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Nasojejunal feeding tube placement in children: four-year cumulative experience
R S Pobiel1, G S Bisset, M S Pobiel
1Department of Radiology, Children's Hospital Medical Center, Cincinnati, OH 45229-2899.
Insights
Fluoroscopic guidance for nasojejunal feeding tube placement in children is highly successful at 97%. However, the radiation exposure, though not negligible, requires careful consideration against the clinical need for these tubes.
Area of Science:
- Pediatric Gastroenterology
- Medical Imaging
- Interventional Radiology
Background:
- Nasojejunal feeding tubes are crucial for nutritional support in pediatric patients.
- Fluoroscopic guidance is commonly employed for accurate tube placement.
- Assessing the safety and efficacy of this procedure is essential.
Purpose of the Study:
- To evaluate the clinical outcomes of fluoroscopically guided nasojejunal tube placement in children.
- To analyze fluoroscopy time, radiation dose, success rates, and reasons for failure.
Main Methods:
- A retrospective review of 562 nasojejunal tube placements in 232 pediatric patients (1 week to 24 years).
- Evaluation of fluoroscopy times, radiation doses, and tube positions.
- Analysis of clinical diagnoses and placement success/failure rates.
Main Results:
- A 97% success rate was achieved in placing tubes at or distal to the duodenojejunal junction.
- Mean fluoroscopy time was 5 minutes 30 seconds, with a mean radiation dose of 0.32 cGy.
- Malrotation was the most frequent cause of unsuccessful placement, significantly increasing fluoroscopy time and radiation dose.
Conclusions:
- Fluoroscopic guidance is an effective method for nasojejunal feeding tube placement in children.
- The radiation exposure associated with the procedure is significant and warrants careful risk-benefit assessment.
- Clinical necessity must be balanced against radiation exposure in pediatric patients.
Purpose:
Experience with fluoroscopically guided nasojejunal feeding tube placement in children was assessed regarding clinical diagnosis, fluoroscopy time, radiation dose, success rate, and placement failures.
Materials And Methods:
From 1987 to 1991, 562 nasojejunal tubes were placed in 232 patients aged 1 week to 24 years (mean, 3 1/2 years) at the authors' institution. In every case, an 8-F feeding tube system was inserted. The fluoroscopy times and tube placement positions were evaluated in all cases.
Results:
The mean fluoroscopy time was 5 minutes 30 seconds, which corresponded to an estimated mean midline fluoroscopy dose of 0.32 cGy. The tube was placed at or distal to the duodenojejunal junction in 543 attempts, for a success rate of 97%. The most common cause for unsuccessful tube placement was malrotation, with the fluoroscopic time and radiation dose significantly (P < .001) prolonged in these cases.
Conclusion:
Fluoroscopic guidance of placement of nasojejunal feeding tubes in children is successful, but the radiation exposure is not negligible and must be weighed against the need for nasojejunal feeding.