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Prospective observational study of self-placing nasojejunal tubes (Tiger Tube) on the ICU

Introduction

Nutritional support is vital to improving the clinical outcomes in patients on the ICU. Enteral nutrition should be administered early and aggressively, thereby reducing the need for parenteral nutrition (TPN). Nasogastric (NG) feeding may not be tolerated due to gastroparesis, small and large bowel ileus associated with drugs and/or surgery.

Objectives

We hypothesised that if NG feeding was not tolerated within 24 hours, following suitable use of prokinetics, then a self-propelling nasojejunal (NJ) tube (Tiger Tube [TT tube]; Wilson Cook, USA) would be placed and NJ feeding commenced reducing TPN requirements.

Design

A prospective observational study.

Methods

We prospectively monitored patients with NG feeding intolerance. If enteral feed was not tolerated, patients were commenced on prokinetic agents (metaclopramide 10 mg three times daily i.v. and or erythromycin 250 mg i.v.). Despite prokinetic therapy, if still intolerant a TT tube was placed. One hour pre-TT and 4 hours post-TT placement patients received erythromycin (500 mg i.v.). The TT tube was placed according to the manufacturer's protocol. (The NG tube was also left in situ for aspirate assessment.) Abdominal X-ray was performed 6 hours after initiation of TT placement to confirm location and NJ feeding commenced.

Results

NJ feeding was commenced promptly on medical and surgical patients intolerant of standard NG feeding, and placement of the TT tube was successful (35/40 patients, 87.5%). Estimated savings in patient days of TPN have been illustrated in Table 1 (n = 40).

Table 1 (abstract P215)

Conclusion

The TTs were easily placed aided by prokinetics (87.5%). All tubes were placed by the nurse/doctor at the bedside and did not require endoscopic placement. Significant financial and manpower resources have been saved by a simple bedside technique. No clinical complications were noted with the use of TT tubes in our study. A randomised study is now planned.

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Cook, M., Tilliard, A., Cecconi, M. et al. Prospective observational study of self-placing nasojejunal tubes (Tiger Tube) on the ICU. Crit Care 10, P215 (2006). https://doi.org/10.1186/cc4562

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Keywords

  • Erythromycin
  • Prospective Observational Study
  • Gastroparesis
  • Prokinetic Agent
  • Nasojejunal Tube