Sequential Single And Double Wire-guided Post-pyloric Feeding Tube Placement In Critically Ill Patients

ObjectiveThis study is aimed to evaluated the safety,efficacy and influence factors of sequential single and double wire-guided post-pyloric feeding tube placement in critically ill patients.MethodA prospective collected data was performed from October 2018 to October 2019.Patients who met the inclusion criteria were recruited in the Third Affiliated Hospital of Soochow University.We collected clinical and catherization data of the patients.The clinical data included age,primary diagnosis,in-bed time,BMI,NUTRIC score,APACHE II score,SOFA score,artificial airway,bowel sounds,blood glucose,mechanical ventilation,sub-hypothermia hibernation,the usage of prokinetics,sedative and vasoactive drugs.The catherization data included success rate,the time of procedure,the attempts to pass the pylorus,the position of tube tip,vital signs,and adverse events during catheterization,and tube indwelling period.The factors influenced the success rate of placement,the time of procedure and the attempts to pass the pylorus were analyzed.Result1.A total of 158 patients was enrolled in this study and the complete data of 156 patients was collected.Post-pyloric position were achieved in 132 patients.The success rate was 84.6%,the average time of procedure was 15.1±9.4 min,?10 min in 64 patients(48.5%),10-20 min in 41 patients(31.1%),at?20min in 27 patients(20.5%).Post-pyloric position was achieved in 97 patents(73.5%)for first attempt and 35 patients(26.5%)for twice or more attempts.The position of tube tip was in second segment of the duodenum in 8 patients(6.1%),third segment of the duodenum in 134patients(10.6%),fourth segment of duodenum in 47 patients(35.6%),and reached the jejunum in 63 patients(47.7%).2.There were no statistic significant difference in pulse,respiration,blood pressure and oxygen saturation before,during and after tube placement procedure.3.Among the 156 patients catheterization procedure,cough was developed in 35(22.4%)patients,There was a statistical difference between patients with sedation score of ?3(20,17.5%)and patients with sedation score of>3(15,37.5%)(P<0.05).Nausea was observed in 4 patients with sedation score of>3.Nasal mucosa bleeding occurred in 12 patients.Tube indwelling period was 23.1±14.5 days.Tube obstruction occurred in 2 patients.Accidental tube removal occurred in 3 patients due to irritability.4.APACHE ? score?20 was a risk factor for successful catheterization and the attempts to pass the pylorus,with OR values of 15.023(2.859,78.951)and 3.181(1.215,8.330).Mechanical ventilation was a risk factor for successful catheterization with OR values of 4.655(1.113,19.474).Bowel sounds was a protective factor for successful catheterization with OR values of 0.074(0.015,0.358).The use of sub-hypothermia hibernation was a risk factor for the attempts to pass the pylorus with OR value of 6.044(1.550,23.570).Conclusion1.Sequential single and double wire-guided post-pyloric feeding tube placement has value in clinical application for its' success rate and shorten time of procedure.2.The higher the APACHE score,the lower the success rate of catheterization and the more attempts to pass the pylorus.Patients applying mechanical ventilation have lower success rate of catheterization.Higher success rate to pass the pylorus in patients with bowel sounds.Patients applying sub-hypothermia hibernation have more attempts to pass the pylorus.3.Age,the in-bed time,BMI,SOFA score,artificial airway,blood glucose,prokinetics,sedative and vasoactive drugs are unrelated with the success rate of placement,the time of procedure and the attempts to pass the pylorus.