MOTILITY AGENTS FOR THE PLACEMENT OF WEIGHTED AND UNWEIGHTED FEEDING TUBES IN CRITICALLY ILL PATIENTS

Objective. To determine if successful attempts at feeding tube placeme nt into the small bowel could be increased with the use of a weighted end or by pre-treatment with a drug to increase gastric motility. Desi gn: A prospective randomized control study, double blinded for a drug study drug, in a population of critically ill patients. Setting: A 635 -bed acute care hospital in Philadelphia, Pennsylvania. Patients: Eigh ty-three patients in the critical care setting randomized into four gr oups receiving either parenteral normal saline (NS) 100 cc, erythromyc in (EMY) 200 mg, or metoclopramide (MET), 10 mg, 30 min prior to attem pted tube placement with either a weighted (WEI) (57 patients) or unwe ighted tube (UNW) (26 patients). Results: When analyzed for number of attempts prior to successful tube placement into the stomach there was a significant difference between the unweighted and weighted groups: 2.08+/-1.03 attempts vs 1.51+/-0.94, P less than or equal to 0.015. Du odenal migration at 24 h was demonstrated in three patients in the NS/ UNW group and in two patients in the NS/WEI group as compared to no pa tients in either the EMY/WEI or the MET/WEI groups (p less than or equ al to 0.025, Fisher's exact test). Conclusions: These data demonstrate that the use of weighted feeding tubes decreases the number of attemp ts required to achieve gastric intubation, but that motility agents gi ven prior to tube insertion do not augment advancement of the feeding tube beyond the stomach and may in fact hinder placement into the duod enum.