Safe, timely, convenient, and cost-effective: a single-center experience with bedside placement of enteral feeding tubes by midlevel providers using fluoroscopic guidance.

BACKGROUND: Enteral feeding tube placement has been performed by nurses, gastroenterologists using endoscopy, and interventional radiologists. We hypothesized that midlevel providers placed feeding tubes at bedside using fluoroscopy safely, rapidly, and cost-effectively. METHODS: We retrospectively analyzed bedside feeding tube placement under fluoroscopy by trained nurse practitioners. We compared charges for this method with charges for placement by other practitioners. RESULTS: Nurse practitioners placed 632 feeding tubes in 462 patients. Three hundred seventy-nine placements took place in mechanically ventilated placements. Ninety-seven percent of tubes were positioned past the pylorus. The mean fluoroscopy time was 0.7 ± 1.2 minutes. The mean procedure time was 7.0 ± 5.1 minutes. All tubes were placed within 24 hours of the request. There were no complications. Institutional charges for tube placement were $149 for nurse practitioners, $226 for gastroenterologists, and $328 for interventional radiologists. CONCLUSIONS: The placement of feeding tubes under fluoroscopy by nurse practitioners is safe, timely, and cost-effective.

Delayed post-traumatic saccular aneurysm of PICA in an adolescent.

Delayed traumatic intracranial aneurysms of the posterior circulation caused by nonpenetrating head injury are rare, especially in pediatric patients. The true incidence and natural history of these aneurysms are poorly understood. We report a case of a 15-year-old boy who initially presented with subarachnoid hemorrhage of the posterior fossa without any evidence of associated aneurysm. On a routine computed tomography of the head, however, he was found to have a saccular aneurysm of the proximal posterior inferior cerebellar artery. The patient was treated successfully by microsurgical clipping and PICA/PICA bypass.