Search

Background Nasogastric (NG) feeding tubes are used to deliver nutrition, hydration, and medications to hospitalized infants and children but the ongoing use of non-evidence-based practice (EBP) methods to confirm NG tube (NGT) placement has been associated with adverse patient events. Methods A study was undertaken to ascertain if practice changes have occurred since findings from a previous study were published by the New Opportunities for Verification of Enteral tube Location (NOVEL) project. The NOVEL project was an initiative of the American Society of Parenteral and Enteral Nutrition (ASPEN). A survey was distributed to member organizations participating in the NOVEL project. Respondents were also asked if and when a change in practice occurred in the policy for NGT placement verification, if there was variation within the institutional units and if there were barriers to practice change. Findings Respondents were primarily nurses (205/245) from 166 institutions that provided care to combined adult/pediatric/neonatal (122/166) patients. Respondents indicated a radiograph (64%) or pH measurement (24%) were best practice but in actual practice 42% use pH measurement and 23% use a radiograph to verify NGT placement. There was variability within institutions, with the Neonatal Intensive Care Unit (NICU) most often using aspiration and direct eye visualization to verify placement and the other units within the institutions using EBP method(s). Discussion Comparing these results to previous work by the NOVEL project shows an increase toward the use of EBP method(s) to verify NGT placement verification. Application to practice This study demonstrates variation within units at the same facility using methods unsupported by the literature, demonstrating that many centers still rely on non-EBP methods of NG placement confirmation, despite cautions issued by many major healthcare organizations.

Background During neurally adjusted ventilatory assist (NAVA)/noninvasive (NIV) NAVA, a modified nasogastric feeding tube with electrodes monitors the electrical activity of the diaphragm (Edi). The Edi waveform determines the delivered pressure from the ventilator. Objective Our objective was to determine whether NAVA/NIV-NAVA has advantages in infants with evolving/established bronchopulmonary dysplasia (BPD). Methods Each infant who received NAVA/NIV-NAVA and conventional invasive and NIV was matched with two historical controls. Eighteen NAVA/NIV-NAVA infants’ median gestational age, 25.3 (23.6–28.1) weeks, was compared with 36 historical controls’ median gestational age 25.2 (23.1–29.1) weeks. Results Infants on NAVA/NIV-NAVA had lower extubation failure rates (median: 0 [0–2] vs. 1 [0–6] p = 0.002), shorter durations of invasive ventilation (median: 30.5, [1–90] vs. 40.5 [11–199] days, p = 0.046), and total duration of invasive and NIV to the point of discharge to the local hospital (median: 80 [57–140] vs. 103.5 [60–246] days, p = 0.026). The overall length of stay (LOS) was lower in NAVA/NIVNAVA group (111.5 [78–183] vs. 140 [82–266] days, p = 0.019). There were no significant differences in BPD (17/18 [94%] vs. 32/36 [89%] p = 0.511) or home oxygen rates (14/18 [78%] vs. 23/36 [64%] p = 0.305). Conclusion The combination of NAVA/NIV-NAVA compared with conventional invasive and NIV modes may be advantageous for preterm infants with evolving/established BPD.

Background Despite the publication of a national patient safety alert in 2016, inadvertent feeding through misplaced nasogastric tubes continues to occur, either through failure to review the radiograph, misinterpretation of it, or failure to communicate the results. Objective The objectives were to determine whether training in a new pathway introduced to avoid these “never events” was followed and whether radiographer comments and prompt communication of results could reduce risk and improve patient safety in relation to nasogastric tube placement in children. Materials and methods Following radiographer training in interpretation of nasogastric tube position and use of a commenting proforma and communication pathway, we reviewed all radiographs obtained to check nasogastric tubes performed over a 13-month period in children 0–16 years of age. Then we assessed accuracy of the radiographer comments, adherence to the pathway, and any practice change in children with misplaced nasogastric tubes. Results We reviewed 282 nasogastric tube check radiographs. For 262 radiographs (92.9%) the pathway was followed correctly. Of the total 282 radiographs, 240 (85%) were immediately reported using the standardised commenting proforma, and 235 radiographer comments were affirmed by the radiologist (97% accuracy, confidence interval 0.95–0.99). Of the immediately reported radiographs, 213 (88.8%) nasogastric tubes were considered to be safe for use. Four (1.7%) of the immediately reported nasogastric tubes were misplaced in a bronchus, and the report communicated to the clinical team resulted in removal or re-siting of the tubes. Conclusion Nasogastric tube check radiographs in children can be reported accurately by radiographers trained in their interpretation and the results promptly communicated to clinical staff, improving safety in relation to nasogastric tube placement in children.

