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• W2767169145 abstract "Enteral feeding is the preferred route for nutrition support when possible in critical illness [1]. When nasogastric (NG) feeding is not tolerated, post pyloric feeding into the jejunum should be considered [2]. Placing nasojejunal (NJ) tubes requires access to endoscopy or using blind techniques at the bedside which can be difficult [3]. The Kangaroo™ feeding tube with IRIS technology (Medtronic) is a new device which uses the direct vision of anatomical markers via the integral 3 mm camera as the tube is placed. The live image is projected onto a console and used to confirm position of feeding tube. National guidance recommends confirming the position of NG tube using pH of gastric aspirate of ≤ 5.5 as first line and chest X-ray second line [4]. Waiting for X-ray can delay starting or resuming enteral feeding. We report our early experience in a specialised cardiothoracic critical care unit of testing the IRIS tube to identify either gastric or post pyloric placement. Medtronic supplied the equipment, feeding tubes and training for the trial from February to May 2016. The tube was trialled in 16 patients using 10 fr either 109 cm or 140 cm length. Patients with recent nasal bleeding, maxillofacial injury/abnormality, receiving ECMO support and with coagulopathy were excluded. Tube position visualised with the IRIS tube was confirmed using national guidance as described above. Feeding was commenced once placement was confirmed. The aim was to reconnect the console on subsequent days to re-confirm feeding tube position. An evaluation form was completed for each patient detailing time taken for the procedure, anatomical markers seen (e.g. visualisation of gastric mucosa) and additional confirmation technique used. 16 patients were included in the trial, M=10, F=6, age range 39–79 years, 14 surgical, 2 medical, 14 sedated, 2 awake. NG placement was successful in 9/11 cases and NJ placement was successful in 3/5 cases. Mean time taken for insertion was 9 min for NG and 12 min for NJ tubes. Gastric mucosa was seen in 7/9 NG cases and additionally confirmed by pH in 4/9 and required X-ray in 5/9 cases. Small bowel mucosa was seen in 2/3 cases and additionally confirmed with X-ray in 2/3 and CT in 1/3 cases. Re-confirmation of tube position on day 2 was attempted in 4 patients but no clear images were seen. Following our experience the Kangaroo™ feeding tube with IRIS technology appeared to be a safe device leading to an uncomplicated insertion of feeding tubes for enteral nutritional support in a cardiothoracic critical care unit. It may have the potential to be used as a sole method of confirming correct feeding tube position on initial placement, decreasing the number of X-rays required and reducing delays in starting or resuming enteral feeding. The quality of the images needs to be enhanced before it can be used to re-confirm placement on subsequent days. The IRIS tube could also have a role in placing NJ tubes at the bedside reducing the need for gastroenterology consultation. References [1] Kreymann KG, Berger MM, Deutz NEP. ESPEN guidelines on enteral nutrition: Intensive care. Clin Nutr 2006;25:210–23. [2] Dhaliwal R, Cahill N, Lemieux M. The Canadian critical care nutrition guidelines in 2013: An update on current recommendations and implementation strategies. Nutr Clin Pract 2014;29(1):29–43. [3] Alkhawaja S, Martin C, Butler RJ, et al. Post-pyloric versus gastric tube feeding for preventing pneumonia and improving nutritional outcomes in critically ill adults. Cochrane Database Syst Rev 2015 (8):CD008875. http://dx.doi.org/10.1002/14651858.CD008875.pub2. [4] Patient Safety Alert NPSA/2011.PSA002. Reducing the harm caused by misplaced nasogastric feeding tubes in adults, children and infants. www.nrls.npsa.nhs.uk/alerts." @default.
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• W2767169145 date "2017-12-01" @default.
• W2767169145 modified "2023-09-26" @default.
• W2767169145 title "Pilot study of novel feeding tubes with IRIS technology in critically ill patients" @default.
• W2767169145 doi "https://doi.org/10.1016/j.clnesp.2017.07.042" @default.
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