Experience of Sonography Guided Freka Trelumina Placement in Patients with Severely Impaired Gastric Emptying by Stylet Displacement_West China Medical Journal

Authors：

 ChenPeifu ^1,2 , TangShiyuan ² ,  CaoYu ²

1. Intensive Care Unit, the Second Hospital of Ningbo, Ningbo, Zhejiang 315010, P. R. China;
2. Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

CaoYu, Email: yuyuer@126.com

Keywords：

Sonography guided; Freka Trelumina; Nasointestinal tube; Enteral nutrition; Critical illness; Impaired gastric emptying

DOI：

10.7507/1002-0179.201600275

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Objective To assess the clinical efficacy of sonography guided Freka Trelumina placement by stylet displacement in patients with severely impaired gastric emptying. Methods Twenty-two patients with severely impaired gastric emptying monitored in the Intensive Care Unit from January 8 to May 18, 2016 were chosen to be our study subjects. Freka Trelumina was placed under ultrasonic guidance, and the guide wire displacement was used to determine the location of the catheter. We recorded whether the patient had an intra-gastric injection of warm water, the manual pushing times before the catheter passed through the pylorus, whether the operation succeeded, the time spent on guiding the placement, and the catheter depth. The pros and cons of the method in clinical use, and whether fasting state helped reduce the operating time were analyzed. Results Among the 22 patients, 20 had a successful Freka Trelumina placement, and the success rate was 91%. The number of manual pushing before the catheter passed through the pylorus was 1 in 4 cases (20%), 2 in 5 (25%), and equal to or more than 3 in 11 cases (55%). The catheter could be seen in the third part of duodenum only in 9 cases (45%). The mean placement procedure lasted (20.35±12.93) minutes for the successful cases. The time spent in the 11 patients with empty stomach was (15.00±9.87) minutes, less than (26.89±14.45) minutes in those 9 post prandial patients (P＜0.05). Conclusions With stylet displacement to determine the location of the catheter, sonography guided Freka Trelumina placement has a high success rate. Ultrasonic guidance facilitates the insertion of the tubes in critically ill patients. For patients with empty stomach, it may help reduce the operating time.

Citation： ChenPeifu, TangShiyuan, CaoYu. Experience of Sonography Guided Freka Trelumina Placement in Patients with Severely Impaired Gastric Emptying by Stylet Displacement. West China Medical Journal, 2016, 31(6): 1023-1027. doi: 10.7507/1002-0179.201600275 Copy

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15.	Patrick PG, Marulendra S, Kirby DF, et al. Endoscopic nasogastricjejunal feeding tube placement in critically ill patients[J]. Gastrointest Endosc, 1997, 45(1): 72-76.
16.	Bosco JJ, Gordon F, Zelig MP, et al. A reliable method for the endoscopic placement of a nasoenteric feeding tube[J]. Gastrointest Endosc, 1995, 40(6): 740-743.
17.	Lewis BS, Mauer K, Bush A. The rapid placement of jejunal feeding tubes: the Seldinger technique applied to the gut[J]. Gastrointest Endosc, 1990, 36(2): 139-141.
18.	Lewis SJ, Andersen HK, Thomas S. Early enteral nutrition within 24 h of intestinal surgery versus later commencement of feeding: a systematic review and meta-analysis[J]. J Gastrointest Surg, 2009, 13(3): 569-575.
19.	Koretz RL, Lipman TO. The presence and effect of bias in trials of early enteral nutrition in critical care[J]. Clin Nutr, 2014, 33(2): 240-245.
20.	Alberda C, Gramlich L, Jones N, et al. The relationship between nutritional intake and clinical outcomes in critically ill patients: results of an international multicenter observational study[J]. Intensive Care Med, 2009, 35(10): 1728-1737.
21.	Efrati S, Deutsch I, Antonelli M, et al. Ventilator-associated pneumonia: current status and future recommendations[J]. J Clin Monit Comput, 2010, 24(2): 161-168.
22.	Wan B, Fu H, Yin J. Early jejunal feeding by bedside placement of a nasointestinal tube significantly improves nutritional status and reduces complications in critically ill patients versus enteral nutrition by a nasogastric tube[J]. Asia Pac J Clin Nutr, 2015, 24(1): 51-57.

