title: Placement of nasoenteral feeding tubes using external magnetic guidance.
abstract: BACKGROUND
  Enteral feeding is preferred over parenteral methods, and feeding into the duodenum is preferred over gastric feeding in certain groups of critically ill patients. However, with current techniques, feeding tubes often coil in the stomach, exposing patients to the risk of aspiration. This study investigated whether a nasoenteral feeding tube can be guided beyond the pyloric sphincter, using external magnetic guidance.
  
  
  METHODS
  This is a case series of 288 critically ill patients who needed placement of an enteral feeding tube, carried out in the intensive care units and wards of a university-affiliated community hospital. A 12-French polyurethane nasoduodenal feeding tube was modified by placing a small magnet in the distal tip. After inserting the tube through the nares into the esophagus, an external magnet was used to draw the tube tip beyond the pyloric sphincter and further into the duodenum or jejunum. Placement was verified by plain abdominal x-ray, and the depth of insertion (stomach, proximal duodenum, distal duodenum, or jejunum) was recorded.
  
  
  RESULTS
  Three hundred twenty-nine intubations were performed in 288 patients (mean procedure time 15 minutes). In 293 cases (89.1%), the tube was placed beyond the pyloric sphincter. In 139 insertions (42.2%), the tube tip was in the distal portion of the duodenum or the jejunum. There were no significant complications.
  
  
  CONCLUSIONS
  This case series demonstrates that external magnetic guidance achieves transpyloric placement of an enteral feeding tube in 89.1% of cases. This reliable bedside technique is superior to other methods described in the literature.
authors.affiliation: Department of Family Medicine, Mercer University School of Medicine, and the Medical Center of Central Georgia, Macon, Georgia 31207-0001, USA. gabriel_sa@mercer.edu
authors.forename: Sabry A
authors.initials: SA
authors.lastname: Gabriel
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Ackermann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000628:therapy*; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000295:instrumentation* / Q000379:methods*; D008280:Magnetics / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D011708:Pylorus; D011860:Radiography, Abdominal; D015203:Reproducibility of Results; D012449:Safety