Evaluation of a Nasoenteral Feeding Tube With Balloon to Facilitate Placement.

BACKGROUND: Enteral feeding is essential for critically ill, head trauma, and burn patients who are unable to swallow. OBJECTIVE: To evaluate a new nasoenteral feeding tube with distal tip balloon designed to facilitate post-pyloric migration and avoid misplacement in the trachea. METHODS: A case series was conducted in 50 critically ill patients aged 19 to 89 years receiving mechanical ventilation and requiring enteral nutrition in a teaching hospital. Patients received a soft, flexible, kink-resistant nasoenteral feeding tube with a balloon near the distal tip to enhance postpyloric migration by peristalsis. The feeding tube was inserted with a novel thread technique to reduce posterior nasopharyngeal trauma and tube misplacement. Pulse oximetry provided early detection of misplacement into the trachea. Placement was verified by abdominal radiography performed shortly after the procedure and repeated within 24 hours if needed. RESULTS: Postpyloric placement was achieved at 30 minutes in 24% of patients and by the following morning in 70% of patients. Tracheal intubation occurred in 1 patient but was recognized and corrected without injury. No tube occlusion from kinking occurred. CONCLUSIONS: Early gastric or postpyloric feeding can be provided with this novel feeding tube. Its use facilitates quick bedside recognition of accidental misplacement in the trachea, reducing the chance of pneumothorax. The tip balloon reduces deeper placement into a lung and promotes distal migration into the small intestine. The design prevents occlusion from kinking, which is common with conventional feeding tubes. Nurses easily adopted the tube and insertion technique.

Perception of health-related case studies in the context of introduction to clinical medicine course: students' and teachers' perspective.

BACKGROUND: Integrating theoretical and practical knowledge and stimulating students' active learning is the most important task of modern and high-quality healthcare education. By analyzing clinical cases, undergraduate medical students are trained to make accurate diagnoses, to choose appropriate therapy based on laboratory results and on adequate diagnostic tests. AIM: To examine the effect of clinical cases presentations on short-term memory as well as on the student's and teachers' evaluation of this method of teaching and learning in undergraduate medical studies. METHODS: A total of 107 students in term 4 and term 5 enrolled in Trinity Medical Sciences University in St. Vincent and the Grenadines participated in this cross-sectional study. At the end of the semester, the students and the faculty were asked to complete a survey to assess their perception of case presentations (10 items, 4-point Likert-type scale, strongly agree to strongly disagree). The results of pre- and post-presentation quizzes were evaluated using the Wilcoxon signed rank test for paired samples. RESULTS: Term 4 and term 5 students significantly improved their achievement after intervention (Wilcoxon test Z = - 11.282, p < 0.001, and Wilcoxon test Z = - 10.167, p < 0.001, respectively). The analysis of progress among low- and high-performance students in both terms showed a significant increase in performance. Overall, median students' and teachers' attitude scores were positive. CONCLUSION: Clinical case presentation has a learning potential and facilitates positive interaction between instructors and students and supporting students to become reflective and competent physicians.