title: Jejunal feeding tubes can be efficiently and independently placed by intensive care unit teams.
abstract: BACKGROUND
  Nutrition support is an important therapeutic measure in critically ill patients. Several studies have shown that the enteral route is preferable to the parenteral route. Insertion of a feeding tube beyond the ligament of Treitz combined with continuous gastric drainage will reduce regurgitation and probably also the rate of nosocomial pneumonia. This study was conducted to assess the safety, success rate, and time required to establish jejunal nutrition by the fluoroscopy-guided technique in intensive care unit (ICU) patients.
  
  
  METHODS
  This was a prospective observational study in the ICUs of a 300-bed and a 600-bed community hospital. Indications were large gastric residuals during attempted gastric feeding, severe acute pancreatitis, or recurrent aspiration. Feeding tubes were introduced by the ICU staff at bedside under fluoroscopic guidance (a senior ICU physician and a resident or a registered ICU nurse). The correct jejunal position was documented by the application of a radiopaque contrast medium through the tube. After confirmation of the correct position, jejunal tube feeding was immediately started.
  
  
  RESULTS
  The insertion procedure in 38 patients lasted a median of 17 minutes. The median time from decision to place the tube until start of enteral feeding was 141 minutes. The success rate was 84.2%. No adverse events were observed.
  
  
  CONCLUSIONS
  Fluoroscopic placement of a jejunal feeding tube at the bedside is fast, is safe, and has a high success rate when performed by well-trained ICU staff. Using this method makes the ICU team more self-sufficient when critically ill patients require enteral nutrition and no gastroenterologist is available.
authors.affiliation: Medical ICU, Kantonsspital, St. Gallen, Switzerland. pascal.welpe@garagewelpe.ch
authors.forename: Pascal
authors.initials: P
authors.lastname: Welpe
authors.forename: Adrian
authors.initials: A
authors.lastname: Frutiger
authors.forename: Patrik
authors.initials: P
authors.lastname: Vanek
authors.forename: Gian-Reto
authors.initials: GR
authors.lastname: Kleger
mesh_terms: D000328:Adult; D000368:Aged; D016638:Critical Illness / Q000628:therapy*; D004750:Enteral Nutrition / Q000295:instrumentation / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D005766:Gastrointestinal Contents; D006801:Humans; D007362:Intensive Care Units; D007441:Intubation, Gastrointestinal / Q000295:instrumentation / Q000379:methods*; D007583:Jejunum; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis; D010348:Patient Care Team; D011446:Prospective Studies; D053120:Respiratory Aspiration; D013997:Time Factors; D016896:Treatment Outcome; D000078329:Workforce