Nasojejunal Feeding Tube Placement Research Articles

Application of visual placement of a nasojejunal indwelling feeding tube in intensive care unit patients receiving mechanical ventilation.

Compared with nasogastric nutrition, nasojejunal nutrition may prevent some complications of critically ill patients by maintaining better nutritional status, and blind placement of nasojejunal dwelling feeding tubes is widely used. However, the visual placement seems to be safer and more effective than the blind placement, and is still seldom reported. We tried to develop visual placement of a nasojejunal feeding tube in intensive care unit patients. A total of 122 patients receiving mechanical ventilation were admitted to the Department of Critical Care Medicine of the Fifth Affiliated Hospital of Wenzhou Medical University and received the placement of nasojejunal feeding tubes. These patients were randomly and evenly assigned into two groups, one group receiving visual placement of nasojejunal dwelling feeding tubes and another group receiving blind placement. Actual tube placement was confirmed by X-ray. The primary outcome included the success rates of first placement of feeding tubes. The secondary outcome included the time of tube placement, complications, the total cost, heart rates and respiratory rates. The primary outcome showed that the success rates of first placement were 96.70% (59 cases/61 cases) in the visual placement group, and two cases failed due to pyloric stenosis and gastroparesis. The success rates were 83.6% (51 cases/61 cases) in the blind placement group and 10 cases failed due to either wrong placement or retrograde tube migration. The success rates in the visual placement group were higher than that in the blind placement group (P = 0.015). The secondary outcome showed that the time of tube placement in the visual placement group was shorter than that in the blind placement group (P < 0.0001). The cost of tube placement in the visual placement group was higher than that in the blind placement group (P < 0.0001). The statistical differences in complications, heart and respiratory rates were insignificant between the two groups (P > 0.05). Compared with the blind placement, the visual placement shortened the time of nasojejunal tube placement and increased success rates of first placement. The visual placement was more efficient, easy to operate, safe, and has potential clinical applications.

S2797 Closing the Gap: First Report of Endoscopic Suture Closure of Malignant Gastric Hemorrhage

Introduction: Gastrointestinal bleeding secondary to luminal malignancy is typically difficult to manage with conventional endoscopic therapies. Endoscopic suturing devices have become increasing popular for the management of various resection defects, inadvertent perforations, and bariatric endosurgery. Limited recent data suggests that this technology is effective for refractory bleeding from benign peptic ulcer disease. Herein we describe a case of the successful endoscopic closure of a bleeding malignant gastric ulcer using endoscopic suturing. Case Description/Methods: A 60-year-old male with a past history of primary thrombocytopenia, and recent diagnosis of signet ring gastric adenocarcinoma/linitis plastica (T2, N2, M0) on FLOT chemotherapy (5-fluorouracil, leucovorin, oxaliplatin, and docetaxel) presented with hematemesis and acute on chronic anemia. Physician examination was notable for tachycardia and hypotension. Laboratory evaluation was notable for a hemoglobin of 7.8 g/dL from 15.0 g/dL four days prior. The patient was intubated and urgent upper endoscopy in the intensive care unit was performed which showed active oozing and bleeding from a cratered gastric ulcer (previously biopsy proven adenocarcinoma) on the proximal lesser curvature measuring approximately 20 mm in size (A). Diffuse thickening of gastric folds consistent with linitis plastica was also seen. Initial attempts with bipolar cautery and epinephrine injection were unable to achieve hemostasis. An endoscopic suturing system was employed to place a suture in a figure of eight fashion and cinched at end with closure of the ulcer bed (B). The ulcer bed was not visible after suturing and hemostasis was achieved (C). Repeat upper endoscopy after two weeks for nasojejunal feeding tube placement did not show presence of ulcer and any recurrent bleeding. Patient is being clinically optimized to resume chemotherapy. Discussion: To our knowledge, we describe herein the first case of successful use of endoscopic suturing for closure of a bleeding malignant gastric ulcer. We hypothesize that the thickened gastric folds secondary to the histologic nature of linitis plastica allowed for adequate tissue purchase at the margins of the bleeding gastric ulcer which would typically be precluded in malignant tissue due to its friable nature.Figure 1.: A: Endoscopic image of gastric adenocarcinoma and associated cratered ulcer with oozing hemorrhage. B: Endoscopic image of suture device during closure. C: Endoscopic image of successful approximating edges of ulcer after endoscopic suturing without evidence of bleeding.

