A novel method of post-pyloric feeding tube placement at bedside

J Crit Care. 2013 Dec;28(6):1039-41. doi: 10.1016/j.jcrc.2013.06.018. Epub 2013 Sep 7.

Abstract

Purpose: Post-pyloric feeding tube placement is often difficult, and special equipment or peristalsis agents are used to aid insertion. Although several reports have described blind techniques for post-pyloric feeding-tube placement, no general consensus about method preference has been achieved.

Materials and methods: The technique is performed as follows: via the nostril, a stylet-tipped feeding tube is advanced about 70 cm; to confirm tip location to the right of the epigastric area, towards the right hypochondriac region, 5 mL shots of air are injected to enable touch detection of bubbling; finally, the tube is advanced to a length of 100 cm, during which the strength of bubbling seems to diminish under palpation.

Results: We prospectively enrolled consecutive patients whose oral intake was expected to be difficult for 48 hours in the intensive care unit. Forty-one patients were enrolled and the rate of successful placement at first attempt was 95.1%. Mean duration for successful placement was 15 minutes.

Conclusions: With a novel technique, from the bedside, without special tools or drugs, we successfully placed post-pyloric feeding tubes. Essential points when inserting the tube are confirmation of the location of the tube tip by palpation of injected air, and to avoid deflection and looping.

Keywords: Enteral feeding; Intensive care unit; Palpation method; Post-pyloric feeding tube placement.

MeSH terms

  • APACHE
  • Aged
  • Body Mass Index
  • Critical Care / methods*
  • Enteral Nutrition / instrumentation
  • Enteral Nutrition / methods*
  • Female
  • Humans
  • Intensive Care Units
  • Intubation, Gastrointestinal / instrumentation
  • Intubation, Gastrointestinal / methods*
  • Male
  • Middle Aged
  • Palpation
  • Prospective Studies
  • Pylorus