Department of Gastroenterology and Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Gastrointest Endosc. 2010 Apr;71(4):728-36. doi: 10.1016/j.gie.2009.10.046. Epub 2010 Feb 18.
The early institution of feeding in patients who need postpyloric feeding tubes is often hampered by a limited availability of endoscopists experienced in safe tube positioning.
To test the feasibility of having nurses place postpyloric feeding tubes by using a universal path finding system device.
Prospective study.
Academic hospital.
The success rate and learning curve of a senior nurse placing postpyloric feeding tubes in 50 patients was studied, followed by a study in 160 patients on the success rates and learning curves of 4 inexperienced nurses instructed by the senior nurse. Finally, the success rate of postpyloric feeding tube placement by the senior nurse in 50 critically ill patients was investigated.
Postpyloric feeding tube positioning by nurses using an electromagnetic universal path-finding system device enabling them to follow the path of the tip of the feeding tube on a monitor screen.
Success was defined by postpyloric positioning of the feeding tube. The ultimate aim was to reach at least the duodenojejunal flexure.
In the first part, the senior nurse was successful in 72% of cases. There was a clear learning curve. In the second part, the 4 newly instructed nurses had a success rate of 89.4% without an evident learning curve. In the third part, successful feeding tube positioning was achieved in 78% of critically ill patients. Of the 217 successfully positioned tubes, 74% reached at least the duodenojejunal flexure. In half of the unsuccessful cases, an explanation for the failure was found at endoscopy. No complications were seen.
The generalization to less-specialized hospitals should be investigated.
Postpyloric positioning of feeding tubes by nurses at the bedside without endoscopy is feasible and safe. Nurses may take over some of the tasks of doctors in a time of high endoscopic needs.
在需要胃后喂养管的患者中，早期进行喂养往往受到经验丰富的内镜医生数量有限的限制，他们能够安全地放置管饲管。
测试使用通用路径寻找系统设备让护士放置胃后喂养管的可行性。
前瞻性研究。
学术医院。
研究了一名高级护士在 50 名患者中放置胃后喂养管的成功率和学习曲线，然后在 160 名经验不足的护士由高级护士指导的情况下，研究了他们的成功率和学习曲线。最后，研究了高级护士在 50 名危重病患者中放置胃后喂养管的成功率。
护士使用电磁通用路径寻找系统设备定位胃后喂养管，使他们能够在监视器屏幕上跟踪喂养管尖端的路径。
成功定义为胃后喂养管的定位。最终目标是至少到达十二指肠空肠曲。
在第一部分，高级护士的成功率为 72%。存在明显的学习曲线。在第二部分，4 名新接受指导的护士的成功率为 89.4%，没有明显的学习曲线。在第三部分，78%的危重病患者成功放置了喂养管。在 217 个成功定位的管中，74%至少到达了十二指肠空肠曲。在一半不成功的病例中，在胃镜检查中发现了失败的原因。没有发生并发症。
应在非专科医院进行推广。
护士无需内镜即可在床边进行胃后喂养管定位，是可行且安全的。在内镜需求较高时，护士可以接管医生的部分工作。