Fluoroscopic placement of nasojejunal feeding tubes in COVID-19 patients in the prone position.

BackgroundCoronavirus disease 2019 (COVID‐19) has caused an increase in patients requiring enteral feeding access while undergoing proning for severe acute respiratory distress syndrome (ARDS). We investigated the safety and feasibility of fluoroscopy‐guided nasojejunal (NJ) feeding tube placement in the prone position.MethodsThis is a retrospective cohort study of all patients who underwent fluoroscopic placement of NJ feeding tubes at a single institution between March 2020 and December 2020. Primary end points were success rate and number of attempts. Chi‐squared and Fischer exact tests were used to compare prone and supine groups.ResultsA total of 210 patients were included in the study: 53 patients received NJ feeding tubes while prone and 157 while supine. All but one patient in the prone group had ARDS secondary to COVID‐19, whereas 47 (30.3%) had COVID‐19 in the supine group. The rate of successful placement was 94.3% in the prone group and 100% in the supine group. Mean number of attempts was 1.1 (SD, ±0.4) in the prone and 1.0 (SD, ±0.1) in the supine group (P = .14). Prone patients had a longer median fluoroscopy time (69 s, interquartile range [IQR] = 92; vs 48 s, IQR = 43; P < .001) and received a higher radiation dose during the procedure (47 mGy, IQR = 50; vs 25 mGy, IQR = 33; P = .004). No procedural complications were reported.ConclusionFluoroscopy‐guided NJ feeding tube placement in prone patients is feasible and safe. Patient positioning should not delay obtaining postpyloric feeding access.

Safety and efficacy of intraoperative gastric feeding during burn surgery

BackgroundLarge burns are associated with a dramatic increase in metabolic demand, and adequate nutrition is vital to prevent poor wound healing and septic complications. However, enteral nutrition (EN) support is frequently withheld perioperatively, risking nutritional deficits. We retrospectively examined the safety and feasibility of continuing EN during surgery in patients with an established airway, and estimated the impact of perioperative fasting on overall caloric intake. MethodsMechanically ventilated patients admitted to our urban, verified burn center between January 2012 and July 2017 with greater than 20% total body surface area (TBSA) burns were included in this retrospective analysis. The total volume of EN received by the patient during each 24-h period and goal EN volume as determined by a clinical dietitian were collected. ResultsA total of 45 patients met criteria with mean TBSA of 44% (range 20–84%). Most patients had a gastric feeding tube (86%). Each patient underwent a median of 4 operations (range 1–33) for a total of 249 operative days and 991 non-operative days. There were no aspiration events. On non-operative days, patients met 85% of estimated caloric needs. EN was held on 170 operative days (69%), and on these days, only 34% of total caloric needs were met. EN was continued on 77 operative days (31%), and on these days, 95% of total caloric needs were met (p<0.001). Patients who had EN held for at least 50% of operative procedures (n=30) met only 69% of caloric goals while intubated. By comparison, patients who had EN continued for a majority of procedures (n=15) met 81% of caloric goals (p=0.002). ConclusionsContinuing EN intraoperatively in patients with an established airway appears to be a safe and efficacious way to meet patients’ nutritional needs, including when feeding is delivered via a gastric route. This is particularly important given that placement of nasojejunal feeding tubes can be difficult, particularly in resource-poor settings where endoscopic or fluoroscopic-guided placement may not be practical.

Home enteral nutrition after minimally invasive esophagectomy can improve quality of life and reduce the risk of malnutrition.

