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1.
Evaluation of a Home-Based Behavioral Treatment Model for Children With Tube Dependency.
Taylor, S, Purdy, SC, Jackson, B, Phillips, K, Virues-Ortega, J
Journal of pediatric psychology. 2019;(6):656-668
Abstract
OBJECTIVE To evaluate a home-based behavioral treatment model for children with tube dependency. METHODS Nine children (aged 4-14 years) dependent on nasogastric and gastrostomy tubes were consecutively admitted into a home-based behavioral treatment program. A psychologist specializing in applied behavior analysis led the assessment and treatment phases with the support of caregivers and a multidisciplinary team. Caregivers participated in a caregiver training program and continued the intervention once the service was discontinued. We conducted follow-up visits up to 12 months after treatment. The program was evaluated with a multiple-baseline across participants design. We computed on-treatment and intention-to-treat effects according to the Hedges-Pustejovsky-Shadish model. We monitored behavioral (food acceptance and swallowing) and nutritional outcomes (body weight, oral intake, and tube intake), treatment acceptability and satisfaction, caregiver stress, and estimated treatment cost savings. RESULTS Food acceptance, swallowing, oral intake, and tube intake demonstrated large treatment gains relative to pretreatment levels (effect size range of the intention-to-treat analysis = 0.74-2.1). All participants maintained or increased their body weight. Follow-up effect sizes indicated further improvements. By the final follow-up assessment, six out of the nine children had ceased tube feeding, and one had tube feeds reduced. Caregivers and health professionals provided strong ratings of treatment satisfaction. The cost-savings analysis suggested that a home-based treatment may be a cost-effective alternative to prolonged tube feeding as well as to other treatment approaches. CONCLUSIONS This study provides evidence supporting home-based multicomponent behavioral interventions in the treatment of pediatric feeding disorders. CLINICAL TRIAL IDENTIFIER ACTRN12614001127695, https://goo.gl/XSQ4ZH.
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2.
Placement of a Jejunal Feeding Tube via an Ultrasound-Guided Antral Progressive Water Injection Method.
Zhang, Q, Sun, JH, Liu, JT, Wang, XT, Liu, DW
Chinese medical journal. 2018;(14):1680-1685
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Abstract
BACKGROUND Jejunal feeding tube allows the nutrition of critical care patients more easy and safe. However, its placement remains a challenge. This study aimed to introduce a jejunal feeding tube through an ultrasound-guided antral progressive water injection method and subsequently to examine its efficacy. METHODS Between April 2016 and April 2017, 54 patients hospitalized in the Department of Critical Care Medicine, Peking Union Medical College Hospital, China who needed nutritional support through a jejunal feeding tube were recruited for this study. Patients who applied ultrasound-guided antral progressive water injection method were classified into the experimental group. Patients who applied conventional method were registered as control group. RESULTS No significant differences were found in age, body mass index, and Acute Physiology and Chronic Health Evaluation score, but a significant difference in operation time was found between the experimental group and the control group. Of the 24 individuals in the control group, 17 displayed clear catheter sound shadows once the tube entered the esophagus. In comparison, of the 30 individuals in the experimental group, all harbored catheter sound shadows through the esophageal gas injection method. Subsequent observation revealed that in the control group (via ultrasonographic observation), 15 individuals underwent successful antral tube entry, for a success rate of 63%. In the experimental group (via antral progressive water injection), 27 individuals underwent successful antral tube entry, for a success rate of 90%. There was a significant difference between the success rates of the two groups (χ2 = 5.834, P = 0.022). CONCLUSION The antral progressive water injection method for the placement of a jejunal feeding tube is more effective than the traditional ultrasonic placement method.
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Blind bedside postpyloric placement of spiral tube as rescue therapy in critically ill patients: a prospective, tricentric, observational study.