1. Doig GS, Heighes PT, Simpson F, et al. Early enteral nutrition reduces mortality in trauma patients requiring intensive care: a meta-analysis of randomised controlled trials[J]. Injury, 2011, 42(1): 50-56.
2. Heyland DK, Stephens KE, Day AG, et al. The success of enteral nutrition and ICU-acquired infections: a multicenter observational study[J]. Clin Nutr, 2011, 30(2): 148-155.
3. Huang HH, Hsu CW, Kang SP, et al. Association between illness severity and timing of initial enteral feeding in critically ill patients: a retrospective observational study[J]. Nutr J, 2012, 11: 30.
4. Stupak DP, Abdelsayed GG, Soloway GN. Motility disorders of the upper gastrointestinal tract in the intensive care unit: pathophysiology and contemporary management[J]. J Clin Gastroenterol, 2012, 46(6): 449-456.
5. Levy H. Nasogastric and nasoenteric feeding tubes[J]. Gastrointest Endosc Clin N Am, 1998, 8(3): 529-549.
6. Mcclave SA, Dibaise JK, Mullin GE, et al. ACG clinical guideline: nutrition therapy in the adult hospitalized patient[J]. Am J Gastroenterol, 2016, 111(3): 315-334.
7. Blumenstein I, Shastri YM, Stein J. Gastroenteric tube feeding: techniques, problems and solutions[J]. World J Gastroenterol, 2014, 20(26): 8505-8524.
8. Ott DJ, Mattox HE, Gelfand DW, et al. Enteral feeding tubes: placement by using fluoroscopy and endoscopy[J]. AJR Am J Roentgenol, 1991, 157(4): 769-771.
9. Mann NS, Nair PK, Mann SK, et al. Nasoenteral feeding tube insertion via fiberoptic endoscope for enteral hyperalimentation[J]. J Am Coll Nutr, 1984, 3(4): 333-339.
10. Wiggins TF, Delegge MH. Evaluation of a new technique for endoscopic nasojejunal feeding-tube placement[J]. Gastrointest Endosc, 2006, 63(4): 590-595.
11. Greenberg M, Bejar R, Asser S. Confirmation of transpyloric feeding tube placement by ultrasonography[J]. J Pediatr, 1993, 122(3): 413-415.
12. Hernández-Socorro CR, Marin J, Ruiz-Santana S, et al. Bedside sonographic-guided versus blind nasoenteric feeding tube placement in critically ill patients[J]. Crit Care Med, 1996, 24(10): 1690-1694.
13. Heyland DK, Dhaliwal R, Drover JW, et al. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients[J]. JPEN J Parenter Enteral Nutr, 2003, 27(5): 355-373.
14. Pinilla JC, Samphire J, Arnold C, et al. Comparison of gastrointestinal tolerance to two enteral feeding protocols in critically ill patients: a prospective, randomized controlled trial[J]. JPEN J Parenter Enteral Nutr, 2001, 25(2): 81-86.
15. Patrick PG, Marulendra S, Kirby DF, et al. Endoscopic nasogastricjejunal feeding tube placement in critically ill patients[J]. Gastrointest Endosc, 1997, 45(1): 72-76.
16. Bosco JJ, Gordon F, Zelig MP, et al. A reliable method for the endoscopic placement of a nasoenteric feeding tube[J]. Gastrointest Endosc, 1995, 40(6): 740-743.
17. Lewis BS, Mauer K, Bush A. The rapid placement of jejunal feeding tubes: the Seldinger technique applied to the gut[J]. Gastrointest Endosc, 1990, 36(2): 139-141.
18. Lewis SJ, Andersen HK, Thomas S. Early enteral nutrition within 24 h of intestinal surgery versus later commencement of feeding: a systematic review and meta-analysis[J]. J Gastrointest Surg, 2009, 13(3): 569-575.
19. Koretz RL, Lipman TO. The presence and effect of bias in trials of early enteral nutrition in critical care[J]. Clin Nutr, 2014, 33(2): 240-245.
20. Alberda C, Gramlich L, Jones N, et al. The relationship between nutritional intake and clinical outcomes in critically ill patients: results of an international multicenter observational study[J]. Intensive Care Med, 2009, 35(10): 1728-1737.
21. Efrati S, Deutsch I, Antonelli M, et al. Ventilator-associated pneumonia: current status and future recommendations[J]. J Clin Monit Comput, 2010, 24(2): 161-168.
22. Wan B, Fu H, Yin J. Early jejunal feeding by bedside placement of a nasointestinal tube significantly improves nutritional status and reduces complications in critically ill patients versus enteral nutrition by a nasogastric tube[J]. Asia Pac J Clin Nutr, 2015, 24(1): 51-57.

West China Medical Journal

Experience of Sonography Guided Freka Trelumina Placement in Patients with Severely Impaired Gastric Emptying by Stylet Displacement

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