Bedside placement of transpyloric feeding tubes in the pediatric intensive care unit using gastric insufflation

OBJECTIVE

To test the effectiveness of gastric insufflation as an adjunct to placement of feeding tubes in the small bowel.

DESIGN

Prospective, randomized, controlled study.

SETTING

Pediatric intensive care unit in a tertiary children's hospital.

PATIENTS

A total of 50 children requiring enteral nutrition via a nasoenteral feeding tube in the small bowel.

INTERVENTIONS

An unweighted nasoenteral feeding tube attached to a three-way stopcock and a 60 mL syringe was inserted through the nares into the stomach. After 10 mL/kg of air was injected, the tube was advanced a distance estimated to position the tip of the tube proximal to the pylorus. An additional 10 mL/kg of air was then injected, and the tube was advanced a distance needed to place the tube in the fourth part of the duodenum. In the control group, feeding tubes were inserted through the nares and into the stomach. The tube was then advanced a distance estimated to place the tube in the fourth part of the duodenum. No air was injected in the control group.

MEASUREMENTS AND MAIN RESULTS

When gastric insufflation was used, 23 of 25 feeding tubes were successfully placed in the small bowel on the first attempt compared with 11 of 25 in the control group (p = .001). All feeding tubes were successfully placed after two attempts in the gastric insufflation group compared with 18 of 25 in the control group (p < .001). The time between the first attempt at placement of a transpyloric feeding tube and the initiation of feeding was significantly shorter in the study group than in the control group. There were no complications in either group.

CONCLUSION

Gastric insufflation allows rapid placement of feeding tubes into the small bowel with fewer attempts compared with a standard insertion technique in children.