Chest
Volume 100, Issue 6, December 1991, Pages 1643-1646
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Clinical Investigations in Critical Care
Bedside Method for Placing Small Bowel Feeding Tubes in Critically III Patients: A Prospective Study

https://doi.org/10.1378/chest.100.6.1643Get rights and content

Enteral delivery of nutrients is important for optimal treatment of critically ill patients. It maintains gut digestive and barrier functions, decreases gut bacterial translocation, decreases the incidence of sepsis, and improves outcome. Gastric emptying is impaired in many critically ill patients and feeding into a gastroparetic stomach leads to large gastric residuals and aspiration. We describe a simple bedside technique for placement of small bowel feeding tubes. Using this technique, we successfully placed 213/231 (92 percent) of feeding tubes in critically ill patients. Three percent were in the first portion of the duodenum, 25 percent in the second portion, 47 percent in the third portion, and 17 percent in the proximal jejunum. The average time for placement of small bowel feeding tubes was 40± 14 min (mean ± SD). Abdominal roentgenograms failed to properly locate 13 (6 percent) tubes. The most accurate and cheapest methods for confirming small bowel location of feeding tubes were bile aspiration, pH change from acidic to basic, and blue dye injection.

Section snippets

Patients

We established a “feeding tube placement” service in our intensive care unit (ICU) in 1987. We report herein the results of 231 consecutive requests for bedside placement of a duodenal feeding tube between November 1987 and October 1990. These requests included patients admitted to the trauma (30 percent), general surgery (15 percent), cardiac surgery (15 percent), neurosurgery (20 percent), and internal medicine (20 percent) services. The majority of patients (95 percent) were intubated at the

RESULTS

We attempted 231 bedside small bowel feeding tube placements and were successful in 213 (92 percent). Seven (3 percent) were placed into the first portion of the duodenum, 57 (25 percent) into the second portion of the duodenum, 109 (47 percent) into the third portion of the duodenum, and 40 (17 percent) into the proximal jejunum (Table 1). The average time to place the feeding tubes was 40 ±14 min (mean ± SD). We failed to enter the small bowel in 18 attempts (8 percent). These tubes were

DISCUSSION

We describe a method for placing feeding tubes into the small bowel at the bedside. A similar technique was first described by Thurlow6 in patients in the surgery ward. This technique is simple but requires some training and experience. Once mastered, however, it is highly effective (92 percent). We have taught this technique to our house officers. Most are achieving placement of 70 to 80 percent.

This bedside technique is very safe. We have monitored oxygenation using pulse oximeters in most

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Manuscript received February 19; revision accepted June 18.

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