Evaluation of a Nasoenteral Feeding Tube With Balloon to Facilitate Placement

2020 ◽  
Vol 40 (1) ◽  
pp. 37-44
Author(s):  
Sabry Gabriel ◽  
Richard Ackermann ◽  
Samy Gabriel ◽  
Caleb Ackermann ◽  
Leslie Swadener-Culpepper
Keyword(s):  
Critically Ill ◽  
Case Series ◽  
Feeding Tube ◽  
Burn Patients ◽  
Insertion Technique ◽  
Abdominal Radiography ◽  
Feeding Tubes ◽  
Distal Migration ◽  
Hospital Patients ◽  
Nasoenteral Feeding

Background Enteral feeding is essential for critically ill, head trauma, and burn patients who are unable to swallow. Objective To evaluate a new nasoenteral feeding tube with distal tip balloon designed to facilitate post-pyloric migration and avoid misplacement in the trachea. Methods A case series was conducted in 50 critically ill patients aged 19 to 89 years receiving mechanical ventilation and requiring enteral nutrition in a teaching hospital. Patients received a soft, flexible, kink-resistant nasoenteral feeding tube with a balloon near the distal tip to enhance postpyloric migration by peristalsis. The feeding tube was inserted with a novel thread technique to reduce posterior nasopharyngeal trauma and tube misplacement. Pulse oximetry provided early detection of misplacement into the trachea. Placement was verified by abdominal radiography performed shortly after the procedure and repeated within 24 hours if needed. Results Postpyloric placement was achieved at 30 minutes in 24% of patients and by the following morning in 70% of patients. Tracheal intubation occurred in 1 patient but was recognized and corrected without injury. No tube occlusion from kinking occurred. Conclusions Early gastric or postpyloric feeding can be provided with this novel feeding tube. Its use facilitates quick bedside recognition of accidental misplacement in the trachea, reducing the chance of pneumothorax. The tip balloon reduces deeper placement into a lung and promotes distal migration into the small intestine. The design prevents occlusion from kinking, which is common with conventional feeding tubes. Nurses easily adopted the tube and insertion technique.

scholarly journals The Placement of Post-pyloric Feeding Tubes Using DRX-Revolution Mobile X-Ray System in an ICU. A Case Series

2016 ◽  
Vol 2 (3) ◽  
pp. 131-134
Author(s):  
Leonid Koyfman ◽  
Andrei Schwartz ◽  
Yair Benjamin ◽  
Alexander Smolikov ◽  
Moti Klein ◽  
...  
Keyword(s):  
Enteral Nutrition ◽  
Critically Ill ◽  
Enteral Feeding ◽  
Nasogastric Tube ◽  
Critically Ill Patients ◽  
Case Series ◽  
Feeding Tube ◽  
Nasogastric Feeding ◽  
X Ray ◽  
Feeding Tubes

Abstract Enteral nutrition is crucial for ensuring that critically ill patients have a proper intake of food, water, and medicine. Methods to ensure this requirement should be initiated as early as possible. The use of PPF has several advantages compared to the use of a nasogastric feeding tube. In the present paper, the cases of three critically ill patients with a nonfunctional gastrointestinal system on admission to ICU, are detailed. Enteral feeding through a nasogastric tube by prokinetic agent therapy had been unsuccessful. The bedside placement of a post-pyloric feeding tube by the DRX-Revolution X-ray system is described.

26 Clogged Feeding Tubes: Why Does It Matter?

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S22-S23
Author(s):  
Sarah Zavala ◽  
Ashley Wang ◽  
Cheryl W Zhang ◽  
Jennifer M Larson ◽  
Yuk Ming Liu
Keyword(s):  
Risk Factors ◽  
Length Of Stay ◽  
Nutritional Support ◽  
Total Body Surface Area ◽  
Tube Feeding ◽  
Feeding Tube ◽  
Admission Diagnosis ◽  
Burn Patients ◽  
Feeding Tubes ◽  
Burn Unit

