Video-assisted placement of enteral feeding tubes using the Integrated Real-Time Imaging System (IRIS)-technology in critically ill patients

• Published in: Clinical nutrition (Edinburgh, Scotland) Vol. 40; no. 8; pp. 5000 - 5007
• Main Authors: Slingerland-Boot, Rianne, Bouw-Ruiter, Marianne, van Manen, Christiaan, Arbous, Sesmu, van Zanten, Arthur
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.08.2021
• Subjects: Aged; APACHE; clinical nutrition; cohort studies; Computer Systems; Critical Care - methods; Critical Illness - therapy; Efficacy; enteral feeding; Enteral Nutrition; Feasibility Studies; Feeding tube; Female; Humans; ICU; Intensive Care Units; Intention to Treat Analysis; Intubation, Gastrointestinal - methods; ligaments; Male; Middle Aged; Nutrition Assessment; Organ Dysfunction Scores; patients; Placement confirmation; Post-pyloric; Prospective Studies; Radiography; Safety; Technology - methods; Video-Assisted Techniques and Procedures; X-radiation; Feeding tube; Efficacy; ICU; Safety; Placement confirmation; Post-pyloric
• ISSN: 0261-5614; 1532-1983; 1532-1983
• DOI: 10.1016/j.clnu.2021.07.026

In critically ill patients, nasogastric (NG) and nasojejunal (NJ) feeding tube placements are standard procedures. However, about 1.9% of blind tube insertions are malpositioned in the tracheopulmonary system, whereas guided procedures may result in a significant delay in nutritional delivery. Guided methods, such as Cortrak and fluoroscopy, have success rates of 82.6–85% and 93% respectively. The current study aims to investigate the performance of video-assisted feeding tube placement in the post-pyloric position using Integrated Real Time Imaging System (IRIS-) technology. A prospective cohort study in patients requiring enteral feeding was conducted in a mixed medical-surgical intensive care unit (ICU). The primary outcome was the post-pyloric placement of IRIS feeding tubes, as confirmed by X-ray. Secondary study objectives included gastric placement, ease of use and adverse events. Thirty-one feeding tubes were placed using IRIS-technology; one patient was excluded for analysis due to protocol violation. One procedure was terminated due to significant bleeding (epistaxis) and desaturation. Only eighteen (58%) feeding tubes were placed in post-pyloric position (including two past the ligament of Treitz). In subjects who needed post-pyloric placement due gastroparesis, IRIS was mostly unsuccessful (success rate of 25%). However, when gastric placement was the primary objective, 96.8% of tubes were correctly placed. During insertion, tracheal visualization occurred in 27% of cases, and the IRIS feeding tube was repositioned early in the procedure without causing patient harm. Real-time video-assisted post-pyloric feeding tube placement in critically ill ICU patients was only successful in 58% of cases and therefore currently cannot be recommended for this indication. However, a high success rate (96.8%) for gastric placement was achieved. IRIS tube placement detected tracheal misplacement immediately and had few adverse events.