Bedside post-pyloric tube placement using direct visualisation in mechanically ventilated patients: A single centre...

Post-pyloric feeding tubes are used for intensive care patients unable to tolerate gastric feeding. The Kangaroo Feeding Tube with IRIS Technology ('IRIS') uses real-time visualisation of anatomical markers to guide bedside placement, however limited studies currently explore post-pyloric insertions in mechanically ventilated patients. We describe a case series of 'IRIS' post-pyloric placements performed by trained intensivists and dietitians.

This was a prospective, single-centred clinical effectiveness study of mechanically ventilated adults referred for bedside post-pyloric tube placement between May 2020 and May 2021. The feasibility, success rates, anatomical visualisation using 'IRIS' and nutritional outcomes were documented.

Twelve patients were included in total. The primary indication for post-pyloric placement was gastric feeding intolerance, with a median of 3.5 (IQR 0-6) days with inadequate nutrition prior to placement. All tubes were inserted within 24 h of referral as there was always a trained clinician available. Post-pyloric placement was successful for 9/12 patients (75%), as identified on the 'IRIS' console and X-ray confirmation. Only 3 (25%) patients required parenteral nutrition (mean duration 4 [SD 1] days). Respiratory misplacement occurred in 1 patient (8%) and was clearly differentiated from gastrointestinal anatomy, permitting early removal. Although duodenal placement was possible, no tubes reached the jejunum solely using the 'IRIS' method.

Post-pyloric tube placement using 'IRIS' in mechanically ventilated patients was feasible, successful and safe, resulting in reduced durations with inadequate enteral nutrition. Further, larger-scale studies are required to confirm these findings and explore the effectiveness of 'IRIS' in achieving deep small-intestinal placement.