Abstract Introduction Many patients treated on a burn unit require tube feeding as their primary caloric source or as supplemental feeding due to their injuries. Burn patients specifically require higher caloric intake due to the hypermetabolic state of burn injuries. Inadequate nutritional support contributes to longer ICU stays and higher mortality. Clogged feeding tubes reduce nutrition provided due to temporary discontinuation of feeding. The objective of this study was to identify risk factors for the incidence of tube clogging. Methods This was a single-center retrospective chart review of all patients admitted to an American Burn Association-verified Burn Unit between August 2017 and October 2019 who received tube feeds during their admission. Data collected included baseline demographics, clinical outcomes, and details about tube feed formulations, number of clogs, and details leading up to the clog. Baseline demographics were compared using descriptive statistics. Nominal data was compared using Chi-square test. Continuous data was analyzed using student’s t-test or Mann-Whitney U test. Results A total of 170 patients were included; admission diagnoses included burn (97), soft tissue infections (29), SJS/TEN (11), and others (33). At least one clogged feeding tube was experienced by 51 patients and some experienced up to seven separate clogs. SJS/TEN patients were less likely to experience a clog (9.2 vs 0%, p = 0.035) and frostbite patients were more likely to experience a clog (0 vs 5.9%, p = 0.026). Burn mechanism did not affect incidence of tube feed clog, but patients with larger total body surface area (TBSA) burned were more likely to have a clog (15.55 vs 25.03%, p = 0.004). It was a median of 12 days until the first clog occurred (IQR 7.8–17.3). Two tube feed formulas demonstrated an increased likelihood of clog: a renal formulation (16.8 vs 33.3%, p = 0.017) and a polymeric concentrated product (5.0 vs 17.6%, p = 0.008). Both products have a high viscosity. Patients who experienced a clog had a longer length of stay (21.5 vs 44.0 days, p = 0.001). Conclusions This study identified several risk factors associated with higher incidence of clogged feeding tube in the burn unit including tube feed formulation and viscosity, admission diagnosis, and larger TBSA in burn patients. This study also confirms that clogged feeding tubes, and the resultant insufficient nutritional support, may contribute to an increased length of stay.

Successful Use of Intravenous Methylnaltrexone for Opioid-Induced Constipation in Critically Ill Pediatric Patients

2021 ◽  
Author(s):  
Kimberly P. Mills ◽  
Christopher C. McPherson ◽  
Ahmed S. Said ◽  
Michael A. Lahart
Keyword(s):  
Adverse Events ◽  
Critically Ill ◽  
Primary Outcome ◽  
Pediatric Patients ◽  
Case Series ◽  
Opioid Withdrawal ◽  
Limited Data ◽  
Serious Adverse Events ◽  
Patient Response ◽  
Hospital Patients

Abstract Objectives Methylnaltrexone is U.S. Food and Drug Administration (FDA) approved as a subcutaneous injection for adults with opioid-induced constipation (OIC). Case series have described the use of methylnaltrexone for OIC in the pediatric oncology population. There are limited data describing its intravenous use in critically ill pediatric patients. Methods We conducted a retrospective observational study at St. Louis Children's Hospital. Patients less than 18 years old who received at least one dose of intravenous methylnaltrexone while admitted to an intensive care unit between January 2016 and August 2019 were included. The primary outcome was documented laxation within 24 hours of methylnaltrexone administration. Results Sixteen patients received a total of 34 doses of intravenous methylnaltrexone. Patients received a median of 1.69 (interquartile range [IQR], 0.9–4.86) morphine milligram equivalents per kilogram per 24 hours, over a median of 14 days (IQR, 11–30), before methylnaltrexone administration. The median dose of methylnaltrexone was 0.15 mg/kg (IQR, 0.15–0.16). Ten patients (63%) responded to the first dose of methylnaltrexone, and 14 patients (88%) responded to at least one dose. Overall, 26 doses (76%) led to patient response. Four patients (25%) experienced adverse events (emesis, abdominal pain) after methylnaltrexone administration. No signs or symptoms of opioid withdrawal were documented. Conclusions Intravenous methylnaltrexone appears to be safe and effective in treating OIC in critically ill pediatric patients. No serious adverse events or signs of opioid withdrawal were observed after single and repeat dosing. Patients responded to methylnaltrexone with varying opioid dosing and durations prior to administration.

