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Related Experiment Videos

When does metoclopramide facilitate transpyloric intubation?

K Whatley, W W Turner, M Dey

    JPEN. Journal of Parenteral and Enteral Nutrition
    |November 1, 1984
    PubMed
    Summary

    Administering metoclopramide before feeding tube insertion significantly increases transpyloric intubation success in critically ill patients. However, metoclopramide given after intubation does not aid tube advancement.

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    Area of Science:

    • Critical Care Medicine
    • Gastroenterology
    • Clinical Pharmacology

    Background:

    • Postpyloric feeding may reduce aspiration and improve tolerance.
    • Duodenal intubation is challenging in critically ill patients due to gastric atony.
    • Metoclopramide is known to enhance gastric emptying.

    Purpose of the Study:

    • To evaluate the efficacy of metoclopramide in facilitating transpyloric (duodenal) intubation.
    • To compare the effectiveness of preinsertion versus postinsertion metoclopramide administration.

    Main Methods:

    • A pilot study assessed intravenous metoclopramide post-failed intubation.
    • A randomized prospective study compared preinsertion metoclopramide with placebo.
    • Weighted nasal feeding tubes were used in 10 critically ill adult patients.

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    Main Results:

    • Metoclopramide administered after failed intubation did not promote transpyloric passage.
    • Preinsertion metoclopramide resulted in immediate duodenal intubation in 4 out of 5 patients.
    • No control patients achieved spontaneous duodenal intubation (p = 0.048).

    Conclusions:

    • Preinsertion intravenous metoclopramide significantly improves the success rate of transpyloric feeding tube placement.
    • Postinsertion metoclopramide is ineffective for advancing feeding tubes past the pylorus.