title: A secure "double-check" technique of bedside post pyloric feeding tube placement using transnasal endoscopy.
abstract: Enteral feeding has become an important means of providing nutritional support to seriously ill patients. Placement of the feeding tube through the pyloric ring and past the ligament of Treitz into the proximal jejunum is critical to reduce the risk of gastroesophageal regurgitation and microaspiration. We started utilizing transnasal endoscopy for intestinal feeding tube placement, placing enteral tubes for 40 patients between March 2008 and February 2009. Although we achieved a high success rate comparable to previous reports, we experienced several cases of failure, which was corrected with repeated endoscopy. Based on these experiences, we modified our method by adding a "double-check" transnasal endoscopy through the other nasal passage. After April 2010, we have placed the feeding tube by "double-check" method for all patients (more than 40 patients) who required transnasal endoscopic feeding tube placement. We have not experienced any misplacement in all these patients after 24 h later with 100% successful rate since the introduction of "double-check" procedure. We describe our experience with "double-check" transnasal endoscopic feeding tube placement, which we found to be a helpful adjunct, for patients in intensive care unit.
authors.affiliation: Department of Emergency and Critical Care Medicine, Hyogo College of Medicine, 1-1, Mukogawa-cho, Nishinomiya, Hyogo 663-8501 Japan.
authors.forename: Atsunori
authors.initials: A
authors.lastname: Hashimoto
authors.forename: Munehiko
authors.initials: M
authors.lastname: Oya
authors.forename: Mika
authors.initials: M
authors.lastname: Iwano
authors.forename: Chisako
authors.initials: C
authors.lastname: Fuse
authors.forename: Tomoko
authors.initials: T
authors.lastname: Inoue
authors.forename: Taihei
authors.initials: T
authors.lastname: Yamada
authors.forename: Mariko
authors.initials: M
authors.lastname: Terashima
authors.forename: Takaaki
authors.initials: T
authors.lastname: Osako
authors.forename: Takahiro
authors.initials: T
authors.lastname: Ueda
authors.forename: Isamu
authors.initials: I
authors.lastname: Yamada
authors.forename: Atsunori
authors.initials: A
authors.lastname: Nakao
authors.forename: Joji
authors.initials: J
authors.lastname: Kotani