title: A new technique for bedside placement of enteral feeding tubes: a prospective cohort study.
abstract: BACKGROUND
  To accomplish early enteral feeding in the critically ill patient a new transnasal endoscopic approach to the placement of postpyloric feeding tubes by intensive care physicians was evaluated.
  
  
  METHODS
  This was a prospective cohort study in 27 critically ill patients subjected to transnasal endoscopy and intubation of the pylorus. Attending intensive care physicians were trained in the handling of the new endoscope for transnasal gastroenteroscopy for two days. A jejunal feeding tube was advanced via the instrument channel and the correct position assessed by contrast radiography. The primary outcome measure was successful postpyloric placement of the tube. Secondary outcome measures were time needed for the placement, complications such as bleeding and formation of loops, and the score of the placement difficulty graded from 1 (easy) to 4 (difficult). Data are given as mean values and standard deviation.
  
  
  RESULTS
  Out of 34 attempted jejunal tube placements, 28 tubes (82%) were placed correctly in the jejunum. The duration of the procedure was 28 ± 12 minutes. The difficulty of the tube placement was judged as follows: grade 1: 17 patients, grade 2: 8 patients, grade 3: 7 patients, grade 4: 2 patients. In three cases, the tube position was incorrect, and in another three cases, the procedure had to be aborted. In one patient bleeding occurred that required no further treatment.
  
  
  CONCLUSIONS
  Fast and reliable transnasal insertion of postpyloric feeding tubes can be accomplished by trained intensive care physicians at the bedside using the presented procedure. This new technique may facilitate early initiation of enteral feeding in intensive care patients.
authors.affiliation: Department of Anaesthesiology and Intensive Care Medicine, University Medical Centre Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße, 24105 Kiel, Germany. zick@anaesthesie.uni-kiel.de
authors.forename: Günther
authors.initials: G
authors.lastname: Zick
authors.forename: Alexander
authors.initials: A
authors.lastname: Frerichs
authors.forename: Markus
authors.initials: M
authors.lastname: Ahrens
authors.forename: Bodo
authors.initials: B
authors.lastname: Schniewind
authors.forename: Gunnar
authors.initials: G
authors.lastname: Elke
authors.forename: Dirk
authors.initials: D
authors.lastname: Schädler
authors.forename: Inéz
authors.initials: I
authors.lastname: Frerichs
authors.forename: Markus
authors.initials: M
authors.lastname: Steinfath
authors.forename: Norbert
authors.initials: N
authors.lastname: Weiler
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000379:methods*; D016099:Endoscopy, Gastrointestinal; D004750:Enteral Nutrition / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education*; D008875:Middle Aged; D019095:Point-of-Care Systems; D011446:Prospective Studies; D011708:Pylorus; D016896:Treatment Outcome