Placement of a Magnetic Small Bowel Feeding Tube at the Bedside.

BACKGROUND: Current methods of achieving postpyloric enteral access for feeding are fraught with difficulties, which can markedly delay enteral feeding and cause complications. Bedside tube placement has a low success rate, often requires several radiographs to confirm position, and delays feeding by many hours. Although postpyloric enteral tubes can reliably be placed in interventional radiology (IR), this involves greater resource utilization, delays, cost, and inconvenience. We assessed the utility of bedside enteral tube placement using a magnetic feeding tube (Syncro-BlueTube; Syncro Medical Innovations, Macon, GA, USA) as a means to facilitate initial tube placement. METHODS: We recorded the time to insertion, location of tube, success rate, and need for radiographs in a series of patients given magnetic feeding tubes (n = 46) inserted by our hospitalist service over an 8-month interval. RESULTS: Of the 46 attempted magnetic tube placements, 76% were successfully placed in the postpyloric position, 13% were in the stomach, and 11% could not be placed. In 83% of the magnetic tubes, only 1 radiograph was needed for confirmation. The median time to placement was 12 minutes (range, 4-120 minutes). CONCLUSION: The use of a magnetic feeding tube can increase the success rate of bedside postpyloric placement, decrease the time to successful placement, and decrease the need for supplemental radiographs and IR.

Visual color perception in green exercise: positive effects on mood and perceived exertion.

Positive effects of green exercise on physical and psychological wellbeing have been found, yet little is known about the underlying cognitive mechanisms responsible for such effects. The purpose of this visual sensation study was to establish the extent to which the color green, as a primitive visual feature of many natural environments, contributes to the green exercise effect. Fourteen participants performed three moderate-intensity 5-min cycling tasks (50% peak power output) while watching video footage of a rural cycling course that simulated cycling through a real natural environment. The three randomly counter-balanced video conditions were unedited (V(GREEN)), achromatic (V(GRAY)) or red filter (V(RED)). Lower total mood disturbance and ratings of perceived exertion were found during the V(GREEN) compared to V(GRAY) and V(RED). Feelings of anger were higher after V(RED) compared to the other conditions. Feelings of tension, depression, fatigue, vigor, and confusion did not differ among conditions. This is the first study to show that the color green, as a primitive feature of visual sensation, has a contributory effect toward positive green exercise outcomes.

Peripherally inserted central catheter use in the hospitalized patient: is there a role for the hospitalist?

BACKGROUND: Peripherally-inserted central venous catheters (PICCs) are frequently used in hospitals for central intravenous access. These catheters may offer advantages over traditional central catheters with respect to ease of placement and decreased complication rates. However, hospital physicians have not traditionally been trained to place PICCs. METHODS: We trained 3 of 5 hospitalists to place PICCs in our small university-affiliated community hospital as we converted from a house physician model to a hospitalist model for inpatient care. We then looked retrospectively at the rates of all PICC and other central catheter placements as well as the number of femoral and nonfemoral catheter days for the 18-month period prior to and after the inception of the hospitalist program. RESULTS: Comparing the periods prior to and after the inception of the hospitalist program, the total number of central catheter placements doubled and the PICC rate rose from 20% to 80% of all central catheters. The rate of femoral and subclavian catheter placements decreased by approximately 50% and the rate of internal jugular catheter placement was roughly unchanged. There was also a fall in the number of femoral catheter days and a great increase in the number of total nonfemoral catheter days. The rate of catheter-related bacteremia remained low and did not appear to increase. CONCLUSIONS: PICCs may be a safe and easy alternative to centrally placed catheters for the hospital physician attempting to secure central intravenous access and may lead to a decrease in the need for more risky central venous catheter (CVC) insertions.