ENDOSCOPIC NASOGASTRIC-JEJUNAL FEEDING TUBE PLACEMENT IN CRITICALLY ILL PATIENTS

Background: Historically, placement of small bowel nasoenteric feeding tubes in the critically ill patient has been difficult because of lac k of bedside fluoroscopy, inadequately designed endoscopic tubes, or f ailure of the tube to spontaneously pass into the duodenum following p lacement. Methods: We followed-up 54 consecutive critically ill patien ts who had a combined nasogastric-jejunal feeding tube placed at the b edside using a new endoscopic, nonfluoroscopic method of placement. Da ta were obtained on the placement procedure, outcomes, and complicatio ns that followed. Results: Tubes were successfully placed in 94% of th e patients in an average time of 12 minutes. Negative outcomes include d the following: inadvertent removal by patient or staff (21%), intole rance to tube feeding (14%), clogging (9%), kinking (6%), and cracking at the tube adapter (11%). The duration of the tube following placeme nt ranged from 1 to 42 days, with an average of 9 days. Conclusion: Th e combined tubes were easy to place endoscopically. The endoscopic, no nfluoroscopic method of placing feeding tubes can be performed at the bedside and allows for gastric decompression and enteral feeding to be rapidly and efficiently achieved, which is particularly useful for in tubated patients in an intensive care setting. Negative outcomes shoul d decrease by avoidance of inadvertent tube removal and by improved tu be maintenance and materials.