Bedside transpyloric tube placement in the pediatric intensive care unit: a modified insufflation air technique

Abstract

The gastric insufflation technique required no expensive equipment, minimal training, and consistently allowed transpyloric passage of feeding tubes. The use of 10 ml/kg air may significantly improve the rate of success without increasing risks.

A Randomized Controlled Trial Comparing Three Different Techniques of Nasojejunal Feeding Tube Placement in Critically Ill Children

“…Gastric insufflation in the pediat- ric critical care population has also been studied, with success rate varying between 86% and 100%. 10,11 Several studies have evaluated the use of prokinetic agents to facilitate the intubation of the small bowel. The 2 most frequently reported medications are metoclopramide and erythromycin.…”

How to Promote Bedside Placement of the Postpyloric Feeding Tube

“…A total of 545 citations were identified from the literature search. Fourteen studies 5 ‐ 7 , 20 ‐ 30 involving 753 patients met our inclusion criteria. The other studies were excluded for various reasons (Figure 1).…”

“…Of the 14 included studies, 10 studies enrolled adult patients 7 , 20 ‐ 26 , 28 , 30 and 4 enrolled pediatric patients 5 , 6 , 27 , 29 . The study population comprised critically ill patients in 10 studies 5 ‐ 7 , 20 , 24 ‐ 29 and non–critically ill patients in 4 studies 21 . ‐ 23 , 30 The follow‐up time after initial placement varied from 30 minutes to 48 hours.…”

“…‐ 23 , 30 The follow‐up time after initial placement varied from 30 minutes to 48 hours. Two studies aimed at placing the postpyloric tube in the jejunum, 29 , 30 and 7 studies aimed at placing the postpyloric tube in the duodenum 5 , 7 , 20 , 21 , 24 ‐ 26 ; the other 5 studies did not specify the exact targeted location of the postpyloric tube 6 , 22 , 23 , 27 , 28 . The details of the study characteristics are summarized in Table 1.…”

“…Prokinetic agents and gastric air insufflation are the most commonly used techniques. Several reports have described the use of these methods as an aid to placement of transpyloric feeding tubes 5 , 6 . However, the success rate of beside placement methods for postpyloric enteral feeding tubes varies, especially between adult and pediatric patients.…”