Bedside Method for Placing Small Bowel Feeding Tubes in Critically III Patients: A Prospective Study

Abstract

Enteral delivery of nutrients is important for optimal treatment of critically ill patients. It maintains gut digestive and barrier functions, decreases gut bacterial translocation, decreases the incidence of sepsis, and improves outcome. Gastric emptying is impaired in many critically ill patients and feeding into a gastroparetic stomach leads to large gastric residuals and aspiration. We describe a simple bedside technique for placement of small bowel feeding tubes. Using this technique, we successfully placed 213/231 (92 percent) of feeding tubes in critically ill patients. Three percent were in the first portion of the duodenum, 25 percent in the second portion, 47 percent in the third portion, and 17 percent in the proximal jejunum. The average time for placement of small bowel feeding tubes was 40 +/- 14 min (mean +/- SD). Abdominal roentgenograms failed to properly locate 13 (6 percent) tubes. The most accurate and cheapest methods for confirming small bowel location of feeding tubes were bile aspiration, pH change from acidic to basic, and blue dye injection.