BEDSIDE VIDEOSCOPIC PLACEMENT OF FEEDING TUBES - DEVELOPMENT OF FIBEROPTICS THROUGH THE TUBE

Objective: Transpyloric small intestine feeding tube placement can be difficult and tedious, Currently accepted techniques are associated wi th disadvantages and risk. The purpose of this study is to describe th e development of a new technique: bedside videoscopic placement using fiberoptics through the tube, Design: Prospective, descriptive case st udy, Setting: Intensive care unit in a teaching hospital, Patients: Su bjects were divided into two groups: a) group 1: eight healthy volunte ers (seven male, one female); b) group 2: nine critically ill patients (six male, three female; eight of these patients were intubated). int erventions: Standard 12-Fr (4.0-mm) feeding tubes (n=19) were placed, Two patients from group 2 had feeding tubes placed on two separate occ asions. The feeding tubes were inserted by the oral (n=8) or nasal (n= 11)route under direct vision, using a 6.7-Fr (2.2-mm) fiberoptic scope through the feeding tube. Measurements and Main Results: We visualize d enteric structures clearly through the feeding tube in all subjects and patients. Based on visual landmarks, we advanced the feeding tube through the pylorus and into the duodenum in all individuals. Transpyl oric tube placement was confirmed videoscopically (n=19)and radiograph ically (n=18). In three subjects from group 1, the feeding tube entere d the first part of the duodenum, while, in the remainder of the subje cts, the tube passed into or beyond the second portion of the duodenum , In eight (73%) of 11 attempts on the nine critically ill patients fr om group 2, the feeding tubes were advanced to the distal duodenum or jejunum. The time required for placement in group 2 ranged from 2 to 4 3 mins (mean 18+/-12 [SD]). The feeding tubes remained in place 10+/-4 days and patients met their estimated caloric needs within 24 hrs. Re sidual volumes of nutrition in the small bowel were <5 mt. There were no documented episodes of aspiration, Conclusion: This new technique h as the potential for rapid, accurate, and safe feeding tube placement in patients requiring nutritional support.