Endoscopically placed naso-jejunal feeding tubes in ICU patients: a retrospective review

Introduction

The preferred method of nutritional support in intensive care patients is via the enteral feeding route due to its favourable trophic effects on the intestinal mucosa, reduced rate of complications and lower costs when compared with parenteral nutrition. Impaired gastric emptying can be a limiting factor in providing enteral nutrition, commonly affected by critical illness, and naso-jejunal tube feeding can be useful in patients who fail to tolerate naso-gastric tube feeding. Endoscopic placement of naso-jejunal tubes can be performed at the bedside, is highly successful, 85–90% success rate can be expected and enteral feeding can start immediately following the procedure.

Method

This retrospective review evaluated the use of feeding tubes (8 fr, 240 cm: Wilson-Cook Medical Inc.) endoscopically placed in ICU patients over a 15 month period.

Results

A total of 27 patients had 36 naso-jejunal feeding tubes placed endoscopically (five patients had more than one placement). The patients were typically male admitted to the ICU following an emergency procedure. All were placed successfully and used for a mean 5.7 days/tube (range 1–27 days). Avoidable complications such as blockages or accidental misplacement of the tube occured in 28% of the tubes.

A review of these results suggests that the majority of patients would have benefited from placement of an enteral feeding tube during theatre, and that the success of naso-jejunal feeding could be improved by attention to the care of the feeding tubes once placed.

Conclusion

Following this review, new standards and guidelines have been produced within the Critical Care Directorate for the multidisciplinary team members caring for patients who have naso-jejunal feeding tubes.