Bedside Small Bowel Feeding Tube Placement in Critically III Patients Utilizing a Dietitian/Nurse Team Approach

Abstract

Background: To determine if a previously described protocol for small bowel feeding tube (SBFT) placement would be feasible for use in SurgicaUtraund burn intensive care population; if limiting the number of -professionals placing the tubes would achieve a sufficient success rate for cost effectiveness; and to determine the effectiveness of a certified nutrition support dietitian (CNSD)/clinical nurse specialist (CNS) team approach to tube placement. Alefltod: Prospective trial of bedside small bowel feeding tube placement by a CNSENSD team. The setting was a n university-affiliated surgicaUtrauma/burn intensive care unit. A total of 74 patients were included i n the study. Results: We successfully placed 64 of 74 (86.4%) SBFTs in our intensive care unit. The CNS successfully placed 32 of 38 tubes and the CNSD placed 32 of 36 tubes. Of the successfully placed tubes 41 (64%) were at or beyond the ligament of Treitz. Of the other 23 (36%)) 6 were in the second portion of the duodenum, 12 were in the third portion of the duodenum and 5 were in the fourth portion of the duodenum. Of physicians and nurses surveyed, 100% were more satisfied with bedside SBFT placement us fluoroscopy SBFT placement. Conclusions:Successful bedside placement of SBFT in a surgical/ traumdburn intensive care setting by a CNSDENS team approach is a feasible cost effective alternative to fluoroscopy SBFT placement.

Bedside Electromagnetic‐Guided Feeding Tube Placement: An Improvement Over Traditional Placement Technique?

“…9,10,22 Benefits to restricting tube placement to a small group of individuals is that placement success rates tend to be improved when a select group of clinicians place tubes frequently and use consistent techniques during the procedure. 9,10 Success reported from using other bedside feeding tube placement methods includes insufflating air, with a published success rate of 77%, 23 prokinetic agents (90%), 24 pH sensing tubes (81%), 25 "corkscrew" technique with air injection (90%), 26 external magnets (89%), 27 electromyography (80%), 28 or electrocardiography (60%).…”

Effect of gastrointestinal motility and feeding tube site on aspiration risk in critically ill patients: a review

“…42 Although a few hospitals have specially trained nurses or physicians to place small-bowel feeding tubes at the bedside, most hospitals that were surveyed do not use specially trained personnel. [46][47][48] When post-pyloric tube placement is desired, attempts may be made at the bedside to blindly manipulate the tube through the pylorus. Other times clinicians may place the tube in the stomach and wait for peristalsis to propel the tube downward (perhaps with the aid of metoclopramide or erythromycin).…”

Small‐Bowel Feeding Tube Placement at Bedside: Electronic Medical Device Placement and X‐Ray Agreement

“…When compared with less‐experienced clinicians, the experienced clinician's ability to interpret the combination of images from the EMPD and the clinical observations most likely lead to a higher rate of agreement. Previously, limiting the number of clinicians involved in the placement of a SBFT at bedside led to a higher success rate . Most placements in this study were completed in teams of 2, with 1 clinician as the primary leader of the tube placement.…”