Placement of feeding tubes using fluoroscopy guidance and over-the-wire technique: A technical review

Abstract

Nutritional support is essential for improving the outcome in critically ill patients. Enteral nutrition possesses advantages over total parenteral nutrition in that it maintains the physiologic barrier function of the gastrointestinal mucosa. Short-term enteral nutrition can be achieved through transnasal feeding tubes. Traditionally, feeding tubes have been placed at bedside in a blind fashion. However, blind tube placement is unreliable as it may result in improper positioning of the tubes. Numerous complications arising from misplacement have been reported in the literature. A number of modalities may be used in order to improve the accuracy and safety of transnasal feeding tube placement. Fluoroscopy is widely accepted for this purpose. Together with the use of water-soluble contrast media and over-the-wire technique, fluoroscopy-guided placement of nasogastric or nasojejunal feeding tubes offers a higher rate of technical success while decreasing procedure time as well as the incidence of procedure-related complications.

Accidental pneumothorax secondary to a malpositioned nasogastric tube in a patient presenting with acute ischaemic stroke

“…The risk of challenging or multiple NG tube placements is increased by patient factors including critical illness, altered mental status, non-cooperativeness and an impaired cough reflex [5] -factors which are not uncommon in the acute stroke patient cohort. Over the first eleven days of the patient's admission, NG tube malposition was confirmed by chest radiograph on eight occasions.…”

“…Over the first eleven days of the patient's admission, NG tube malposition was confirmed by chest radiograph on eight occasions. Given the increased risk, we suggest that any future NG tube insertion attempts for this patient should be performed under fluoroscopic guidance, which can provide real-time continuous visualisation of the tube as it passes through the pharynx and oesophagus into the stomach, reducing the risk of placement into the respiratory tree [5]. Another technique to prevent tracheobronchial NG tube insertion is Roubenoff and Ravich's two-step method [6].…”

Nasogastric/nasoenteric tube-related adverse events: an integrative review

“…The disadvantage is that it cannot be performed at the bedside, however, researchers reported that the success rate was 90% when using fluoroscopy guidance (92) .…”

A New Method to Detect Gastro-esophageal Reflux in Critically Ill Mechanically Ventilated Patients: A Clinical Proof of Concept Study

“…In addition in tube-fed patients, the process of tube insertion and accurate placement is of importance. Insertion of a Gastric Feeding Tube (GFT) can beperformed blindly at the bedside, by CO2 guided method [7], by Comtrack technique [8] or with magnetic , uoroscopic or endoscopic guidance into the stomach [9,10]. Although generally safe and effective, there is a wide spectrum of known complications.…”