title: A novel method of post-pyloric feeding tube placement at bedside.
abstract: OBJECTIVE
  Post-pyloric feeding tube placement is often difficult, and special equipment or peristalsis agents are used to aid insertion. Although several reports have described blind techniques for post-pyloric feeding-tube placement, no general consensus about method preference has been achieved.
  
  
  METHODS
  The technique is performed as follows: via the nostril, a stylet-tipped feeding tube is advanced about 70 cm; to confirm tip location to the right of the epigastric area, towards the right hypochondriac region, 5 mL shots of air are injected to enable touch detection of bubbling; finally, the tube is advanced to a length of 100 cm, during which the strength of bubbling seems to diminish under palpation.
  
  
  RESULTS
  We prospectively enrolled consecutive patients whose oral intake was expected to be difficult for 48 hours in the intensive care unit. Forty-one patients were enrolled and the rate of successful placement at first attempt was 95.1%. Mean duration for successful placement was 15 minutes.
  
  
  CONCLUSIONS
  With a novel technique, from the bedside, without special tools or drugs, we successfully placed post-pyloric feeding tubes. Essential points when inserting the tube are confirmation of the location of the tube tip by palpation of injected air, and to avoid deflection and looping.
authors.affiliation: Emergency and Critical Care Medicine, The University of Tokushima Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
authors.forename: Hisakazu
authors.initials: H
authors.lastname: Kohata
authors.forename: Nao
authors.initials: N
authors.lastname: Okuda
authors.forename: Emiko
authors.initials: E
authors.lastname: Nakataki
authors.forename: Taiga
authors.initials: T
authors.lastname: Itagaki
authors.forename: Mutsuo
authors.initials: M
authors.lastname: Onodera
authors.forename: Hideaki
authors.initials: H
authors.lastname: Imanaka
authors.forename: Masaji
authors.initials: M
authors.lastname: Nishimura
mesh_terms: D018806:APACHE; D000368:Aged; D015992:Body Mass Index; D003422:Critical Care / Q000379:methods*; D004750:Enteral Nutrition / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007441:Intubation, Gastrointestinal / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010173:Palpation; D011446:Prospective Studies; D011708:Pylorus
keywords: Enteral feeding; Intensive care unit; Palpation method; Post-pyloric feeding tube placement