Lv, B, Hu, L, Chen, L, Hu, B, Zhang, Y, Ye, H, Sun, C, Zhang, X, Lan, H, Chen, C
Critical care (London, England). 2017;(1):248
Abstract
BACKGROUND Various special techniques for blind bedside transpyloric tube placement have been introduced into clinical practice. However, transpyloric spiral tube placement facilitated by a blind bedside method has not yet been reported. The objective of this prospective study was to evaluate the safety and efficiency of blind bedside postpyloric placement of a spiral tube as a rescue therapy subsequent to failed spontaneous transpyloric migration in critically ill patients. METHODS This prospective, tricentric, observational study was conducted in the intensive care units (ICUs) of three tertiary hospitals. A total of 127 consecutive patients with failed spontaneous transpyloric spiral tube migration despite using prokinetic agents and still required enteral nutrition for more than 3 days were included. The spiral tube was inserted postpylorically using the blind bedside technique. All patients received metoclopramide intravenously prior to tube insertion. The exact tube tip position was determined by radiography. The primary efficacy endpoint was the success rate of postpyloric spiral tube placement. Secondary efficacy endpoints were success rate of a spiral tube placed in the third portion of the duodenum (D3) or beyond, success rate of placement in the proximal jejunum, time to insertion, length of insertion, and number of attempts. Safety endpoints were metoclopramide-related and major adverse tube-associated events. RESULTS In 81.9% of patients, the spiral feeding tubes were placed postpylorically; of these, 55.1% were placed in D3 or beyond and 33.9% were placed in the proximal jejunum, with a median time to insertion of 14 min and an average number of attempts of 1.4. The mean length of insertion was 95.6 cm. The adverse event incidence was 26.0%, and no serious adverse event was observed. CONCLUSIONS Blind bedside postpyloric placement of a spiral tube, as a rescue therapy subsequent to failed spontaneous transpyloric migration in critically ill patients, is safe and effective. This technique may facilitate the early initiation of postpyloric feeding in the ICU. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR-OPN-16008206 . Registered on 1 April 2016.
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Safety and Efficacy of Electromagnetic-Guided Bedside Placement of Nasoenteral Feeding Tubes versus Standard Placement.
Shadid, H, Keckeisen, M, Zarrinpar, A
The American surgeon. 2017;(10):1184-1187
Abstract
Although enteral feeding in critically ill patients has been shown to be beneficial, reliable postpyloric placement of feeding tubes remains a challenge. The standard of care involves blind placement, frequently requiring multiple attempts, and radiographs. To evaluate the effect of electromagnetic-guided bedside placement in reducing time to establishment of feeding, lung placement, use of radiography, and cost, we initiated a prospective trial using electromagnetic-guided bedside placement and compared them to a retrospective cohort. Fifty-three consecutive placements of nasoenteral feeding tubes were made using electromagnetic-guidance on patients requiring enteral nutrition in a surgical intensive care unit at a tertiary care center. Sixty-three placement attempts in the preceding seven months served as controls. There were no significant differences between the two groups in terms of age, sex, weight, body mass index, hiatal or ventral hernias, or previous esophageal/gastric operations. The number of radiographs needed per patient, need for fluoroscopy, radiology charge per patient for the tube placement, and time from first attempt at placement to confirmation of postpyloric location were lower for the electromagnetic-guided group. Use of electromagnetic guidance allows reliable and cost-effective postpyloric enteral feeding tube placement compared with blind insertion.
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Prophylactic Nasogastric Decompression for Routine Gastrectomy.
