A secure "double-check" technique of bedside post pyloric feeding tube placement using transnasal endoscopy

Role of Ultrasonography in Detecting the Localisation of the Nasoenteric Tube

OBJECTIVE

In this study, we aimed to determine the success rate of nasoenteric tube (NET) insertion into the postpyloric area using ultrasonography (USG) and compare with the commonly used method direct abdominal graphy.

METHODS

A single anaesthesiologist placed all the NETs. The NET was visualised by two radiologists simultaneously using USG. The localisation of the tube was confirmed using an abdominal graph in all patients.

RESULTS

The blind bedside method was used for NET insertion into 34 patients. Eleven of the tubes were detected passing through the postpyloric area using USG. In one case, the NET could not be visualised in the postpyloric area using USG; however, it was detected in the postpyloric area through control abdominal radiography. In 22 patients, NETs were detected in the stomach using control abdominal radiography. The rate of imaging post pyloric using USG was 91.6%. When all cases were considered, catheter localisation was detected accurately using USG by 97% (33 in 34 patients).

CONCLUSION

USG is a reliable and practical alternative to radiography, which can be used to detect localisation of the nasogastric tube and NET.

Gastrointestinal tract access for enteral nutrition in critically ill and trauma patients: indications, techniques, and complications

BACKGROUND

Enteral nutrition (EN) is a widely used, standard-of-care technique for nutrition support in critically ill and trauma patients.

OBJECTIVE

To review the current techniques of gastrointestinal tract access for EN.

METHODS

For this traditional narrative review, we accessed English-language articles and abstracts published from January 1988 through October 2012, using three research engines (MEDLINE, Scopus, and EMBASE) and the following key terms: "enteral nutrition," "critically ill," and "gut access." We excluded outdated abstracts.

RESULTS

For our nearly 25-year search period, 44 articles matched all three terms. The most common gut access techniques included nasoenteric tube placement (nasogastric, nasoduodenal, or nasojejunal), as well as a percutaneous endoscopic gastrostomy (PEG). Other open or laparoscopic techniques, such as a jejunostomy or a gastrojejunostomy, were also used. Early EN continues to be preferred whenever feasible. In addition, evidence is mounting that EN during the early phase of critical illness or trauma trophic feeding has an outcome comparable to that of full-strength formulas. Most patients tolerate EN through the stomach, so postpyloric tube feeding is not needed initially.

CONCLUSION

In critically ill and trauma patients, early EN through the stomach should be instituted whenever feasible. Other approaches can be used according to patient needs, available expertise, and institutional guidelines. More research is needed in order to ensure the safe use of surgical tubes in the open abdomen.