Experience in Bedside Placement, Clinical Validity, and Cost‐Efficacy of a Self‐Propelled Nasojejunal Feeding Tube

Abstract

Background: The procedures needed to insert nasojejunal tubes (NJTs) are often invasive or uncomfortable for the patient and require hospital resources. The objectives of this study were to describe our experience in inserting a self-propelling NJT with distal pigtail end and evaluate clinical validity and cost efficacy of this enteral nutrition (EN) approach compared with parenteral nutrition (PN). Materials and Methods: Prospective study from July 2009 to December 2010, including hospitalized noncritical patients who required short-term jejunal EN. The tubes were inserted at bedside, using intravenous erythromycin as a prokinetic drug. Positioning was considered correct when the distal end was beyond the ligament of Treitz. Migration failure was considered when the tube was not positioned into the jejunum within 48 hours postinsertion. Results: Fifty-six insertions were recorded in 47 patients, most frequently in severe acute pancreatitis (69.6%). The migration rates at 18 and 48 hours postinsertion were 73.2% and 82.1%, respectively. There was migration failure in 8.9% of cases, and 8.9% were classified null (the tube was no longer in the gastrointestinal tract at 18 hours). There were no reported or observed complications. The mean duration of the EN was 12 ± 10.8 days. Five different types of EN formula were used. The total study cost was 53.9% lower compared with using PN in all patients. Conclusions: Our study demonstrated that bedside insertion of a self-propelling NJT is a safe, cost-effective, and successful technique for postpyloric enteral feeding in at least 73% of the patients, and only 18% of patients could eventually need other placement techniques. It can avoid the need for more aggressive or expensive placement techniques or even PN if we cannot achieve enteral access.

Postpyloric feeding tube placement at the bedside: Complication rate and impact on length of stay

“…In the event of postplacement x‐ray demonstrating gastric placement, additional prokinetic agents are used in hopes that the tube will pass into the ideal position via peristalsis. Although radiologist‐placed tubes do not use prokinetic agents, bedside insertion of PPFTs with concurrent administration of prokinetic agents has been shown to be safe and effective 14 . Our study found shorter hospital and PICU LOS for those who had access to earlier EN.…”

Practice Patterns and Utilization of Tube Feedings in Acute Pancreatitis Patients at a Large US Referral Center

“…Novel technologies, such as bedside insertion of a self-propelling NJ tube, may be cost-effective in such patients to reduce costs and risks related to repeated endoscopy and sedation. 30…”

Erythromycin versus metoclopramide for post-pyloric spiral nasoenteric tube placement: a randomized non-inferiority trial

“…Thus, using prokinetic agents to facilitate transpyloric migration is a sensible strategy, and a randomized controlled trial (RCT) had demonstrated that metoclopramide could improve the success rate of post-pyloric placement of spiral NETs compared with a control group without promotility agents (55.0% vs. 27.3%, P = 0.0001) [ 6 ]. Although several studies of the ability of erythromycin to promote post-pyloric placement of spiral or straight-ended NETs have been reported [ 8 – 13 ], there is limited evidence that erythromycin, as a common prokinetic medication, facilitates transpyloric migration of spiral NETs in critically ill patients.…”