title: Rapid placement of transpyloric feeding tubes: a comparison of pH-assisted and standard insertion techniques in children.
abstract: OBJECTIVE
  To compare transpyloric feeding tube placement using a pH-assisted placement technique versus a standard placement technique in pediatric patients requiring enteral nutrition.
  
  
  METHODS
  Critically ill children younger than 4 years were prospectively and randomly assigned to either a pH-assisted or a standard feeding tube placement group. Identical pH-assisted feeding tubes were used in both groups; however, feeding tubes in the standard group were not attached to a portable pH meter. Successful transpyloric placement was confirmed by radiography before beginning feedings. If placement was not successful, a second placement attempt was made after metoclopramide administration. Information regarding tube placement success, number of radiographs, time to initiation of feedings, and daily caloric intake was collected. A cost comparison between the two groups was performed.
  
  
  RESULTS
  Thirty-four patients were enrolled in the pH-assisted group, and 34 were enrolled in the standard feeding tube group. Ninety-seven percent of patients in the pH-assisted group had successful placement after the first attempt, compared with 53% of patients in the standard group. The average time to successful placement of pH-assisted feeding tubes was 6 minutes. All patients in the pH-assisted group had successful placement after the second attempt, compared with 78% of patients in the standard group. A pH of greater than 5.6 accurately predicted transpyloric placement in 97% (33 of 34) of individuals in the pH-assisted group. Children in the pH-assisted group required significantly fewer radiographs than those in the standard group. Hospital costs were $114 per patient in the pH-assisted group and $135 per patient in the standard group.
  
  
  CONCLUSIONS
  Our findings indicate that bedside transpyloric placement of pH-assisted feeding tubes can be accomplished rapidly and with a high success rate. This method is associated with decreased radiation exposure and economic savings when compared with a standard placement technique.
authors.affiliation: Division of Critical Care Medicine, Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
authors.forename: B
authors.initials: B
authors.lastname: Krafte-Jacobs
authors.forename: M
authors.initials: M
authors.lastname: Persinger
authors.forename: J
authors.initials: J
authors.lastname: Carver
authors.forename: L
authors.initials: L
authors.lastname: Moore
authors.forename: R
authors.initials: R
authors.lastname: Brilli
mesh_terms: D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D002149:Energy Intake; D004750:Enteral Nutrition / Q000191:economics / Q000295:instrumentation; D005260:Female; D017721:Hospital Costs; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007441:Intubation, Gastrointestinal / Q000191:economics / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D011708:Pylorus / Q000000981:diagnostic imaging; D011859:Radiography; D013997:Time Factors