TITLE

POST-PYLORIC ACCESS ON THE ICU: ENDOSCOPIC PLACEMENT OF THE BENGMARK TUBE

AUTHOR(S)
Constable, G.; Pappachan, J.; Stroud, M.A.
PUB. DATE
April 2003
SOURCE
Gut;Apr2003 Supplement 1, Vol. 52, pA74
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
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placement of the BT that takes advantage of the preformed to prevent displacement of the tube as the endoscope is withdrawn, thereby obviating the need for screening, and also to reduce the risk of reflux into the stomach following successful placement.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 The endoscope is then withdrawn fully prior removal of the...
ACCESSION #
9747780

 

Related Articles

  • A simple modification of Ciaglia Blue Rhino technique for tracheostomy: using a guidewire dilating forceps for initial dilation. Sheu, Chau-Chyun; Tsai, Jong-Rung; Hung, Jen-Yu; Cheng, Meng-Hsuan; Chong, Inn-Wen; Hwang, Jhi-Jhu; Huang, Ming-Shyan // European Journal of Cardio-Thoracic Surgery;Jan2007, Vol. 31 Issue 1, p114 

    Abstract: Objective: The potential difficulty in doing initial dilation in the percutaneous dilational tracheostomy (PDT) with the Ciaglia Blue Rhino (CBR) technique has been reported by others and encountered in our clinical practice. To resolve this problem, we developed a modified CBR...

  • Aortoenteric fistula as shown by multidetector computed tomography. Kayami, I.; Groves, A. M.; Syed, R // Heart;Mar2005, Vol. 91 Issue 3, p304 

    The article presents a medical case where an 80-year-old man with a history of abdominal aortic aneurysm, repaired 10 years previously, presented to the emergency room with a four-hour history of severe epigastric pain. Examination demonstrated a distended, tender, but non-rigid abdomen. ECG was...

  • Endoscopic Position Control of Nasoenteral Feeding Tubes by Transnasal Re-endoscopy: A Prospective Study in Intensive Care Patients. Wiegand, Nico; Bauerfeind, Peter; Delco, Fabiola; Fried, Michael; Wildi, Stephan M. // American Journal of Gastroenterology;May2009, Vol. 104 Issue 5, p1271 

    OBJECTIVES:In critically ill patients, correct placement of enteral feeding tubes is usually controlled by X-ray. A bedside method without radiation exposure would be preferable. This study aimed to demonstrate the feasibility and value of endoscopic position control for enteral feeding tubes by...

  • Systematic Review of the Predictors of Recurrent Hemorrhage After Endoscopic Hemostatic Therapy for Bleeding Peptic Ulcers. Elmunzer, B. Joseph; Young, Scott D.; Inadomi, John M.; Schoenfeld, Philip; Laine, Loren // American Journal of Gastroenterology;Oct2008, Vol. 103 Issue 10, p2625 

    BACKGROUND: An increased knowledge regarding the predictors of rebleeding after endoscopic therapy for bleeding ulcers should improve clinical management and outcomes. The aim of this systematic review was to identify the strongest and most consistent predictors of rebleeding to assist in the...

  • Natural orifice transluminal endoscopic surgery (NOTES) as a diagnostic tool in the intensive care unit. Onders, Raymond; McGee, Michael; Marks, Jeffrey; Chak, Amitabh; Rosen, Michael; Ignagni, Anthony; Faulx, Ashley; Schomisch, Steve; Ponsky, Jeffrey // Surgical Endoscopy;Apr2007, Vol. 21 Issue 4, p681 

    Autopsy studies confirm that many intensive care unit (ICU) patients die from unrecognized sources of abdominal sepsis or ischemia. Computed tomography (CT) scans can be of limited use for these diagnoses and difficult to obtain in critically ill patients who require significant support for...

  • Evaluation of a technique for blind placement of post-pyloric feeding tubes in intensive care: application in patients with gastric ileus. Lee, Andrew J.; Eve, Richard; Bennett, Mark J. // Intensive Care Medicine;Apr2006, Vol. 32 Issue 4, p553 

    Objective: To evaluate a blind ‘active’ technique for the bedside placement of post-pyloric enteral feeding tubes in a critically ill population with proven gastric ileus. Design and setting: An open study to evaluate the success rate and duration of the technique in cardiothoracic...

  • Determining small intestinal transit time and pathomorphology in critically ill patients using video capsule technology. Rauch, Stefan; Krueger, Kristine; Turan, Alparslan; Roewer, Norbert; Sessler, Daniel I. // Intensive Care Medicine;Jun2009, Vol. 35 Issue 6, p1054 

    Gastrointestinal motility can be impaired by serious illness or medications, compromising enteral feeding in critical care patients. We compared small bowel transit time and morphology in neurosurgical critical care (ICU) patients with those in healthy subjects. We evaluated small intestinal...

  • Tratamiento endoscópico de cáncer gástrico temprano en Colombia con seguimiento a cinco años. Gómez, Martín; Otero, William; Arbeláez, Víctor // Revista Colombiana de Gastroenterología;Oct2009, Vol. 24 Issue 4, p347 

    Early gastric cancer (EGC) is being diagnosed more frequently as each day passes. This is true not only in Japan but around the world. Even though the endoscopic treatment is relatively simple, our field does not yet have enough experience in long term monitoring after successful endoscopic...

  • EEG BISPECTRAL INDEX GUIDED SEDATION: BETTER, SAFER, FASTER. Laasch, H. U.; Bell, J.; Wilbraham, L.; England, R. E.; Martin, D. F. // Gut;Apr2004 Supplement 3, Vol. 53, pA46 

    This article focuses on a study related to EEG bispectral index guided sedation. Clinical assessment of depth of sedation is subjective and unreliable. EEG based bispectral index (BIS) is used to guide sedation of paralyzed patients on intensive care units. BIS monitoring enables more effective...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sign out of this library

Other Topics