A tube for enteral nutrition of patients with aphagopraxia and patients with ventilator assistance.

A new feeding tube was designed for use in patients who cannot swallow. A comparison of our ability to pass a commercially available, mercury weighted, small feeding tube or the new, nonweighted feeding tube was made. Forty-one consecutive patients who had endotracheal intubation and who had mechanical ventilation assistance or who had suffered injuries to the central nervous system, producing aphagopraxia were compared. In the 22 patients in whom the guided tube system was first tried, enteric support was possible in 20. Gastric placement was possible in only 12 of 19 patients in whom the mercury weighted tubes were first tried and in only one of these patients did the tube pass into the small intestine beyond the ligament of Treitz. Seventeen of 20 nonweighted tubes passed into the small intestine. The newly designed small feeding tube system should be used as the initial means of gaining access to the intestine for enteric nutritional support of patients in intensive care units and after strokes or neurologic injuries when the patient cannot swallow.

Early postoperative nutritional support using the serosal tunnel jejunostomy.

A silicone rubber serosal tunnel jejunostomy for postoperative nutritional therapy was placed in 38 patients who had major operations. A dilute, chemically defined diet was begun within 48 hours of surgery and an attempt made to advance it slowly to full strength by the fifth day. No catheter-related complications occurred. Intravenous fluid therapy was shortened to less than three days in 11 (29%) patients. Only 17 (45%) patients tolerated full-strength feedings within the protocol time. Three (8%) patients depended on their tube feedings for over 30 days and the need for parenteral nutrition was avoided. Of six septic patients, four had complete intolerance of the diet; two of these developed massive gastric hypersecretion. Serum albumin was a statistically significant indicator of whether a patient could tolerate tube feedings. No patient with an albumin less than 3 g/dl tolerated full-strength feedings and the pded. Of six septic patients, four had complete intolerance of the diet; two of these developed massive gastric hypersecretion. Serum albumin was a statistically significant indicator of whether a patient could tolerate tube feedings. No patient with an albumin less than 3 g/dl tolerated full-strength feedings and the patients with albumin greater than 4 g/dl had no problems. Postoperative feeding utilizing the serosal tunnel jejunostomy is technically safe, but feeding difficulties can be anticipated in those patients who are septic or severely malnourished; these are the patients whose nutritional needs are the greatest. The greatest benefits accrue to those patients who are in need of long-term nutritional support. We recommend routine placement of these catheters in major operations.