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Published on: January 17, 2011
Rapid placement of transpyloric feeding tubes: a comparison of pH-assisted and standard insertion techniques in
B Krafte-Jacobs1, M Persinger, J Carver
1Division of Critical Care Medicine, Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
Insights
pH-assisted feeding tube placement in critically ill children is rapid and highly successful. This method reduces radiation exposure and healthcare costs compared to standard techniques.
Area of Science:
- Pediatric critical care medicine
- Gastroenterology
- Medical device technology
Background:
- Enteral nutrition is crucial for critically ill children.
- Accurate feeding tube placement is essential for effective and safe delivery of nutrition.
- Transpyloric placement is often preferred but can be challenging.
Purpose of the Study:
- To compare the efficacy and safety of pH-assisted transpyloric feeding tube placement versus standard placement in pediatric patients.
- To evaluate success rates, time to placement, and resource utilization.
Main Methods:
- A prospective randomized study involving critically ill children under 4 years old.
- Comparison of pH-assisted feeding tube placement with a standard technique.
- Confirmation of placement by radiography and assessment of various clinical outcomes.
Main Results:
- pH-assisted placement achieved 97% success on the first attempt versus 53% for standard placement.
- Average placement time for pH-assisted tubes was 6 minutes.
- pH-assisted group required fewer radiographs and incurred lower hospital costs ($114 vs. $135 per patient).
Conclusions:
- Bedside transpyloric placement using pH-assisted feeding tubes is rapid and highly successful in pediatric patients.
- This technique leads to reduced radiation exposure and significant economic savings.
- pH-assisted placement offers a superior alternative to standard methods for enteral access.
Objective:
To compare transpyloric feeding tube placement using a pH-assisted placement technique versus a standard placement technique in pediatric patients requiring enteral nutrition.
Methods:
Critically ill children younger than 4 years were prospectively and randomly assigned to either a pH-assisted or a standard feeding tube placement group. Identical pH-assisted feeding tubes were used in both groups; however, feeding tubes in the standard group were not attached to a portable pH meter. Successful transpyloric placement was confirmed by radiography before beginning feedings. If placement was not successful, a second placement attempt was made after metoclopramide administration. Information regarding tube placement success, number of radiographs, time to initiation of feedings, and daily caloric intake was collected. A cost comparison between the two groups was performed.
Results:
Thirty-four patients were enrolled in the pH-assisted group, and 34 were enrolled in the standard feeding tube group. Ninety-seven percent of patients in the pH-assisted group had successful placement after the first attempt, compared with 53% of patients in the standard group. The average time to successful placement of pH-assisted feeding tubes was 6 minutes. All patients in the pH-assisted group had successful placement after the second attempt, compared with 78% of patients in the standard group. A pH of greater than 5.6 accurately predicted transpyloric placement in 97% (33 of 34) of individuals in the pH-assisted group. Children in the pH-assisted group required significantly fewer radiographs than those in the standard group. Hospital costs were $114 per patient in the pH-assisted group and $135 per patient in the standard group.
Conclusions:
Our findings indicate that bedside transpyloric placement of pH-assisted feeding tubes can be accomplished rapidly and with a high success rate. This method is associated with decreased radiation exposure and economic savings when compared with a standard placement technique.
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