The potential benefits of home enteral nutrition (HEN) and the effects of HEN on quality of life (QOL) after esophagectomy remain unclear. The aim was to investigate the effect of 3 months HEN on health related QOL and nutritional status of esophageal cancer patients who were preoperatively malnourished. 142 malnourished (PG-SGA stage B or C) patients with esophageal cancer were assigned to receive Ivor Lewis minimally invasive esophagectomy (MIE group) with laparoscopic jejunal feeding tube placement or open esophagectomy (OE group) with nasojejunal feeding tube placement. After discharge, patients in the MIE group received HEN with 500-1000 kcal/d for 3 months, while the OE group patients did not receive HEN, as nasojejunal feeding tubes had been removed. QLQ-C30 and PG-SGA questionnaires were used to evaluate the QOL and the risk of malnutrition. 67 patients were enrolled in the MIE group and 75 patients were enrolled in the OE group. Symptoms related to fatigue, nausea, vomiting, pain, and appetite loss were significantly decreased in the patients treated with 3 months HEN. Similarly, patients treated with 3 months HEN had a lower risk of malnutrition than patients did not receive HEN (PG-SGA score, 5.7 vs 7.9, p<0.01). More patients in the MIE group (received 3 months HEN) were able to complete postoperative chemoradiotherapy than patients in the OE group (p<0.01). MIE and subsequent treatment with 3 months HEN can improve the QOL and reduce the risk of malnutrition in preoperatively malnourished patients.

Electromagnetic guided versus endoscopic placement of nasojejunal feeding tubes after pancreatoduodenectomy: a prospective pilot study

Electromagnetic guided versus endoscopic placement of nasojejunal feeding tubes after pancreatoduodenectomy: a prospective pilot study

Electromagnetic-Guided Versus Endoscopic Placement of Nasojejunal Feeding Tubes After Pancreatoduodenectomy: A Prospective Pilot Study.

An altered anatomy such as after pancreatoduodenectomy is currently seen as relative contraindication for bedside electromagnetic (EM)-guided nasojejunal feeding tube placement. The aim of this study was to determine the feasibility and safety of bedside EM-guided placement of nasojejunal feeding tubes as compared with endoscopy in patients after pancreatoduodenectomy. We performed a prospective monocenter pilot study in patients requiring enteral feeding after pancreatoduodenectomy (July 2012-March 2014). Primary end point was the success rate of primary tube placement confirmed on plain abdominal x-ray followed by successful enteral feeding. Overall, 53 (42%) of 126 patients who underwent pancreatoduodenectomy required a nasojejunal feeding tube, of which 36 were placed under EM guidance and, in 17, it was placed by endoscopy. Initial tube placement was successful in 21 (58%) of 36 patients with EM guidance and 9 (53%) of 17 patients with endoscopy (P = 0.71). No complications occurred during the placement procedures. Dislodgement and/or blockage of the tube occurred in 14 (39%) of 36 patients in the EM-guided group and 8 (47%) of 17 patients in the endoscopic group (P = 0.57). Bedside EM-guided placement of nasojejunal feeding tubes by nurses was equally successful as endoscopic placement in patients after pancreatoduodenectomy.

An improved method of nasojejunal feeding tube placement for patients requiring endoscopic nasobiliary drainage.

To avoid a second endoscopy for nasojejunal feeding tube placement (NFTP) in patients undergoing endoscopic nasobiliary drainage (ENBD), we studied improved NFTP method and compared it to endoscopic method. Patients with ENBD were divided into two groups. One group (18 patients) received endoscopic NFTP and the other group (26 patients) received improved NFTP. Placement time, physical condition of the patients and complications were recorded. In 18 patients who underwent endoscopic NFTP, NFT was successfully placed on the first attempt in 14 patients with a first placement success rate of 77.8%. NFT was wrongly intubated into the trachea in one patient inducing coughing, and after it was removed, the second placement was successful. The total success rate of endoscopic NFTP was 83.3% with an average placement time of 17.0 minutes. In 26 patients undergoing improved NFTP, all were successfully placed on the first attempt with a success rate of 100%, and an average placement time of 2.55 minutes. In patients with ENBD, the success rate of improved NFTP was significantly higher than endoscopic NFTP (χ²=36.4, p<0.05) with a significantly shorter placement time (t=18.5, p<0.05). For patients with ENBD, improved NFTP method is superior to the endoscopic method as it is more effective, convenient, faster, and cheaper. Additionally it avoids a second endoscopy and has fewer complications, better security and a higher success rate. The improved method is a safer, easier, more effective and practical method of EN and deserves general adoption in clinical work.

