Bedside sonographic guided vs blind postpyloric feeding tube placement in critically ill patients

Abstract

Purpose: To compare a blind manual bedside method for placing feeding tubes into the small bowel to a sonographic bedside technique. Methods: 47 patients, hemodynamically stable, mechanically ventilated and which required a nasoenteric tube placement for enteral feeding. A blind bedside method for postpyloric placement was always attempted first and the technique was considered successful when a postpyloric location of the tip of the tube was achieved as shown by an abdominal roentgenogram. However, if after 30 minutes we failed to enter the small bowel we attempted a sonographic bedside technique. Finally, a nasogastric tube was inserted into the stomach. Results: The blind method was successful in 13 (27.6%) of the 47 patients and the final location of these tubes was the proximal jejunum. The average time for placement was 11.1±7.4 min (range 5 to 30). The sonographic technique was successful in 28 (82.3%) of the remaining patients and the final location was 7 (20%) in the second portion of the duodenum, 9 (26%) in the third, and 12 (35%) in the proximal jejunum. The average time for placement was 17.9±7.4 min (range 5 to 35). The pyloric outlet was sonographically severely hypokinetic in 17 patients and in 6 of them we were unable to achieve postpyloric tube placement. Conclusions: The sonographic bedside technique has a success rate of 82.36% (confidence interval; 65%-93%) after the failure of the blind method, proving that the former is significantly more successful. Clinical Implications: This sonographic technique facilitates the bedside insertion of feeding tubes in patients who cannot be moved and in those with severe impairment of the peristaltic activity of the stomach.