The learning curve in blind bedside postpyloric placement of spiral tubes: data from a multicentre, prospective observational study

Abstract

Objective This study sought to quantify the learning curve for the blind bedside postpyloric placement of a spiral tube in critically ill patients. Methods We retrospectively analysed 127 consecutive experiences of three intensivists who performed comparable procedures of blind bedside postpyloric placement of a spiral tube subsequent to failed self-propelled transpyloric migration in a multicentre study. Each intensivist’s cases were divided chronologically into two groups for analysis. The assessment of the learning curve was based on efficiency and safety outcomes. Results All intensivists achieved postpyloric placement for over 80% of their patients. The junior intensivist showed major improvement in both efficiency and safety outcomes, and the learning curve for both outcomes was approximately 20 cases. The junior intensivist showed a significant increase in the success rate of proximal jejunum placement and demonstrated a substantial decrease in the major adverse tube-associated events rate. The time to insertion significantly decreased in each intensivist as case experience accumulated. Conclusions Blind bedside postpyloric placement of a spiral tube involves a significant learning curve, indicating that this technique could be readily acquired by intensivists with no previous experience using an adequate professional training programme.

A Two-Stage Bedside Intubation Method to Improve Success Rate of Post-pyloric Placement of Spiral Nasoenteric Tubes in Critically Ill Patients: A Multi-Center, Prospective Study

“…On the other hand, prior to the implementation of this study, training program was conducted for all the operators, including a 60-min theoretical training and operational training program of intubation procedures. In addition, previous studies have found that significant improvements in the effectiveness of all trained operators and a significant reduction in adverse events among primary intensivists as increased operating experience ( 26 ). In general, operator experience played a significant role in the success and safety of post-pyloric tube placement, and a rigorous intensive training program ensured the implementation of our study.…”

“…Then, intensive training was given to all operators (ICU physicians and bedside nurses) involved in the study. Upon completion of the theoretical training, all operators were required to watch five tube placements and perform at least 5 procedures under the supervision of the above senior intensivist ( 26 ).…”

Efficacy and safety of a modified method for blind bedside placement of post-pyloric feeding tube: a prospective preliminary clinical trial

“…Notably, it is easier to gain the necessary expertise to perform the modified operation through training, which is conducive to its promotion. 37 …”

Is metoclopramide beneficial for the post-pyloric placement of nasoenteric tubes? A systematic review and meta-analysis of randomized controlled trials

“…Unfortunately, neither Silva's meta-analysis nor our results demonstrated the e cacy of metoclopramide, even though three RCTs were newly included in this updated meta-analysis. Several clinical heterogeneity deriving from participants (e.g., age, comorbidities, and concomitant medication) [28][29][30], operators (e.g., years of training, profession status, and educational degree of operators) [15,31], intervention (e.g., the timing of medication, the dosage of metoclopramide, and the type of feeding tube) [12][13][14][15][16][17][18], outcome assessment (e.g., the follow-up period and the assessment personnel) [12][13][14][15][16][17][18] and the like, as well as insu cient sample sizes, may be liable for failing to establish metoclopramide's bene cial effects.…”