Use of an electromagnetic device for insertion of bedside nasojejunal feeding tube in critically ill patients

To evaluate the efficacy of an electromagnetic device for correct bedside placement of nasojejunal feeding tube for patients in intensive care unit (ICU). The clinical data of 109 patients in ICU who accepted bedside nasojejunal feeding tube placement from January 2010 to September 2012 were retrospectively analyzed. All the patients were divided into three groups according to the difference in type of nasojejunal feeding tube and the placement technique: control group 1 (n=48, Flocare feeding tube and bedside blind insertion group), control group 2 (n=28, Corflo(®) feeding tube and bedside blind insertion group), observation group (n=33, Corflo(®) feeding tube and electromagnetic tube placement device group). The success rate, the times of placement, duration of nasojejunal feeding, and safety were compared among three groups. The success rate of control group 2 and observation group were higher than control group 1 (71.43%, 90.91% vs. 33.33%), rate of partial success and failure rate were lower than those of control group 1 (partial success rate: 17.86%, 3.03% vs. 35.42%; failure rate: 10.71%, 6.06% vs. 31.25%, all P<0.05), and no differences were found between control group 2 and observation group. The average times for successful placement in observation group was lower than that of control group 1 and control group 2 (1.6±0.5 vs. 6.6±3.2, 5.8±2.3, both P<0.05), and the average time for successful placement was shorter in observation group than that of control group 1 and control group 2 (12.48±3.78 minutes vs. 25.27±3.61 minutes, 23.58±4.87 minutes, both P<0.05), but there was no difference between control group 1 and control group 2. No complications occurred in all three groups. Placement of a nasojejunal tube with the aid of an electromagnetic device is an excellent method for enteral nutrition, as it is safer, more efficient, with high successful rate, less time spending, and easier to master for beginners.

Application of stent placement or nasojejunal feeding tube placement in patients with malignant gastric outlet obstruction: A retrospective series of 38 cases

BackgroundMalignant gastric outlet obstruction (MGOO), a late complication of advanced carcinoma of the stomach, duodenum, periampulla or pancreas, causes significant malnutrition and morbidity. The current treatment for MGOO is palliative in nature, with the goal of maintaining the best quality of life possible during the terminal phase of the illness. MethodsA total of 38 patients with MGOO were enrolled in our institute from January 2007 to December 2011; 18 patients received nasojejunal (NJ) feeding tube placement, and 20 patients received duodenal stent placement. Food intake, measured by the gastric outlet obstruction scoring system (GOOSS), survival, complications, recurrent obstructive symptoms, and reintervention were evaluated in both groups. ResultsNo significant differences were noted with regard to patient characteristics, survival rate (NJ group: 140 days vs. stent group: 186 days, p = 0.617), and complication rate. Recurrent obstructions developed more frequently in patients treated with NJ feeding tube placement than in those treated with duodenal stent placement [12 (66.7%) vs. 5 (25%), p = 0.014]. The duration for patency was shorter in the NJ group than in the stent group (median: 40 days vs. 130 days, p = 0.009). The GOOSS score was significantly better in the stent group than in the NJ group. ConclusionNJ tube placement and duodenal stent placement are both effective and safe treatments for patients with MGOO. Both groups had similar complication rates and survival rates. While NJ tube placement is associated with lower costs, stent placement has a longer duration of patency, superior oral intake, and a lower reintervention rate. We suggest that stent placement should be considered first in patients who are able to afford the related costs.

