NONRADIOGRAPHIC ASSESSMENT OF ENTERAL FEEDING TUBE POSITION

Objective: To determine whether a clinical, nonradiographic criterion can be used to predict when the tip of a blindly placed feeding tube i s in the small intestine, Design: Prospective sample, Setting: Pediatr ic intensive care unit at a tertiary care children's hospital,Patients : Critically ill children requiring transpyloric feeding, intervention s: The small bowel was intubated, using a blind, bedside transpyloric feeding tube placement protocol, The feeding tube was considered to be in the small bowel when <2 mt of a 10-mL aliquot of insufflated air c ould be aspirated from the feeding tube, This clinical criterion was c onfirmed with an abdominal radiograph, Measurements and Main Results: Patient age ranged from 1 month to 19 yrs (median 6 months), Weight ra nged from 2.2 to 60 kg (median 4.9), Median time to feeding tube place ment was 10 mins (range 5 to 60), Eighty nine percent of the patients were mechanically ventilated, white 28% of these patients were pharmac ologically paralyzed, Seventy-five feeding tubes were inserted, There were no known complications, Ninety-nine (74/75) percent of the feedin g tubes were positioned in the small bower, The inability to aspirate insufflated air correctly predicted small bowel intubation with 99% ce rtainty (Sequential Probability Ratio Test, p =.05 and power = .80), T his test incorrectly predicted the position of only one feeding tube, the 26th, which was in the stomach, Of the 74 feeding tubes positioned in the small bowel, 13 feeding tubes were in the duodenum and 61 were in the jejunum, Conclusions: The inability to aspirate insufflated ai r confirms the transpyloric position of a feeding tube, Other clinical criteria did not successfully predict small bowel intubation, Use of this single test may obviate confirmatory abdominal radiographs in car efully selected patients and may lead to more cost-effective and timel y initiation of enteral feedings.