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Bedside Methods for Transpyloric Feeding Tube Insertion in Hospitalized Children: A Systematic Review of Randomized
Heather Hawk1, Hector Valdivia2
1Oregon Health and Science University, School of Nursing, OR, United States of America.
Insights
Bedside transpyloric tube placement in children lacks a standard method. Gastric insufflation shows moderate efficacy and safety, and a trained team improves success, but more research is needed.
Area of Science:
- Pediatric critical care
- Gastroenterology
- Medical device technology
Background:
- Enteral nutrition is vital for hospitalized children, particularly those critically ill.
- Post-pyloric feeding tube placement is challenging, often requiring fluoroscopy and delaying nutrition.
- No standardized bedside method exists for pediatric transpyloric tube placement.
Purpose of the Study:
- To review and assess the efficacy of various bedside transpyloric tube placement methods in children.
- To identify potential best practices for improving tube insertion success and efficiency.
Main Methods:
- Systematic literature search for trials on bedside transpyloric tube placement in children (1 month to 18 years).
- Included studies evaluated gastric insufflation, prokinetic agents, pH-guided, and electromagnetic devices.
- Fourteen articles were included: 6 RCTs, 5 quasi-experimental, 3 cohort studies.
Main Results:
- Intervention protocols varied significantly across studies.
- Most interventions showed some efficacy, except erythromycin.
- Gastric insufflation was safe and moderately effective.
- A small, trained team positively impacted transpyloric tube insertion.
Conclusions:
- Research heterogeneity prevents clear best practice guidelines.
- Gastric insufflation is a safe and moderately effective method.
- High-quality studies with clear, single-variable protocols are needed.
- Further research on dedicated teams for this procedure is recommended.
Problem:
Enteral nutrition is a critical component of therapy for many hospitalized children. Some children, especially those with critical illness, require post-pyloric enteral nutrition, but placement of post-pyloric feeding tubes poses challenges, necessitating costly fluoroscopy procedures and delaying initiation of enteral nutrition. There is no established standard method for pediatric transpyloric tube placement at the bedside.
Eligibility Criteria:
We searched for trials that assessed the efficacy of methods for transpyloric tube placement at the bedside. Studies that evaluated gastric insufflation, prokinetic agents, pH guided devices, and electromagnetic devices with an objective of bedside transpyloric tube placement in children ages one month to 18 years were included.
Results:
After each author independently reviewed the search results, we agreed on fourteen articles for inclusion, consisting of six randomized controlled trials, five quasi-experimental studies, and three cohort studies. Intervention protocols varied, both within and between studies, with most trials incorporating more than one variable in the intervention.
Conclusions:
The heterogeneity of the research does not provide clear direction about best practices. All interventions demonstrated some efficacy, with the exception of erythromycin. Gastric insufflation, the most prevalent intervention studied, is safe and at least moderately effective. The research demonstrates the positive impact of a small, trained team of personnel for the insertion of a transpyloric tube.
Implications:
High quality studies with clear protocols evaluating a single variable are needed in order to establish a bedside transpyloric tube placement protocol. We recommend studies on the efficacy of a dedicated team for this procedure.
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