Evaluation of Delivery of Enteral Nutrition in Critically Ill Patients Receiving Mechanical Ventilation

2008 ◽  
Vol 17 (1) ◽  
pp. 53-61 ◽  
Author(s):  
Debra O’Meara ◽  
Eduardo Mireles-Cabodevila ◽  
Fran Frame ◽  
A. Christine Hummell ◽  
Jeffrey Hammel ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Enteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Feeding Tube ◽  
Feeding Tubes ◽  
Academic Center ◽  
Specific Step ◽  
Feeding Process ◽  
Medical Intensive Care

Background Published reports consistently describe incomplete delivery of prescribed enteral nutrition. Which specific step in the process delays or interferes with the administration of a full dose of nutrients is unclear. Objectives To assess factors associated with interruptions in enteral nutrition in critically ill patients receiving mechanical ventilation. Methods An observational prospective study of 59 consecutive patients who required mechanical ventilation and were receiving enteral nutrition was done in an 18-bed medical intensive care unit of an academic center. Data were collected prospectively on standardized forms. Steps involved in the feeding process from admission to discharge were recorded, each step was timed, and delivery of nutrition was quantified. Results Patients received approximately 50% (mean, 1106.3; SD, 885.9 Cal) of the prescribed caloric needs. Enteral nutrition was interrupted 27.3% of the available time. A mean of 1.13 interruptions occurred per patient per day; enteral nutrition was interrupted a mean of 6 (SD, 0.9) hours per patient each day. Prolonged interruptions were mainly associated with problems related to small-bore feeding tubes (25.5%), increased residual volumes (13.3%), weaning (11.7%), and other reasons (22.8%). Placement and confirmation of placement of the small-bore feeding tube were significant causes of incomplete delivery of nutrients on the day of admission. Conclusions Delivery of enteral nutrition in critically ill patients receiving mechanical ventilation is interrupted by practices embedded in the care of these patients. Evaluation of the process reveals areas to improve the delivery of enteral nutrition.

scholarly journals A Novel Technique for Post-pyloric Feeding Tube Placement in Critically Ill Patients: A Pilot Study

2005 ◽  
Vol 33 (2) ◽  
pp. 229-234 ◽  
Author(s):  
R. J. Young ◽  
M. J. Chapman ◽  
R. Fraser ◽  
R. Vozzo ◽  
D. P. Chorley ◽  
...  
Keyword(s):  
Gastric Emptying ◽  
Pilot Study ◽  
Real Time ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Feeding Tube ◽  
Insertion Time ◽  
Tube Placement ◽  
Feeding Tubes ◽  
Feeding Tube Placement

Delivery of enteral nutrition in critically ill patients is often hampered by gastric stasis necessitating direct feeding into the small intestine. Current techniques for placement of post-pyloric feeding catheters are complex, time consuming or both, and improvements in feeding tube placement techniques are required. The Cathlocator™ is a novel device that permits real time localisation of the end of feeding tubes via detection of a magnetic field generated by a small electric current in a coil incorporated in the tip of the tube. We performed a pilot study evaluating the feasibility of the Cathlocator™ system to guide and evaluate the placement of (1) nasoduodenal feeding tubes, and (2) nasogastric drainage tubes in critically ill patients with feed intolerance due to slow gastric emptying. A prospective study of eight critically ill patients was undertaken in the intensive care unit of a tertiary hospital. The Cathlocator™ was used to (1) guide the positioning of the tubes post-pylorically and (2) determine whether nasogastric and nasoduodenal tubes were placed correctly. Tube tip position was compared with data obtained by radiology. Data are expressed as median (range). Duodenal tube placement was successful in 7 of 8 patients (insertion time 12.6 min (5.3–34.4)). All nasogastric tube placements were successful (insertion time 3.4 min (0.6–10.0)). The Cathlocator™ accurately determined the position of both tubes without complication in all cases. The Cathlocator™ allows placement and location of an enteral feeding tube in real time in critically ill patients with slow gastric emptying. These findings warrant further studies into the application of this technique for placement of post-pyloric feeding tubes.

