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Bedside Placement of Nasoenteric Feeding Tubes Using Fluoroscopic Guidance by Trained Mid-level Practitioners

  • Richard G. Barton
  • Tricia B. Hauschild
  • Katy Y. Fu
  • Mary C. Mone
  • Edward J. Kimball
  • Raminder Nirula
Reference work entry

Abstract

A variety of methods for the placement of nasoenteric feeding tubes in critically ill patients have been reported. These methods include blind placement by nurses, endoscopic placement by gastroenterologists and placement under fluoroscopic guidance by interventional radiologists. We provide procedural details and report our experience with placement of nasoenteric feeding tubes at the bedside, using fluoroscopic guidance, by trained mid-level practitioners.

In this chapter we have reviewed our previously published results (Hauschild et al. 2012). Trained nurse practitioners placed 632 nasoenteric feeding tubes at the bedside, under fluoroscopic guidance, in 462 patients. The majority of these patients were mechanically ventilated. The vast majority (97 %) of tubes were placed distal to the pylorus. Mean fluoroscopy time was 0.7 ± 1.2 min, and the mean procedure time was 7.0 ± 5.1 min. All tubes were placed within 24 h of request. There were no complications. Institutional charges for feeding tube placement were $149 for nurse practitioners, $226 for gastroenterologists, and $328 for interventional radiologists.

Bedside placement of nasoenteric feeding tubes in critically ill patients under fluoroscopic guidance by trained mid-level practitioners is safe, effective, timely, and may be less costly compared to tubes placed by gastroenterologists or interventional radiologists.

Keywords

Nurse Practitioner Feeding Tube Fluoroscopic Guidance Tube Placement Interventional Radiology Suite 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

List of Abbreviations

cm

Centimeters

CPT

Current procedural terminology

mg

Milligrams

References

  1. Baskin WN. Acute complications associated with bedside placement of feeding tubes. Nutr Clin Pract. 2006;21:40–55.CrossRefPubMedGoogle Scholar
  2. Braunschweig CL, Levy P, Sheean PM, et al. Enteral compared with parenteral nutrition: a meta-analysis. Am J Clin Nutr. 2001;74:534–42.PubMedGoogle Scholar
  3. Cerra FB, Benitez MR, Blackburn GL, et al. Applied nutrition in ICU patients. A consensus statement of the American College of Chest Physicians. Chest. 1997;111:769–78.CrossRefPubMedGoogle Scholar
  4. Cohn SM, Price MA, Villarreal CL. Trauma and surgical critical care workforce in the United States: a severe surgeon shortage appears imminent. J Am Coll Surg. 2009;209:446–52.CrossRefPubMedGoogle Scholar
  5. Davies AR, Froomes PR, French CJ, et al. Randomized comparison of nasojejunal and nasogastric feeding in critically ill patients. Crit Care Med. 2002;30:586–90.CrossRefPubMedGoogle Scholar
  6. Fang JC, Hilden K, Holubkov R, et al. Transnasal endoscopy vs. fluoroscopy for the placement of nasoenteric feeding tubes in critically ill patients. Gastrointest Endosc. 2005;62:661–6.CrossRefPubMedGoogle Scholar
  7. Foote JA, Kemmeter PR, Prichard PA, et al. A randomized trial of endoscopic and fluoroscopic placement of postpyloric feeding tubes in critically ill patients. J Parenter Enter Nutr. 2004;28:154–7.CrossRefGoogle Scholar
  8. Hauschild TB, Fu KY, Hipwell RC, et al. Safe, timely, convenient, and cost-effective: a single-center experience with bedside placement of enteral feeding tubes by midlevel providers using fluoroscopic guidance. Am J Surg. 2012;204:958–62.CrossRefPubMedGoogle Scholar
  9. Heyland DK. Nutritional support in the critically ill patients. A critical review of the evidence. Crit Care Clin. 1998;14:423–40.CrossRefPubMedGoogle Scholar
  10. Heyland DK, Drover JW, MacDonald S, et al. Effect of postpyloric feeding on gastroesophageal regurgitation and pulmonary microaspiration: results of a randomized controlled trial. Crit Care Med. 2001;29:1495–501.CrossRefPubMedGoogle Scholar
  11. Heyland DK, Drover JW, Dhaliwal R, et al. Optimizing the benefits and minimizing the risks of enteral nutrition in the critically ill: role of small bowel feeding. J Parenter Enter Nutr. 2002;26 Suppl 6:51–7.CrossRefGoogle Scholar
  12. Jabbar A, McClave SA. Pre-pyloric versus post-pyloric feeding. Clin Nutr. 2005;24:719–26.CrossRefPubMedGoogle Scholar
  13. Kudsk KA. Beneficial effect of enteral feeding. Gastrointest Endosc Clin N Am. 2007;17:647–62.CrossRefPubMedPubMedCentralGoogle Scholar
  14. Kudsk KA, Croce MA, Fabian TC, et al. Enteral versus parenteral feeding. Effects on septic morbidity after blunt and penetrating abdominal trauma. Ann Surg. 1992;215:503–11.CrossRefPubMedPubMedCentralGoogle Scholar
  15. Marderstein EL, Simmons RL, Ochoa JB. Patient safety: effect of institutional protocols on adverse events related to feeding tube placement in the critically ill. J Am Coll Surg. 2004;199:39–47.CrossRefPubMedGoogle Scholar
  16. Marik PE, Zaloga GP. Early enteral nutrition in acutely ill patients: a systematic review. Crit Care Med. 2001;29:2264–70.CrossRefPubMedGoogle Scholar
  17. Marik PE, Zaloga GP. Gastric versus post-pyloric feeding: a systematic review. Crit Care. 2003;7:R46–51.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Montejo JC, Grau T, Acosta J, et al. Multicenter, prospective, randomized, single-blind study comparing the efficacy and gastrointestinal complications of early jejunal feeding with early gastric feeding in critically ill patients. Crit Care Med. 2002;30:796–800.CrossRefPubMedGoogle Scholar
  19. Moore FA, Feliciano DV, Andrassy RJ, et al. Early enteral feeding, compared with parenteral, reduces postoperative septic complications. The results of a meta-analysis. Ann Surg. 1992;216:172–83.CrossRefPubMedPubMedCentralGoogle Scholar
  20. Sorokin R, Gottlieb JE. Enhancing patient safety during feeding-tube insertion: a review of more than 2,000 insertions. J Parenter Enter Nutr. 2006;30:440–5.CrossRefGoogle Scholar
  21. Welpe P, Frutiger A, Vanek P, et al. Jejunal feeding tubes can be efficiently and independently placed by intensive care unit teams. J Parenter Enter Nutr. 2010;34:121–4.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Richard G. Barton
    • 1
  • Tricia B. Hauschild
    • 1
  • Katy Y. Fu
    • 1
  • Mary C. Mone
    • 1
  • Edward J. Kimball
    • 1
  • Raminder Nirula
    • 1
  1. 1.Department of Surgery, Division of General SurgeryUniversity of Utah Health Sciences CenterSalt Lake CityUSA

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