Air insufflation technique of enteral tube insertion: a randomized, controlled trial

Abstract

Objective: To test air insufflation as an adjunct to placement of enteral feeding tubes.

Design: Prospective, randomized study.

Setting: Intensive care unit in a tertiary hospital.

Subjects: Sixty-four consecutive patients requiring enteral nutrition, in whom a decision to insert a nasoenteral feeding tube was made.

Interventions: A 12-Fr feeding tube was inserted to the level of the fundus of the stomach. A 60-mL syringe was used to pump 500 mL of air into the stomach. The tube was then advanced. An abdominal flat plate was obtained within 2 hrs of completion of the procedure and the tube position noted. If the tube was not in the duodenum, the patient was placed on a promotility agent and a repeat radiograph was performed the next day. The technique varied from our control technique only by the instillation of air.

Measurements and main results: Using the study technique, 21 of 32 tubes were successfully placed, as seen on the initial radiograph, in our study patients compared with only 12 of 34 tubes in our control patients (p< .02). In addition, the success rate at 24 hrs was 25 of 32 vs. 16 of 34 (p< .02). Only 3 of 21 tubes placed in the antrum, body, or fundus of the stomach advanced to the duodenum the following day, compared with 5 of 12 tubes initially placed in the pylorus (p< .075). No complications were noted.

Conclusion: Instilling air into the stomach may facilitate the ability to get the feeding tube to the level of the pylorus, at which point it is more likely to advance into the duodenum and beyond.