title: Nonradiographic assessment of enteral feeding tube position.
abstract: OBJECTIVE
  To determine whether a clinical, nonradiographic criterion can be used to predict when the tip of a blindly placed feeding tube is in the small intestine.
  
  
  METHODS
  Prospective sample.
  
  
  METHODS
  Pediatric intensive care unit at a tertiary care children's hospital.
  
  
  METHODS
  Critically ill children requiring transpyloric feeding.
  
  
  METHODS
  The small bowel was intubated, using a blind, bedside transpyloric feeding tube placement protocol. The feeding tube was considered to be in the small bowel when <2 mL of a 10- mL aliquot of insufflated air could be aspirated from the feeding tube. This clinical criterion was confirmed with an abdominal radiograph.
  
  
  RESULTS
  Patient age ranged from 1 month to 19 yrs (median 6 months). Weight ranged from 2.2 to 60 kg (median 4.9). Median time to feeding tube placement was 10 mins (range 5 to 60). Eighty-nine percent of the patients were mechanically ventilated, while 28% of these patients were pharmacologically paralyzed. Seventy-five feeding tubes were inserted. There were no known complications. Ninety-nine (74/75) percent of the feeding tubes were positioned in the small bowel. The inability to aspirate insufflated air correctly predicted small bowel intubation with 99% certainty (Sequential Probability Ratio Test, p = .05 and power = .80). This test incorrectly predicted the position of only one feeding tube, the 26th, which was in the stomach. Of the 74 feeding tubes positioned in the small bowel, 13 feeding tubes were in the duodenum and 61 were in the jejunum.
  
  
  CONCLUSIONS
  The inability to aspirate insufflated air confirms the transpyloric position of a feeding tube. Other clinical criteria did not successfully predict small bowel intubation. Use of this single test may obviate confirmatory abdominal radiographs in carefully selected patients and may lead to more cost-effective and timely initiation of enteral feedings.
authors.affiliation: Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Harrison
authors.forename: B
authors.initials: B
authors.lastname: Clay
authors.forename: M J
authors.initials: MJ
authors.lastname: Grant
authors.forename: S V
authors.initials: SV
authors.lastname: Sanders
authors.forename: H F
authors.initials: HF
authors.lastname: Webster
authors.forename: J C
authors.initials: JC
authors.lastname: Reading
authors.forename: J M
authors.initials: JM
authors.lastname: Dean
authors.forename: M K
authors.initials: MK
authors.lastname: Witte
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D004750:Enteral Nutrition / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D011237:Predictive Value of Tests; D011446:Prospective Studies