Evaluation of a bedside technique for postpyloric placement of feeding catheters

To establish the success rate, time taken and expertise required to place a feeding catheter into the small intestine using a device that permits real-time localisation of the catheter through detection of an electromagnetic field.

Prospective observational study.

A tertiary, mixed medical-surgical, adult intensive care unit, between February 2008 and February 2009.

60 attempts at postpyloric intubation by eight clinicians (consultant and trainee intensivists and a dietitian) in 57 critically ill patients who were undergoing mechanical ventilation and were receiving, or suitable to receive, enteral nutrition.

Patients were classified into an initial group (10 patients), who had the catheter placed by a single clinician to establish the most effective technique, and a subsequent group (50 patients), who had the catheter placed by any of the eight clinicians. Catheter position was confirmed on abdominal x-ray by an independent radiologist.

Postpyloric catheter placement was successful in 56/60 attempts (93%), in 54/57 patients (95%), with a median time to placement of 7.2 min (interquartile range [IQR], 4.3-12.5 min). In the initial group, placement was successful in 7/10 attempts (70%), with a median time to placement of 20.8 min (IQR, 9.5-32.3 min), compared with 49/50 attempts (98%) and a median time of 5.9 min (IQR, 3.9-11.9 min) in the subsequent group (P = 0.003).

An electromagnetically guided device enabled reliable and rapid bedside placement of small intestinal feeding catheters. Proficiency with the technique was quickly developed and successfully disseminated to a range of clinicians.