Emergency and Critical Care Medicine, The University of Tokushima Graduate School, 3-18-15 Kuramoto, Tokushima 770-8503, Japan.
J Crit Care. 2013 Dec;28(6):1039-41. doi: 10.1016/j.jcrc.2013.06.018. Epub 2013 Sep 7.
Post-pyloric feeding tube placement is often difficult, and special equipment or peristalsis agents are used to aid insertion. Although several reports have described blind techniques for post-pyloric feeding-tube placement, no general consensus about method preference has been achieved.
The technique is performed as follows: via the nostril, a stylet-tipped feeding tube is advanced about 70 cm; to confirm tip location to the right of the epigastric area, towards the right hypochondriac region, 5 mL shots of air are injected to enable touch detection of bubbling; finally, the tube is advanced to a length of 100 cm, during which the strength of bubbling seems to diminish under palpation.
We prospectively enrolled consecutive patients whose oral intake was expected to be difficult for 48 hours in the intensive care unit. Forty-one patients were enrolled and the rate of successful placement at first attempt was 95.1%. Mean duration for successful placement was 15 minutes.
With a novel technique, from the bedside, without special tools or drugs, we successfully placed post-pyloric feeding tubes. Essential points when inserting the tube are confirmation of the location of the tube tip by palpation of injected air, and to avoid deflection and looping.
胃后喂养管的放置常常较为困难，通常会使用特殊设备或蠕动剂来辅助插入。尽管已有多项报道描述了胃后喂养管的盲目放置技术，但对于方法偏好尚未达成共识。
该技术的操作步骤如下：经鼻腔插入带有引导丝的喂养管，推进约 70cm；为确认尖端位置在胃区右侧、右季肋区方向，向管内注入 5ml 空气以触诊气泡；最后，将管推进至 100cm 长，在此过程中，触诊时气泡的强度似乎减弱。
我们前瞻性地纳入了预计在重症监护病房中需要禁食 48 小时的连续患者。共纳入 41 例患者，首次尝试的成功率为 95.1%。成功置管的平均用时为 15 分钟。
通过一种新颖的技术，我们无需特殊工具或药物，从床边即可成功放置胃后喂养管。插入喂养管时的要点包括触诊注入的空气以确认管尖端的位置，并避免弯曲和缠绕。
