placement time, tube shift rate, and blocking rate. In addition, the evaluation indicators of ultrasound-guided tube placement (from 1 January 2018 to 31 July 2019) were compared with those of previous endoscope-guided placement (from 1 January 2015 to 31 December 2017) by analysing the data from the electronic medical record system. Results: The success rate of ultrasound-guided tube placement was 90.7% (49/54). All 49 patients tolerated the Freka-Trelumina feeding tube. The average ultrasound-guided tube placement time for the 49 patients was 18.4 ± 12.8 min (range, 5-36 min). The Freka-Trelumina feeding tube had a shift rate of 10.2% (5/49). The blocking rate of the Freka-Trelumina feeding tube was 12.2% (6/49). The success rate of tube placement, tube shift rate and blocking rate for endoscope-guided tube placement were 100% (62/62), 11.3% (7/62), and 12.9% (8/62), respectively. The average endoscope-guided tube placement time for the 62 patients was 16.5 ± 5.7 min (range, 12-31 min). The comparison between the ultrasound-guided group and the endoscope-guided group showed that the success rate of tube placement, tube placement time, tube shift rate and blocking rate were similar. Conclusion: The ultrasound-guided method can be done non-invasively at the bedside, which is safe and convenient, and the Freka-Trelumina feeding tube can be placed in time to achieve the goal of early enteral nutrition and gastrointestinal decompression.

Ultrassonografia à beira do leito para localização da sonda nasoenteral: concordância entre enfermeiro e médico

“…A interposição de gás é apontada em diversos estudos como um fatorque pode dificultar a avaliação do trato gastrointestinal por meio da US (9,10,12,20,31,32) .O que se deve às características da US: ondas sonoras de alta frequência penetram os tecidos e são por eles refletidas. Ao retornar para o transdutor essas ondas são convertidas em imagens.…”

“…A literatura apresenta outros fatores que podem dificultar o emprego da técnica de US, reduzindo sua acurácia diagnóstica. São eles a presença de obesidade (12,31) , de abdome doloroso ou distendido (31) , de ferida operatória, de drenos ou de abdome aberto (9) , e ainda pacientes confusos ou pouco colaborativos durante o exame (19) .…”

“…Embora quase um terço dos pacientes do presente estudo tivesse diagnóstico de obesidade, esta não foi identificada como dificultador nas avaliações realizadas. Resultados menos animadores foram obtidos por outros autores que puderam ter a sonda com posicionamento confirmado por US em 49 dos 54 pacientes avaliados, e atribuíram sua dificuldade à interposição de gás e obesidade (31) .…”

Bedside ultrasonography for the confirmation of nasogastric tube placement: agreement between nurse and physician

“…The interposition of gas is pointed out in several studies as a factor that can hinder to assess the gastrointestinal tract using US (9,10,12,20,31,32) . This is due to the characteristics of US: high-frequency sound waves penetrate the tissues and are reflected by them.…”

“…The literature presents other factors that may hinder the use of the US technique, reducing its diagnostic accuracy. Such as the presence of obesity (12,31) , painful or distended abdomen (31) , surgical wound, drains or open abdomen (9) , and patients who are confused or uncollaborative during the examination (19) .…”