An improved method for nasojejunal feeding tube placement in patients requiring endoscopic nasobiliary drainage

Objective: To avoid a second endoscopy for nasojejunal feeding tube placement (NFTP) in patients undergoing endoscopic nasobiliary drainage (ENBD), we studied improved NFTP method and compared it to endoscopic method. Methods: Patients with ENBD were divided into two groups. One group (18 patients) received endoscopic NFTP and the other group (26 patients) received improved NFTP. Placement time, physical condition of the patients and complications were recorded. Results: In 18 patients who underwent endoscopic NFTP, NFT was successfully placed on the first attempt in 14 patients with a first placement success rate of 77.8%. NFT was wrongly intubated into the trachea in one patient inducing coughing, and after it was removed, the second placement was successful. The total success rate of endoscopic NFTP was 83.3% with an average placement time of 17.0 minutes. In 26 patients undergoing improved NFTP, all were successfully placed on the first attempt with a success rate of 100%, and an average placement time of 2.55 minutes. In patients with ENBD, the success rate of improved NFTP was significantly higher than endoscopic NFTP (χ 2 =36.4, p<0.05) with a significantly shorter placement time (t=18.5, p<0.05). Conclusion: For patients with ENBD, improved NFTP method is superior to the endoscopic method as it is more effective, convenient, faster, and cheaper. Additionally it avoids a second endoscopy and has fewer complications, better security and a higher success rate. The improved method is a safer, easier, more effective and practical method of EN and deserves general adoption in clinical work.

Endoscopically Assisted Nasojejunal Feeding Tube Placement: Technique and Results in Five Dogs

Interest in noninvasive feeding tube placement in companion animals led to the adaption of a human technique utilizing endoscopy to place nasojejunal feeding tubes. Data from medical records in which nasojejunal feeding tubes were attempted were reviewed. Feeding tubes were attempted and successfully placed in five dogs within a median of 35 min. Feeding tubes remained in place for approximately 7 days. Complications included facial irritation (5/5), sneezing (5/5), fractured facial sutures (4/5), vomiting (3/5), diarrhea (3/5), crimping of feeding tube (3/5), regurgitation (1/5), epistaxis (1/5), clogging of the feeding tube (2/5), and oral migration with premature removal of the feeding tube (1/5). The deployment technique used in this study was found to be cumbersome. Despite minor complications, endoscopy can be used to rapidly and accurately place nasoenteric feeding devices.

Duodenal perforation due to a kink in a nasojejunal feeding tube in a patient with severe acute pancreatitis: a case report

IntroductionNasojejunal feeding tube placement can be achieved by fluoroscopic or endoscopic techniques. Significant complications due to nasojejunal feeding tube placement, such as hydrothorax, duodenal perforation and retroperitoneal emphysema, are very rare. We present a case of massive retroperitoneal emphysema and abscess because of duodenal perforation caused by a kink in a nasojejunal feeding tube.Case presentationA 34-year-old Chinese woman was admitted to our intensive care unit due to hypertriglyceridemia and severe acute pancreatitis. As she suffered from acute respiratory distress syndrome and required mechanical ventilation, a nasojejunal feeding tube was placed by transnasal endoscopic technique. The procedure took place at her bedside. Half a month later, she had a high fever and abdominal distension. An abdominal radiography was performed and showed that the nasojejunal feeding tube was kinking on the third portion of the duodenum and the tip of the nasojejunal feeding tube was inserted into the right retroperitoneum on the second portion of the duodenum.ConclusionWhen a nasojejunal feeding tube is placed through the transnasal endoscopic technique, an abdominal radiography should be used to confirm the tube's position and indicate if it is kinking or beyond the ligament of Treitz.

Clinical value of endoscopic placement of nasojejunal feeding tube for nutritional support in patients with severe acute pancreatitis

Objective To evaluate the clinical value of endoscopically nasojejunal feeding tube placement (ENFTP) for nutritional support in patients with severe acute pancreatitis (SAP). Methods Those SAP patients who treated with ENFTP (n= 47) or with total parenteral nutrition (TPN) (n=50) were retrospectively analyzed for laboratory parameters before and 1,2 and 4 weeks after nutrition support. Outcomes in the two groups were compared with respect to complications,mortality, duration of feeding, feeding costs,mechanical ventilation time and length of ICU or hospital stay. Results Four weeks after nutrition sypport, the hemoglobin and albumin were increased in ENFTP group as compared to TPN groups (P < 0. 05), while the blood sugar was decreased significant in ENFTP group than in TPN group (P<0.05). The incidence of peripancreatic or biliary infection and catheter-related infection were lower in ENFTP group than in TPN group. Duration of feeding and hospital stay were shorter, and nutrition cost was lower in ENFTP group (P<0.05). In addition, the APACHE Ⅱ score was significantly improved in ENFTP group(P<0.05). Conclusion ENFTP seems to be safe and less expensive in treatment of patients with acute pancreatitis. Key words: Pancreatitis, acute necrotizing; Enteral nutrition; Parenteral nutrition, total

