Constable, G.; Pappachan, J.; Stroud, M.A.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA74
Academic Journal
Introduction: Gastroparesis, high gastric aspirate volumes and retrograde peristalsis are common on the intensive care unit (ICU) and often thwart attempts at enteral feeding. This may result in a higher incidence of nosocomial pneumonia, increased mortality, longer ICU stay and prolonged periods of parenteral nutrition. Post-pyloric feeding improves nutrient delivery and may reduce time to achieve feeding goal rates, but tubes are frequently difficult to place, requiring multiple attempts, endoscopy, and fluoroscopy. Furthermore, transfer of patients to the x ray department is often not possible and fluoroscopy on the ICU is not practical. Bengmark Tube: The bengmark tube (BT), a self-locating nasa-jejunal tube designed for placement at the bedside, is reported to achieve over 90% spontaneous trans-pyloric passage and stay in position longer than alternative tubes. The principle is based upon a preformed large diameter coil that facilitates movement beyond the pylorus and limits regurgitation back through the pylorus, but spontaneous passage requires adequate gastric emptying. In an attempt to overcome the practical difficulties of obtaining post-pyloric access in the ICU we have used a simple technique of endoscopic placement of the BT that takes advantage of the preformed to prevent displacement of the tube as the endoscope is withdrawn, thereby obviating the need for screening, and also to reduce the risk of reflux into the stomach following successful placement. Method: A suture is applied to the distal end of the BT, which is then flushed with water prior to complete insertion of the wire. The BT is then transferred from nose to mouth by means of laryngoscope and McGills forceps. The BT is grasped at the mouth with forceps deployed in the therapeutic channel of an endoscope and then carried into position under direct vision. Within D2 the wire is partially removed and the coil observed to form. The endoscope is then withdrawn fully prior removal of the...


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