Fluoroscopically guided nasoenteric feeding tube placement: results of a 1-year study.

Abstract

Nasoenteric tube feeding is a widely used alternative to parenteral intravenous nutritional support or gastrostomy tube placement. Unmonitored tube passage may result in complications and delays the beginning of tube feedings. The authors studied the results of 882 fluoroscopically guided feeding tube placements in 448 patients in 1 year to determine rates of success and complications, as well as the long-term outcome of this population of patients. Seven hundred sixty-four attempts (86.6%) were successful in positioning the tube distal to the third portion of the duodenum. Four major complications (three fatal arrhythmias and one tracheobronchial injury) were encountered. Only seven patients (2%) experienced aspiration events that were due to positioning of the tube in the distal duodenum. Seventy-seven percent of patients required either one or two tubes; the average "tube life" was 7.8 days. Most repositionings were required because of patient noncompliance or inappropriate administration of solid medications. Fluoroscopically guided nasoenteric tube passage is safe, easily performed, and highly successful, and has resulted in widespread clinical acceptance in our institution.

Progression rate of self-propelled feeding tubes in critically ill patients

“…The cause of the difficulty was pre-existent oropharyngeal trauma in a few patients, but in the majority of patients the cumbersome equipment present in the upper airways, and the high flexibility of the feeding tube were the only identifiable causes. Inadvertent passage of nasoenteric feeding tubes into the lung or pleural space has been described, especially in comatose patients [23,24]. That the high flexibility of the tube was a disadvantage is even more likely as the progression was better in patients with a tracheotomy compared with those with orotracheal tubes.…”

Endoscopic placement of nasojejunal feeding tubes in ICU patients

“…One advantage of fluoroscopic guidance is that tube positioning is confirmed and feeds can be initiated immediately. In addition, documented complications, including tracheobronchial misplacement and cardiac arrhythmias, are rare (0.4%) [6]. Disadvantages to the use of fluoroscopy include the need for a C-arm fluoroscope unit or travel to the radiology department.…”

Enteral feeding. Nasogastric, nasojejunal, percutaneous endoscopic gastrostomy, or jejunostomy: its indications and limitations

“…14 Placing nasoenteral feeding tubes postpylorically can be difficult. Spontaneous transpyloric passage of standard feeding tubes after 24 hours is only in the order of 30% and does not seem to be affected by tip profile or addition of a weight to the tip of the feeding tube.…”