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A Randomized Controlled Trial Comparing Three Different Techniques of Nasojejunal Feeding Tube Placement in Critically Ill Children

Lorri M. Phipps, RN, MSN, CPNP^*, Mark D. Weber, RN, MSN, CPNP^||, Beth R. Ginder, RN, BSN^*, Michael A. Hulse, DO and Neal J. Thomas, MD, MSc^,

From the ^* Department of Pediatrics, Division of Nursing, Division of Pediatric Critical Care Medicine, and Department of Health Evaluation Sciences and the Department of Radiology, Division of Pediatric Radiology, Penn State Children's Hospital, Penn State University College of Medicine, Hershey, Pennsylvania; and the^|| Department of Pediatrics, Division of Critical Care Medicine, West Virginia University Hospital, Morgantown, West Virginia

Correspondence: Lorri M. Phipps, RN, MSN, CPNP, Pediatric Critical Care Medicine, Penn State Children's Hospital, 500 University Drive, MC H085, Hershey, PA 17033. Electronic mail may be sent to lphipps{at}psu.edu.

Background: The goal of this study was to compare 3 different techniques used to place nasojejunal (NJ) feeding tubes in the critically ill or injured pediatric patients. This was a randomized, prospective trial in a university-affiliated 12-bed pediatric intensive care unit. Patients were critically ill children requiring placement of an NJ feeding tube. Patient age, weight, medications, use of mechanical ventilation, and patient tolerance were recorded. An abdominal radiograph obtained immediately after the placement determined correct placement. The final placement was recorded, as was the number of placement attempts. Methods: Patients were randomized to 1 of 3 groups: standard technique, standard technique facilitated with gastric insufflation, and standard technique facilitated with the use of preinsertion erythromycin. To ensure equal distribution, all patients were stratified by weight (<10 kg vs 10 kg) before randomization. All NJ tubes were placed by one of the investigators. If unsuccessful, a second attempt by the same investigator was allowed. Successful placement of the NJ tube was defined by confirmation of the tip of the tube in the first part of the duodenum or beyond by a pediatric radiologist blinded to the treatment groups. Results: Seventy-five pediatric patients were enrolled in the study; 94.6% (71/75) of tubes were passed successfully into the small bowel on the first or second attempt. Evaluation of the data revealed no significant association with a specific technique and successful placement (p = .1999). Conclusions: When placed by a core group of experienced operators, the majority of NJ feeding tubes can be placed in critically ill or injured children on the first or second attempt, regardless of the technique used.

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