A simple and safe bedside method of transpyloric feeding tube placement in critically ill patients

Background

Early enteral nutrition is an accepted gold standard in the treatment of critically ill patients. The major limiting factor is depressed gastric motility. However, while small bowel function usually remains intact, the placement of postpyloric feeding tubes increases the number of patients absorbing a sufficient volume of enteral nutrition early in their ICU course. To eliminate the need of invasive and expensive interventions, many bedside techniques have been proposed. Recently one effective way has been described in critically ill critically [1]. We modified this method and used it in 27 adult patients.

Methods

Thirty-one postpyloric feeding tubes were placed blindly in 27 consecutive ventilated postsurgical ICU patients using a bedside protocol. The feeding tube was considered to be postpyloric when following the insufflation of 20 ml of air an amount less then 5 ml could be reaspirated. The explanation is the immediat collapse of the narrow small intestine lumen, when air is reaspirated. The tube position was confirmed by abdominal radiography.

Results

In all 31 cases the enteral feeding tube was placed successfully. The average placement time was 14 min. Nineteen tubes (61.2 %) were positioned in the duodenum and 12 tubes (38.8%) in the jejunum. The inability to reaspirate insufflated air correctly predicted transpyloric position in all cases. Initially the administration of enteral feeding was in 100% successfully possible. After 2 days of continous enteral nutrition, we observed duodeno-gastric reflux in one patient. No further complications occured.

Conclusion

A simple bedside placement protocol enables the positioning of postpyloric feeding tubes in adult ventilated critically ill patients. The inability to aspirate insufflated air from the tube confirmed the correct position in every case. This approach leads to a cost effective and early initiation of enteral feeding in the critical care setting without requiring extensive methods.