Motility agents for the placement of weighted and unweighted feeding tubes in critically ill patients

Abstract

These data demonstrate that the use of weighted feeding tubes decreases the number of attempts required to achieve gastric intubation, but that motility agents given prior to tube insertion do not augment advancement of the feeding tube beyond the stomach and may in fact hinder placement into the duodenum.

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

“…20 Conversely, several authors dispute the use of erythromycin as an effective prokinetic agent when used as an adjunct in the placement of NJ feeding tubes. 8,21 Before initiation of this study, it was our PICU policy that the nurse responsible for placing the NJ feeding tubes was the nurse caring for that patient at the time the order was written. The nurses had variable levels of experience and, subsequently, variable levels of success.…”

“…These include a "blind" bedside insertion, the use of weighted vs unweighted feeding tubes, 7 fluoroscopic placement, and the use of prokinetic agents such as metoclopramide or erythromycin. 8 Other novel approaches recently described include gastric insufflation, 9 -11 magnetic-assisted placement, 12 and a combination of other techniques coupled with electrocardiographic guidance. 13 A randomized controlled trial comparing the 3 most commonly used techniques has never been performed in critically ill children.…”

Clinical Costs of Feeding Tube Placement

“…Several bedside "blind" methods using specific placement techniques, weighted or nonweighted tubes, pH sensors, prokinetic agents, magnets, and bioelectrical detection devices have been reported, all with success rates of 80%-85%. [5][6][7] Although small-bore tubes are useful, their insertion can lead to serious complications, 8 and morbidity associated with feeding tube placement is now being appreciated. Because the tubes frequently have a metal stylet to facilitate passage, they can be accidentally directed into the airway in patients with altered gag or cough reflexes.…”

Chronic intestinal pseudo-obstruction

“…Erythromycin, and other macrolides, are motilin analogs and are potent prokinetics exerting stimulatory effects on gastric emptying, antral and duodenal contractility [72][73][74][75][76][77][78][79][80][81][82]. [74] or in facilitating enteric tube placement [76,78,80], there is also evidence for efficacy in more diffuse motor disorders and pseudo-obstruction [83][84][85][86][87][88][89][90][91]. The efficacy of macrolides in the distal small intestine and colon has not been established.…”