Bedside placement of transpyloric feeding tubes in the pediatric intensivecare unit using gastric insufflation

Objective: To test the effectiveness of gastric insufflation as an adjunct to placement of feeding tubes in the small bowel. Design: Prospective, randomized, controlled study. Setting: Pediatric intensive care unit in a tertiary children's hospital, Patients: A total of 50 children requiring enteral nutrition via a nasoente ral feeding tube in the small bowel. Interventions: An unweighted nasoenteral feeding tube attached to a three-w ay stopcock and a 60 mL syringe was inserted through the nares into the sto mach. After 10 mL/kg of air was injected, the tube was advanced a distance estimated to position the tip of the tube proximal to the pylorus, An addit ional 10 mL/kg of air was then injected, and the tube was advanced a distan ce needed to place the tube in the fourth part of the duodenum. In the cont rol group, feeding tubes were inserted through the nares and into the stoma ch. The tube was then advanced a distance estimated to place the tube in th e fourth part of the duodenum, No air was injected in the control group. Measurements and Main Results:When gastric insufflation was used, 23 of 25 feeding tubes were successfully placed in the small bowel on the first atte mpt compared with 11 of 25 in the control group (p = .001), Alt feeding tub es were successfully placed after two attempts in the gastric insufflation group compared with 18 of 25 in the control group (p < .001). The time betw een the first attempt at placement of a transpyloric feeding tube and the i nitiation of feeding was significantly shorter in the study group than in t he control group. There were no complications in either group. Conclusion: Gastric insufflation allows rapid placement of feeding tubes in to the small bowel with fewer attempts compared with a standard insertion t echnique in children.