Feeding tube placement

Gastrostomy Operative placement of a new opening into the stomach, usually associated with feeding tube placement. 

Heiselman DE, Hofer, T, Vidovich RR. Enteral feeding tube placement success with intravenous metoclopramide administration in ICU patients. Chest 1995 107 1686-1688. 

Cone, L. C., Kagan, R. J., Gottschlich, M. M., Enhancing Patient Safety The Effect of Process Improvement on Bedside Fluoroscopy Time Related to Nasoduodenal Feeding Tube Placement in Pediatric Burn Patients, Journal of Burn Care Research, Vol. 30, No. 4,2009, pp. 1-6. 

Hirdes MM, Monkelbaan JF, Haringman JJ, van Oijen MG, Siersema PD, Pullens HJ, et al. Endoscopic clip-assisted feeding tube placement reduces repeat endoscopy rate results from a randomized controUed trial. Am J Gastroenterol August 2012 107(8) 1220-7. 

Araujo-Preza CE, Melhado ME, Gutierrez FJ et al. (2002) Use of capnometry to verify feeding tube placement. Crit Care Med 30 2255-2259... 

Positioning the tip of the feeding tube past the ligament of Treitz may be more effective than postpyloric placement in high-risk patients... 

EN can be administered through four routes, which have different indications, tube placement options, advantages, and disadvantages (Table 58-1). The choice depends on the anticipated duration of use and the feeding site (i.e., stomach versus small bowel). 

Patients unable to tolerate feeding directly into the stomach due to impaired gastric motility or for those at high risk of aspiration, feeding tube tip placement into the duodenum or jejunum may be indicated. When feeding into the small bowel, the continuous method of delivery via an infusion pump is required in order to enhance tolerance. 

The NG, OG, ND, and NJ tubes can be placed at the patient s bedside by trained medical personnel. However, greater skill is required to place the feeding tube beyond the pylorus at the bedside. Several techniques have been described in the literature to help facilitate bedside placement. The tip of the small-bore feeding tube can be inserted into the stomach and allowed to spontaneously pass into the duodenum. Tubes have been modified with various tip shapes, weights, and a stylet (wire placed in the tube to stiffen it) to facilitate transpyloric insertion. Many facilities do not allow the use of the stylet at the bedside, however, due to the risk of inadvertent tube place-... 

Kalliafas S, Choban PS, Ziegler D, et al. Erythromycin facilitates postpyloric placement of nasoduodenal feeding tubes in intensive care unit patients Randomized, double-blinded, placebo-controlled trial. JPEN J Parenter Enteral Nutt 1996 20 385-388. 

It might be expected that EN via tubes would have been used widely before the development of parenteral nutrition (PN) however, this was not actually the case. EN via tubes inserted down the mouth or nose into the stomach and also via rectal tubes was used occasionally in the decades before the development of PN in the 1960s.1 However, modern techniques for enteral access, both the placement of the tubes themselves and the materials for making pliable, comfortable tubes, had not yet been developed. Before the PN era, the formulas delivered by the tube route often were blenderized foods. The National Aeronautics and Space Administration effort in the United States in the 1960s led to the development of low-residue (monomeric) diets for astronauts. These diets were adapted for use in sick patients requiring EN. Nonvolitional feedings in patients who cannot meet nutritional requirements by oral intake thus include EN and PN these techniques are collectively known as specialized nutrition support (SNS). 

Figure 20-1. Growth chart, weight for length, for D.E.C. Note poor weight for length at 5 months before placement of gastrostomy tube (first arrow) and increased weight for length by 2 years 6 months, when she was admitted for metabolic studies and feeding therapies.

Tube packaging is particularly beneficial for protecting the component at a reasonable cost. Also, tubes are less likely than tape to cause problems feeding components into the placement machine. Of course, it is necessary to verify that the tube geometry is compatible with the feeder mechanism on the placement machine. The tube material should be sufficiently thick so as not to bend readily. Bending of tubes is the primary cause for the jamming of devices inside... 

This study has several limitations. First, the manometric technique cannot verify whether an NGT is placed in the stomach or more distal gastrointestinal tract, a critical consideration for enteral nutrition. The desired depth of NGT insertion was determined to just reach the stomach in this study. Therefore, when a nasointestinal tube is placed for administering jejunal feedings, the manometric technique may not be useful to verify the correct placement. Second,... 

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