Pang, MH, Xu, J, Wu, YF, Luo, B
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP. 2015;(7):491-4
Abstract
OBJECTIVE To determine the necessity of using nasogastric tubes for patients with gastrectomy. STUDY DESIGN A non-randomized controlled trial with two arms. PLACE AND DURATION OF STUDY Sichuan Provincial Peoples' Hospital, China, from February 2012 to January 2014. METHODOLOGY One hundred and twenty one patients undergoing gastrectomy were assigned into intubation group and control group based on patient's own will. The intubation group was intubated with a nasogastric tube before operation and extubated at the earliest evidence of passed flatus. Clinical outcomes, such as operation time, bleeding volume, time to passage of flatus, postoperative complications, and length of stay were recorded and compared between the two groups along with patient characteristics. RESULTS The two groups did not differ in patient characteristics with similar distribution of gender, age, diagnosis, tumor location and operation type. Nasogastric intubation before surgery was not associated with statistically significant difference in total surgery duration, bleeding volume of operation or postoperative complications. In addition, patients without nasogastric tubes resumed oral diet earlier (52.5 ± 14.1 vs.18.4 ± 2.0 hours, p < 0.05) and had shorter time to first passage of flatus (43.8 ± 11.2 vs. 49.0 ± 13.3 hours, p=0.02). CONCLUSION It is safe to give up nasogastric intubation for patients undergoing elective gastrectomy and may even result in a better patient outcome.
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One-step percutaneous gastrojejunostomy in early infancy.
Michaud, L, Robert-Dehault, A, Coopman, S, Guimber, D, Turck, D, Gottrand, F
Journal of pediatric gastroenterology and nutrition. 2012;(6):820-1
Abstract
In certain conditions that obviate the use of gastric feedings, the insertion of a jejunal feeding tube via gastrostomy constitutes an alternative to jejunostomy but requires a preexisting gastrostomy. Our aim was to assess a new technique of 1-step gastrojejunal tube insertion through a de novo gastrostomy. A total of 3 infants between 3 and 7 months old and weighing between 4.1 and 5.4 kg had a gastrojejunal feeding tube inserted using a 16-CH French introducer percutaneous endoscopic gastrostomy kit and a transgastric-jejunal feeding tube. No technical difficulties occurred and the gastrojejunal feeding tube was placed successfully in the 3 patients, the total procedure lasting 15 to 20 minutes. Enteral feeding was started within 4 to 6 hours of the procedure. Neither immediate (<24 hours) nor late complications related to the gastrojejunostomy occurred. Nissen fundoplication was performed in 2 of our patients at 12 and 15 months of age, respectively. The gastrojejunostomy tube was still in place in the third patient at age 15 months. Our first experience suggests that 1-step endoscopic placement of a transgastric-jejunal feeding tube without a preexisting gastrostomy tract is feasible in young and low-weight infants.
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Efficacy and safety of placing nasoenteral feeding tube with transnasal ultrathin endoscope in critically ill patients.
Chen, H, Liu, L, Wang, J, Zhang, YZ, Wu, ZY, Lu, FL, Mao, CH, Yu, Q, Cao, DZ
Chinese medical journal. 2009;(21):2608-11
Abstract
BACKGROUND The placement of an enteral feeding tube is the foundation for providing enteral nutrition. But due to the anatomic complexity of the stomach and the duodenum, to a certain degree, there are some technical difficulties in the placement of postpyloric feeding tube, especially in critically ill patients. This study aimed to evaluate the efficacy and safety of placing nasoenteral feeding tube with a transnasal ultrathin endoscope. METHODS Totally 49 patients, involving 46 (93.9%) being American Society of Anesthesiologists Physical Status (ASA-PS) grade III (n = 3) and grade IV (n = 43), in whom a nasoenteral feeding tube was placed with a transnasal ultrathin endoscope by using over-the-wire technique. The related clinic information during the procedure including success rate, time required, complications and monitoring results of vital signs was analyzed. RESULTS The tube was placed at or beyond the Treitz's ligament in all of the 49 cases and the total tube-placement success rate was 100% including the one-time tube-placement success rate 95.9%. The tube placement was successful in 46 (93.9%) cases by transnasal method and 3 (6.1%) cases by transoral method. In the 47 cases whose one-time tube-placement success was obtained, the average procedure time was (6.2 +/- 5.6) minutes. For the 3 patients the endoscope inserted transorally due to the failure of transnasal insertion, the total procedure time was (12.3 +/- 2.1) minutes. In the period of nasoenteral tube placement, the average systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) and average pulse oxygen saturation (SpO(2)) did not show any significant change. Apart from 3 patients in whom nausea occurred in the procedure and 2 nasal bleeding, no any other acute complications arose. CONCLUSION The method of placing nasoenteral feeding tube with the transnasal ultrathin endoscope is not only efficient, time-saving, technically simple, and painless to patients, but also safe especially in critically ill patients.
