A Minimally Invasive, Visualized Method for Nasojejunal Tube Placement

Summary

This study introduces a bedside visualized method to improve nasojejunal tube placement in intensive care unit patients, enhancing efficiency and reducing patient discomfort.

Abstract

Malnutrition is a common issue in critically ill patients, often stemming from illness, injury, or surgery. Prolonged fasting leads to intestinal issues, emphasizing the importance of early enteral nutrition, specifically through jejunal nutrition. While enteral nutrition is crucial, complications with current techniques exist. Nasojejunal (NJ) tubes are commonly used, with placement methods categorized as surgical or non-surgical. Non-surgical methods, including endoscopic guidance, have varying success rates, with endoscopic-assisted placement being the most successful but requiring specialized expertise and logistics.

This study introduces a bedside, visualized method for NJ tube placement to enhance success rates and reduce patient discomfort in the intensive care unit (ICU). In this study involving 19 ICU patients, the method achieved an initial success rate of 94.74% with an average insertion time of 11.2 ± 6.4 min. This visualized method demonstrates efficiency and reduces the need for additional imaging, and the introduction of a miniaturized endoscope shows promise, enabling successful intubation at the bedside and minimizing patient discomfort. Adjustments to the guidewire lens and catheter are necessary but pose opportunities for future refinements.

Introduction

Malnutrition frequently manifests as a common complication in critically ill patients, rendering them incapable of consuming or digesting food normally, primarily as a consequence of illness, injury, or surgical interventions^1,2,3,4. Between 30% and 60% of hospitalized patients continue to experience malnutrition⁵. As a result, the provision of early enteral nutrition support is deemed crucial⁶. The implementation of early jejunal nutrition serves not only to uphold the integrity of gastrointes....

Protocol

This study was approved by the Clinical Research Ethics Committee of the People's Hospital of Anji County. All procedures were carried out in accordance with institutionally approved protocols and with the informed consent of the patients.

1. Patient selection and preparation

1. Choose patients based on the following inclusion and exclusion criteria.
   1. Set the inclusion criteria as patients with acute gastrointestinal dysfunction; those undergoing mechan.......

Discussion

We utilized a small visualization tool to insert NJ tubes at the patient's bedside. By employing visualization methods and adjusting patient positioning, we achieved a 94.47% success rate for the initial tube placement. The average time for inserting the tube was just 11.21 ± 6.44 min (Table 2). One patient initially failed intubation but was successfully intubated after receiving a 10 mg intramuscular injection of metoclopramide 20 min before their second attempt (Table 2).

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Materials

Name	Company	Catalog Number	Comments
Disposable nasogastrointestinal tube	JiangSu Jianzhiyuan Medical Instrument Technology Co., Ltd.	W-4.7-1400mm	The outer diameter of the guide tube is 4.7 mm.
Lidocaine Hydrochloride Gel	Manufacturers are not limited		For local anaesthesia
Medical Endoscopy Image Processor	JiangSu Jianzhiyuan Medical Instrument Technology Co., Ltd.	HD1080	The diameter of the guide wire lens is 2 mm.
Metoclopramide Dihydrochloride Injection	Manufacturers are not limited		Promote gastric motility
SPSS 20.0 software	International Business Machines Corporation		Statistical analysis
Sterile liquid paraffin oil	Manufacturers are not limited		For catheter lubrication