AIR INSUFFLATION TECHNIQUE OF ENTERAL TUBE INSERTION - A RANDOMIZED, CONTROLLED TRIAL

Objective: To test air insufflation as an adjunct to placement of ente ral feeding tubes. Design: Prospective, randomized study. Setting: Int ensive care unit in a tertiary hospital. Subjects: Sixty-four consecut ive patients requiring enteral nutrition, in whom a decision to insert a nasoenteral feeding tube was made. Interventions: A 12-Fr feeding t ube was inserted to the level of the fundus of the stomach. A 60-mL sy ringe was used to pump 500 mt of air into the stomach. The tube was th en advanced. An abdominal flat plate was obtained within 2 hrs of comp letion of the procedure and the tube position noted. If the tube was n ot in the duodenum, the patient was placed on a promotility agent and a repeat radiograph was performed the next day. The technique varied f rom our control technique only by the instillation of air. Measurement s and Main Results: Using the study technique, 21 of 32 tubes were suc cessfully placed, as seen on the initial radiograph, in our study pati ents compared with only 12 of 34 tubes in our control patients (p <.02 ). In addition, the success rate at 24 hrs was 25 of 32 vs. 16 of 34 ( p<.02). Only 3 of 21 tubes placed in the antrum, body, or fundus of th e stomach advanced to the duodenum the following day, compared with 5 of 12 tubes initially placed in the pylorus (p <.075). No complication s were noted. Conclusion: Instilling air into the stomach may facilita te the ability to get the feeding tube to the level of the pylorus, at which point it is more likely to advance into the duodenum and beyond .