A randomised clinical trial of transnasal endoscopy versus fluoroscopy for the placement of nasojejunal feeding tubes in patients with severe acute pancreatitis

Objectives:To compare transnasal endoscopy with fluoroscopy for the placement of nasojejunal feeding tubes (NJTs) in patients with severe acute pancreatitis.Methods:100 patients were randomised to receive NJTs by transnasal endoscopy or...

Feasibility of Self‐Propelling Nasojejunal Feeding Tube in Patients With Acute Pancreatitis

To assess the success rate of a self-propelling nasojejunal feeding tube in patients with acute pancreatitis. All patients admitted for acute pancreatitis were included. A self-propelling nasojejunal feeding tube was introduced into the stomach, and gastrointestinal motility was stimulated using metoclopramide. If the tube failed to advance to the ligament of Treitz, a nasojejunal tube was placed endoscopically. A total of 108 patients, 94 with necrotizing pancreatitis (Balthazar D/E) and 14 with nonnecrotizing pancreatitis (Balthazar B/C), were referred for artificial nutrition. In 11 cases, ileus persisted and parenteral nutrition was initiated. Among the remaining 97 patients, 5 refused tube placement. The self-propelling feeding tube was inserted in 92 patients with successful migration to the ligament of Treitz in 61% (n = 56) and failure in 39% (n = 36). Of the 36 patients with an initial failed placement, endoscopic placement of a nasojejunal tube was successful 80% of the time (29 patients). The success rate of a nasojejunal self-propelling feeding tube placement correlated directly with the severity of the acute pancreatitis (92% in B/C vs 61% in D vs 48% in E; P < .05). Use of a self-propelling nasojejunal tube is a simple technique that can be successfully performed in the majority of patients with acute pancreatitis. The utility of this procedure in the most severe cases of acute pancreatitis continues to pose a challenge.

Successful blind placement of nasojejunal tubes in paediatric intensive care: impact of training and audit

This paper is a report of a study to monitor continuing nasojejunal tube placement success rate and to evaluate a training programme for staff placing these tubes at the bedside. Gastric delivery of enteral feeds is frequently poorly tolerated due to impaired gastric motility in critically ill children. Consequently, there has been an increased interest in the use of the nasojejunal feeding route. Nasojejunal tubes are both safe and well-tolerated, but placements of these tubes are notoriously difficult and therefore often avoided. Consequently, a blind bedside technique was developed, with a placement success of 96%. A training programme using this technique was developed for nursing staff on the unit. This included one-to-one training of key nurses of the nasojejunal tube placement technique and a supervised nasojejunal placement with either the senior nurse or dietitian. This practice was audited in 100 consecutive patients in 2001 and 2004. Patient demographics, diagnosis, time taken for placement and reasons for unsuccessful placements were documented. The 2001 audit (n = 100) indicated that the nasojejunal route was used in 19% of all cases, with 1% and 80% of patients fed via the parenteral and nasogastric route respectively. In 2004 (n = 94), 18% of patients were fed via the nasojejunal route, 3% parenterally and 79% via the gastric route. Placement success continued to be between 94.5-95% in 2001 and 2004. Continued successful placement of blind nasojejunal feeding tubes can be achieved through a well-monitored education programme, regular audit cycles and multidisciplinary team support.

