title: Bedside videoscopic placement of feeding tubes: development of fiberoptics through the tube.
abstract: OBJECTIVE
  Transpyloric small intestine feeding tube placement can be difficult and tedious. Currently accepted techniques are associated with disadvantages and risk. The purpose of this study is to describe the development of a new technique: bedside videoscopic placement using fiberoptics through the tube.
  
  
  METHODS
  Prospective, descriptive case study.
  
  
  METHODS
  Intensive care unit in a teaching hospital.
  
  
  METHODS
  Subjects were divided into two groups: a) group 1: eight healthy volunteers (seven male, one female); b) group 2: nine critically ill patients (six male, three female; eight of these patients were intubated).
  
  
  METHODS
  Standard 12-Fr (4.0-mm) feeding tubes (n = 19) were placed. Two patients from group 2 had feeding tubes placed on two separate occasions. 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.
  
  
  RESULTS
  We visualized 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. Transpyloric tube placement was confirmed videoscopically (n = 19) and radiographically (n = 18). In three subjects from group 1, the feeding tube entered the first part of the duodenum, while, in the remainder of the subjects, the tube passed into or beyond the second portion of the duodenum. In eight (73%) of 11 attempts on the nine critically ill patients from 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 43 mins (mean 18 +/- 12 [SD]). The feeding tubes remained in place 10 +/- 4 days and patients met their estimated caloric needs within 24 hrs. Residual volumes of nutrition in the small bowel were < 5 mL. There were no documented episodes of aspiration.
  
  
  CONCLUSIONS
  This new technique has the potential for rapid, accurate, and safe feeding tube placement in patients requiring nutritional support.
authors.affiliation: Department of Medicine, Madigan Army Medical Center, Tacoma, WA 98431-5000, USA.
authors.forename: K W
authors.initials: KW
authors.lastname: Grathwohl
authors.forename: R V
authors.initials: RV
authors.lastname: Gibbons
authors.forename: T A
authors.initials: TA
authors.lastname: Dillard
authors.forename: J D
authors.initials: JD
authors.lastname: Horwhat
authors.forename: B J
authors.initials: BJ
authors.lastname: Roth
authors.forename: J W
authors.initials: JW
authors.lastname: Thompson
authors.forename: P A
authors.initials: PA
authors.lastname: Cambier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000628:therapy; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004750:Enteral Nutrition / Q000295:instrumentation / Q000379:methods*; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010362:Patients' Rooms; D010865:Pilot Projects; D011446:Prospective Studies; D014741:Video Recording