Techniques and Procedures: Simple Bedside Placement of Nasal‐Enteral Feeding Tubes: A Case Series

Abstract

The placement of postpyloric feeding tubes has been clinically difficult. A study was undertaken to identify a reliable bedside manual technique. One hundred one consecutive enteral feeding tubes were placed in 93 patients at the bedside. One patient was not available for radiographic evaluation. Nonweighted, straight tubes were used in supine patients premedicated with metoclopramide. Two additional stock wire stylets were used to stiffen the tubes. The tubes were simply advanced. If resistance was encountered, the tube was backed up and advanced again. Tip location was checked by injection of blue dye and plain roentgenography. Sixty-nine percent of tubes were placed to the ligament of Treitz or jejunum, 15% in the third or fourth portion of the duodenum (D3/D4), 11% in DlfD2, and 5% in the pylorus or stomach. Ninety-five percent of tubes were used successfully for enteral nutrition. Time for placement was 28 ? 22 minutes (mean k SD). Blue saline injection localized tube position correctly relative to the pylorus more frequently than plain roentgenography 198% us 95%, not statistically significant (NSS)]. Ninety-five percent of feeding tubes were positioned distal to the stomach. Simple bedside placement of stiffened feeding tubes is effective and reliable.

Defining and Assessing Tolerance in Enteral Nutrition

“…Currently, with an assortment of available feeding tubes and numerous successful methods of bedside placement, achieving EN access is now routinely feasible and in many facilities is considered the standard of care in the ICU. [5][6][7] If bedside placement fails to achieve small bowel access, fluoroscopic, endoscopic, and operative interventions can be used.…”

“…Hyperglycemia, caused by endorgan resistance, is common in most critically ill patients and can be exacerbated if the patient is fed Vol. 19,No. 5 in excess of energy expenditure.…”