Nasal Bridling of Endoscopically Placed Nasojejunal Feeding Tubes

Purpose: Post-ampullary, Nasojejunal feedings have been shown to be an important component in the management of critically ill patients and patients with pancreatitis. However, proximal migration or dislodgement of the tubes can occur, limiting the effectiveness of the feeding in ICU patients. Methods: Intensive care unit (ICU) patients undergoing placement of nasojejunal feeding tubes (NJT) from January 2000 to December 2005 were prospectively identified. The feeding tube was positioned endoscopically into the post ampullary duodenum. After feeding tube placement, the NJT was “bridled” with umbilical tape to the posterior nasal septum. Bridling was performed using an NG tube, advanced to the posterior pharynx and pulled out through the mouth. Umbilical tape was secured to the NG tube which was then pulled back through the nose. The bridle was then created by securing the end of the umbilical tape to the feeding tube, with the nasal septum anchoring the tube in position, limiting displacement of the NJT when pulled. Results: A total of 153 NJT were placed and bridled in 139 patients. Positioning of the feeding tube was performed using snare (32%) and rat-tooth forceps (68%). Feeding tube position was confirmed to be post pyloric endoscopically and with abdominal xray after placement. All included patients had undergone repeat abdominal films from 5–19 days after initial placement, at which time feeding tube position was reassessed. Accidental tube dislodgement or gastric proximal migration occurred in 6 cases (4%) and tube occlusion or malfunction in 3 cases (2%). There was mild nosebleeding in 2 patients (1.5%) and perinasal ulceration in 3 patients (2%). Goal tube feedings were achieved within 72 hrs. in 142 cases (93%). Conclusions: Nasal Bridling of endoscopically placed NJT maintains post pyloric feeding tube position at a high rate (94%), with very few complications. This allows for rapid delivery of optimal nutrition in ICU patients.

Nasojejunal feeding tube placement using fluoroscopic guidance: technique and clinical experience in dogs

AbstractObjective: To briefly review the indications for direct intestinal feedings and describe a fluoroscopically guided technique for the placement of nasojejunal (NJ) feeding tubes in dogs. Clinical experience using the described technique is reported in 27 dogs.Data sources: Current human and veterinary literature. Original case data from client owned animals that have undergone fluoroscopically placed NJ feeding tubes for nutritional supplementation.Summary: The described technique was used for short‐term enteral nutritional therapy (1–5 days). In the fluoroscopic NJ placement technique, 17 of 20 tubes advanced into the jejunum remained in place until intentional removal whereas 6 of 7 tubes advanced only to the duodenum moved retrograde. Complications included bile leakage from the externalized opening of the tube, retrograde movement of the tube when placement was proximal to the caudal duodenal flexure, sneezing, and nasal discharge.Conclusions: Clinical experience using NJ feeding tube placement under fluoroscopic guidance has revealed the technique to be a well‐tolerated and reasonably reliable method of providing minimally invasive short‐term direct intestinal feeding in canine patients.

A Randomized Controlled Trial Comparing Three Different Techniques of Nasojejunal Feeding Tube Placement in Critically Ill Children

The goal of this study was to compare 3 different techniques used to place nasojejunal (NJ) feeding tubes in the critically ill or injured pediatric patients. This was a randomized, prospective trial in a university-affiliated 12-bed pediatric intensive care unit. Patients were critically ill children requiring placement of an NJ feeding tube. Patient age, weight, medications, use of mechanical ventilation, and patient tolerance were recorded. An abdominal radiograph obtained immediately after the placement determined correct placement. The final placement was recorded, as was the number of placement attempts. Patients were randomized to 1 of 3 groups: standard technique, standard technique facilitated with gastric insufflation, and standard technique facilitated with the use of preinsertion erythromycin. To ensure equal distribution, all patients were stratified by weight (<10 kg vs > or =10 kg) before randomization. All NJ tubes were placed by one of the investigators. If unsuccessful, a second attempt by the same investigator was allowed. Successful placement of the NJ tube was defined by confirmation of the tip of the tube in the first part of the duodenum or beyond by a pediatric radiologist blinded to the treatment groups. Seventy-five pediatric patients were enrolled in the study; 94.6% (71/75) of tubes were passed successfully into the small bowel on the first or second attempt. Evaluation of the data revealed no significant association with a specific technique and successful placement (p = .1999). When placed by a core group of experienced operators, the majority of NJ feeding tubes can be placed in critically ill or injured children on the first or second attempt, regardless of the technique used.