Evaluation of a Nasoenteral Feeding Tube With Balloon to Facilitate Placement

Abstract

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.

Development of a Competency Model for Placement and Verification of Nasogastric and Nasoenteric Feeding Tubes for Adult Hospitalized Patients

“…An x-ray is then obtained 12-24 h post placement to determine location. 36 In an initial study of 50 patients with this tube, 70% of the tubes were placed in the small bowel with a mean placement time of 7.3 (range, 2-20) min. One inadvertent tracheal placement was prevented using this technique.…”

“…One inadvertent tracheal placement was prevented using this technique. 36 Emerging technologies for determining feeding tube tip location include new pH devices. RightSpot pH indicator (RightBio Metrics, www.rightbiometrics.com) is an in vitro diagnostic pH test to confirm gastric placement of the tube tip.…”

“…The balloon is then inflated in the stomach in order to passively assist with postpyloric migration. An x‐ray is then obtained 12–24 h post placement to determine location 36 . In an initial study of 50 patients with this tube, 70% of the tubes were placed in the small bowel with a mean placement time of 7.3 (range, 2–20) min.…”

A multifaceted comparative analysis of image and video technologies in gastrointestinal endoscope and their clinical applications

“…Balloon-assisted endoscopy is a minimally invasive technique used to place NJ feeding tubes, which are used to provide nutrition to patients who are unable to eat or digest food normally. This technique involves the use of a small, flexible endoscope equipped with a balloon at its tip, which is used to navigate the endoscope through the small intestine ( 68 , 69 ). Once the endoscope reaches the desired location in the small intestine, the feeding tube can be inserted through a channel in the endoscope and advanced into the intestine.…”

Reducing Lung Injury from Blind Insertion of Small-Bore Feeding Tubes

“…Some of these patients may be intubated or sedated, have a decreased level of consciousness, or have a diminished gag reflex, all of which may predispose them to aspiration 8. Accidental feeding tube insertion into the trachea is also relatively common in such patients 3…”