Abstract
In critically ill patients, nasogastric (NG) and nasojejunal (NJ) feeding tube placements are standard procedures. However, about 1.9% of blind tube insertions are malpositioned in the tracheopulmonary system, whereas guided procedures may result in a significant delay in nutritional delivery. Guided methods, such as Cortrak and fluoroscopy, have success rates of 82.6-85% and 93% respectively. The current study aims to investigate the performance of video-assisted feeding tube placement in the post-pyloric position using Integrated Real Time Imaging System (IRIS-) technology. A prospective cohort study in patients requiring enteral feeding was conducted in a mixed medical-surgical intensive care unit (ICU). The primary outcome was the post-pyloric placement of IRIS feeding tubes, as confirmed by X-ray. Secondary study objectives included gastric placement, ease of use and adverse events. Thirty-one feeding tubes were placed using IRIS-technology; one patient was excluded for analysis due to protocol violation. One procedure was terminated due to significant bleeding (epistaxis) and desaturation. Only eighteen (58%) feeding tubes were placed in post-pyloric position (including two past the ligament of Treitz). In subjects who needed post-pyloric placement due gastroparesis, IRIS was mostly unsuccessful (success rate of 25%). However, when gastric placement was the primary objective, 96.8% of tubes were correctly placed. During insertion, tracheal visualization occurred in 27% of cases, and the IRIS feeding tube was repositioned early in the procedure without causing patient harm. Real-time video-assisted post-pyloric feeding tube placement in critically ill ICU patients was only successful in 58% of cases and therefore currently cannot be recommended for this indication. However, a high success rate (96.8%) for gastric placement was achieved. IRIS tube placement detected tracheal misplacement immediately and had few adverse events.
Highlights
IntroductionNasogastric (NG) and nasojejunal (NJ) feeding tube placements are standard procedures
In critically ill patients, nasogastric (NG) and nasojejunal (NJ) feeding tube placements are standard procedures
This prospective cohort study was conducted from May 5, 2019 to December 12, 2019 in critically ill patients admitted to a mixed medical-surgical intensive care unit (ICU) of Gelderse Vallei Hospital (Ziekenhuis Gelderse Vallei (ZGV), in Ede, The Netherlands)
Summary
Nasogastric (NG) and nasojejunal (NJ) feeding tube placements are standard procedures. About 1.9% of blind tube insertions are malpositioned in the tracheopulmonary system, whereas guided procedures may result in a significant delay in nutritional delivery Guided methods, such as Cortrak and fluoroscopy, have success rates of 82.6e85% and 93% respectively. Conclusions: Real-time video-assisted post-pyloric feeding tube placement in critically ill ICU patients was only successful in 58% of cases and currently cannot be recommended for this indication. Most critically ill patients admitted to the intensive care unit (ICU) require enteral nutrition (EN), enteral administration of medication or gastric decompression [1,2]. In patients with a high risk of aspiration (such as the absence of an intact gag reflex), proximal enteric fistulae or in cases of persistent gastric feeding intolerance despite the administration of prokinetics, post-pyloric feeding should be considered, with post ligament of Treitz as the optimal position [1,9e11].
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