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Prospective study of percutaneous endoscopic gastrostomy tubes versus nasogastric tubes for enteral feeding in patients with head and neck cancer undergoing (chemo)radiation.
Corry, J, Poon, W, McPhee, N, Milner, AD, Cruickshank, D, Porceddu, SV, Rischin, D, Peters, LJ
Head & neck. 2009;(7):867-76
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) tubes have largely replaced nasogastric tubes (NGTs) for nutritional support of patients with head and neck cancer undergoing curative (chemo) radiotherapy without any good scientific basis. METHODS A prospective study was conducted to compare PEG tubes and NGTs in terms of nutritional outcomes, complications, patient satisfaction, and cost. RESULTS There were 32 PEG and 73 NGT patients. PEG patients sustained significantly less weight loss at 6 weeks post-treatment (median 0.8 kg gain vs 3.7 kg loss, p < .001), but had a high insertion site infection rate (41%), longer median duration of use (146 vs 57 days, p < .001), and more grade 3 dysphagia in disease-free survivors at 6 months (25% vs 8%, p = .07). Patient self-assessed general physical condition and overall quality of life scores were similar in both groups. Overall costs were significantly higher for PEG patients. CONCLUSION PEG tube use should be selective, not routine, in this patient population.
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The use of carbon dioxide monitoring to determine orogastric tube placement in premature infants: a pilot study.
Ellett, ML, Woodruff, KA, Stewart, DL
Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates. 2007;(6):414-7
Abstract
Enteral nutrition, frequently given through gastric tubes inserted through the nose or mouth, is an important part of supportive care for children unable to maintain adequate nutrition orally. To provide safe enteral nutrition, however, correct tube position must be achieved. Capnography, a noninvasive monitoring technique designed to measure expired carbon dioxide (CO2) levels, has been used previously to identify respiratory placement of nasogastric tubes in adults; however, its use in children is understudied. The purpose of this pilot study was to determine the potential of CO2 monitoring to differentiate respiratory from gastric placement of nasogastric/orogastric (NG/OG) tubes in the youngest, most fragile children-premature infants. Immediately prior to chest radiograph, CO2 levels in 7 premature infants were measured at the open ends of both the endotracheal and NG/OG tubes by using a bedside capnography monitor. The 14 CO2 readings from the correctly placed endotracheal tubes ranged from 32 to 61 mmHg (M = 47.6 mmHg, SD = 10.0). CO2 readings were zero in all 14 correctly placed NG/OG tubes. The results of this pilot study provide evidence that capnography may be useful in differentiating respiratory from gastrointestinal tube placement in premature infants.
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10.
The width of a gastric tube has no impact on outcome after esophagectomy.
Tabira, Y, Sakaguchi, T, Kuhara, H, Teshima, K, Tanaka, M, Kawasuji, M
American journal of surgery. 2004;(3):417-21
Abstract
BACKGROUND We evaluated the impact of the size of gastric tubes on tissue blood flow of the anastomotic site, the frequency of leakage and the postoperative nutritional status. METHODS Forty-four patients were randomly allocated to either reconstruction using subtotal stomach (n = 22) or to reconstruction using slender gastric tube (n = 22) after esophagectomy. The tissue blood flow at the anastomotic site was measured. The postoperative nutritional status of 17 patients without recurrence was examined. Possible correlations between the type of esophageal substitute and the tendency to leakage as well as postoperative nutritional status were examined. RESULTS There was no significant difference in the tissue blood and the frequency of leakage between the types of gastric tubes. There was no significant difference noted between the two in the postoperative nutritional status at 6 and 12 months after operation. CONCLUSIONS The width of gastric tube has no impact on tissue blood flow, the frequency of leakage, and the postoperative nutritional status after esophagectomy.