Endoscopic Insertion of Nasojejunal Feeding Tube at Bedside for Critically Ill Patients: Relationship between Tube Position and Intragastric Countercurrent of Contrast Medium

2019 ◽  
Vol 75 (3) ◽  
pp. 163-167
Author(s):  
Hiroomi Tatsumi ◽  
Masayuki Akatsuka ◽  
Satoshi Kazuma ◽  
Yoichi Katayama ◽  
Yuya Goto ◽  
...  
Keyword(s):  
Contrast Medium ◽  
Feeding Tube ◽  
Tube Insertion ◽  
Abdominal Radiography ◽  
Feeding Tubes ◽  
Tube Position ◽  
Endoscopic Insertion ◽  
Endoscopic Placement ◽  
Nasojejunal Feeding ◽  
Enteral Nutrients

Background and Oblectives: We evaluated the success rate of endoscopically positioned nasojejunal feeding tubes and the intragastric countercurrent of contrast medium thereafter. Method: This retrospective observational study investigated patients who were admitted to a single intensive care unit and required endoscopic placement of a post-pyloric feeding tube between January 2010 and June 2016. The feeding tube was grasped with forceps via a transoral endoscope and inserted into the duodenum or jejunum. Thereafter, we assessed the position of the tube and the intragastric countercurrent using abdominal radiography with contrast medium. Results: The tube tip was inserted at the jejunum and the duodenal fourth portion in 55.8 and 33.6% of patients, respectively. The tip of the inserted tube had moved into the jejunum of 71.7% of patients by the following day. The countercurrent rate was significantly lower among patients with a tube inserted into the duodenal fourth portion or more distal than among those with tubes inserted more proximally (8.4 vs. 45.4%, p = 0.0022). Conclusions: The endoscopic insertion and positioning of a nasojejunal feeding tube seemed effective because the rate of tube insertion into the duodenal fourth portion or more distal was about 90%. The findings of intragastric countercurrents indicated that feeding tubes should be inserted into the duodenal fourth portion or beyond to prevent vomiting and the aspiration of enteral nutrients.

scholarly journals Characterization of Fungal Colonization of Indwelling Esophagostomy Tubes

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Shelly J. Olin ◽  
David A. Bemis ◽  
John R. Dunlap ◽  
Jacqueline C. Whittemore
Keyword(s):  
Structural Integrity ◽  
Case Series ◽  
Morphological Characteristics ◽  
Surface Characteristics ◽  
Feeding Tube ◽  
Fungal Colonization ◽  
Feeding Tubes ◽  
Normal Microbiota ◽  
Tube Exchange ◽  
The Impact

Fungal colonization of feeding tubes occurs rapidly in people, resulting in decreased structural integrity and complications such as luminal obstruction and tube failure. Esophagostomy tubes (E-tubes) are commonly used in dogs and cats for enteral support, but data are lacking regarding colonizing fungi and the impact of colonization on tube integrity. In this study, esophagostomy tubes were collected in lieu of disposal from dogs and cats undergoing feeding tube exchange. Fungi were isolated with culture and identified using morphological characteristics. Scanning electron microscopy was used to evaluate the surface characteristics of the tubes. Two silicone and one polyurethane E-tube were evaluated. Fungi associated with the normal microbiota, including Candida sp. and Penicillium sp., as well as environmental fungi were identified. This case series represents the first documentation of fungal colonization of silicone and polyurethane E-tubes in dogs and cats. Additionally, this is the first report to document degenerative changes in a silicone E-tube.

Fatal Complications of Nasogastric Tube Misplacement in Two Dogs

2021 ◽  
Author(s):  
Jenniffer Rodriguez-Diaz ◽  
Julia P. Sumner ◽  
Meredith Miller
Keyword(s):  
Risk Factors ◽  
Case Report ◽  
Enteral Nutrition ◽  
Case Reports ◽  
Case Series ◽  
Feeding Tube ◽  
Tracheobronchial Tree ◽  
Human Medicine ◽  
Feeding Tubes ◽  
Fatal Complications

ABSTRACT Provision of enteral nutrition via the use of nasoenteric feeding tubes is a commonly used method in both veterinary and human medicine. Although case reports in human medicine have identified fatalities due to misplacement of nasogastric (NG) tubes into the tracheobronchial tree and subsequent pneumothorax, there are no case reports, to our knowledge, of fatalities in veterinary patients. This case report describes two fatalities caused by misplaced NG tubes in intubated patients (one intraoperative, one postoperative). This report highlights risk factors for feeding tube complications and methods to prevent future fatalities such as two-view radiography, two-step insertion, capnography, laryngoscopic-assisted placement, and palpation of the NG tube in the stomach. The recent fatalities discussed within this case series demonstrate that deaths as a result of NG tubes misplaced into the tracheobronchial tree occur in veterinary patients, and measures should be taken to prevent this complication.

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