[Placement of nasoenteral feeding tubes under electrocardiographic guidance in critically ill patients].

INTRODUCTION

Nasoenteral feeding is the preferred method to feed critically ill patients. Infusion of diet into duodenum instead of stomach is considered safer to avoid pulmonary aspiration. To place the tip of the tube inside duodenum, one can perform external maneuvers, aided by the tube's guidance, or use fluoroscopy and/or endoscopy. Spontaneous passage of the tip of the tube into duodenum, even with administration of pro-kinetic drugs, is achieved in <30% of cases.

OBJECTIVE

Assessing helpfulness of electrocardiographic tracing in placement of a nasoduodenal tube in critically ill patients amenable to early enteral feeding.

MATERIAL AND

METHODS

From January, 2001 through January, 2002 at the Intensive Care Unit of Hospital Angeles del Pedregal (Mexico City), a nasoenteral tube was placed in all critically ill patients who were candidate for early enteral feeding, intending to leave the tip inside duodenum with the aid of ECG tracing. During passage of the tube through esophagus, the screen showed postive QRS; on entering stomach, trace became isoelectric and after crossing pylorus, QRS trace turned definitely negative. Once the procedure was over, an X-ray was taken to confirm that the tip of the tube as inside duodenum.

RESULTS

This method was used in 100 consecutive patients. The tip of the tube reached the duodenum in 95 of 100 patients.

CONCLUSIONS

Placement of nasoduodenal tube with the aid of electrocardiographic tracing is a safe method that makes possible the tip of the tube to reach duodenum, or proximal jejunum in the majority of cases.