Videoscopic placement of feeding tubes: Development of a through the tube technique

Purpose: To describe the development of a bedside videoscopic technique for feeding tube placement using fiberoptics through the tube. Methods: Nine critically ill patients (6 males, 3 females; 8 intubated) participated in placement of standard 10 French (3.3 mm) feeding tubes. A total of 11 feeding tubes were placed into the small bowel by the oral (n=4) or nasal (n=7) route under direct vision using a 6.7 French (2.2 mm) fiberoptic scope through the feeding tube. Transpyloric tube placement was confirmed videoscopically and radiographically. Results: Visually we advanced the feeding tubes into the distal duodenum and beyond in 8 attempts (73%) and into the second portion of the duodenum in 3. The time required for placement ranged from 2 to 43 minutes with a mean±standard deviation of 18 ± 12 minutes. The feeding tubes remained in place 10 ± 4 days and patients met their estimated caloric needs within 24 hours. Residues were minimal and there were no documented episodes of aspiration. Conclusions: This technique has the potential for rapid, accurate and safe feeding tube placement. Clinical Implications: Transpyloric small intestine feeding tube placement can be difficult and tedious. Currently accepted techniques are associated with disadvantages and risk. This technique has the potential to offer clinicians a safe and rapid means with which to place feeding tubes in patients requiring nutritional support.