Ultrasound-guided Bedside Placement of Nasojejunal Feeding Tubes for Critically Ill Patients

In critically ill patients, postpyloric feeding via a nasojejunal (NJ) tube is essential for those at high risk of aspiration. However, traditional blind insertion techniques are associated with high failure rates and complications. This study aims to establish a standardized, bedside ultrasound-guided protocol for NJ tube placement to enhance safety and efficacy. The procedure involves real-time tracking of the NJ tube from the esophagus to the jejunum using both linear and curvilinear probes. Key technical steps include pre-procedural assessment of the gastric antral area and motility, cervical verification, and dynamic guidance through the pylorus. The protocol identifies specific sonographic markers for confirmation: the 'Double-Track Sign' serves as the static indicator of tube presence in the gastrointestinal tract, while the dynamic 'Cloud Sign' confirms tube patency and tip location. Real-time visualization enables immediate correction of complications, such as pharyngeal coiling or tracheal deviation. The method facilitates passage through the pylorus by synchronizing advancement with peristalsis. Ultrasound-guided NJ tube placement provides a bedside, radiation-free approach for visualizing tube trajectory and identifying malposition during the procedure. This protocol article presents representative sonographic findings during NJ tube progression; comparative outcomes such as first-attempt success rate, procedure time, and adverse event rates were not evaluated.