A novel method for insertion of post-pyloric feeding tubes at the bedside without endoscopic or fluoroscopic assistance: a prospective study
Adult
Aged, 80 and over
Male
0301 basic medicine
Critical Care
Insufflation
Gastric Acidity Determination
Antibiotic Prophylaxis
Hydrogen-Ion Concentration
Middle Aged
Endoscopy, Gastrointestinal
Erythromycin
3. Good health
Electrocardiography
03 medical and health sciences
Enteral Nutrition
Jejunum
Fluoroscopy
Humans
Female
Intubation, Gastrointestinal
Aged
Monitoring, Physiologic
DOI:
10.1007/s00134-003-2071-x
Publication Date:
2004-01-24T06:42:56Z
AUTHORS (5)
ABSTRACT
To assess a novel method, adapted from already published literature, for bedside placement of nasojejunal feeding tubes using erythromycin, air insufflation of the stomach and continuous ECG guidance.Prospective study in a tertiary teaching hospital.40 consecutive patients who required enteral nutrition and mechanical ventilation for at least 48 h.Erythromycin (200 mg) was administered intravenously 30 min prior to the insertion of the feeding tube. The post-pyloric feeding tube was then inserted into the stomach and 500 ml air insufflated. Stomach ECG was performed, and during further insertion of the tube the QRS complex was continuously monitored for a change in polarity, suggesting passage across the midline through the pylorus. At the end of the procedure aspirate was obtained from the feeding tube and checked for alkaline pH. Exact tube position was determined by abdominal radiography.In 88% of cases the feeding tubes were post-pyloric, with a median time to insertion of 15 min (range 7-75). No major complications were seen in 52 attempts. Change in QRS polarity had 94% sensitivity in predicting post-pyloric tip placement. Of the 32 alkaline pH aspirates 31 were post-pyloric.This procedure is safe, effective and could be performed in a short time period within the confines of the intensive care unit without endoscopic assistance.
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