Nasogastric feeding tube plays an important role in administering enteral feeding and drug delivery for poststroke patients with consciousness disorders or poststroke dysphagia. Nevertheless, placement of nasogastric tubes is not without any risk of potential harm. Inadvertent malposition into the trachea or the distal tracheobronchial tree could induce severe pulmonary complications. As for poststroke patients with long-term dysphoria, such tubes have to be replaced periodically to prevent the overdue service of the tubes. Therefore, the risk of feeding tube misplacement into pulmonary system for these patients is increased. Here, we present a case of a 79-year-old poststroke patient with hydropneumothorax induced by malposition of nasogastric tube into the right pleura after routine replacement, accompanied by acute anterior wall myocardial infarction.

The following provides clinical reporting of seven neonates with iatrogenic pharyngeal trauma due to forceful untrained use of nasogastric feeding tube. A range of symptoms were observed beginning with excessive frothy secretions culminating in more severe pneumothorax in some. These cases are presented in the context of an exhaustive literature review producing only 50 similar cases worldwide. Special attention is paid toward accurate diagnosis, prognosis, and guidance on most effective modes of treatment. Using Medtronic flexible nasopharyngolaryngeal endoscope, examination of the presented neonates was done in the neonatal care unit. Some neonates underwent videofluroscopic study. Ryle tube insertion in neonates could result in range of complications that could be easily avoided and managed.

Background: Surgical feeding ostomies (SFO, e.g. gastrostomy) have replaced natural orifice feeding tubes (NOFT, e.g. nasogastric feeding tube) as the preferred route for long-term enteral nutrition. Reports of complication rates for SFO vary. Many hospitalized patients are required to accept SFO before hospital discharge due to skilled nursing facilities (SNFs) policy, and without supportive data. We compare adverse event rates between SFO and NOFT. Methods: A prospective cohort study of enterally fed inpatients using semiweekly focused physical exam, scripted survey, and chart review. Findings: Over the course of nine weeks, 226 unique patients were seen an average of 6.25 times each for a total of 1118 unique observations. Demographic data were comparable between subgroups. There were 148 subjects with NOFT and 113 subjects with SFO. 35 NOFT crossed over to SFO during the study. More NOFT than SFO observations took place in ICUs (p

Objectives: Chest X-ray imaging is frequently used for verifying the position of a blindly inserted nasogastric tube. A high-quality X-ray increases the likelihood of conclusive visibility of tube tip positioning, thus avoiding risks due to a misplaced tube (e.g., pulmonary intubation, pneumothorax, small bowel insertion). Therefore, this study aims to determine patient-related and environmental factors affecting the visibility of nasogastric tubes on X-ray in adults. Methods: A retrospective descriptive analysis of routinely collected clinical data was performed on all included patients (N = 215) from a prospective randomized trial in a general hospital. A chest X-ray was taken of each patient needing a nasogastric feeding tube, after which visibility and positioning of the tube on X-ray was independently evaluated by 3 radiologists. Results: In 14.9% (n = 32) of all patients, image quality was insufficient, so no conclusive visibility of nasogastric tube positioning could be found. A patient-related predictor regression model (sex, age, body mass index) explained 21% of variance for an insufficient visibility of the nasogastric tube (Nagelkerke R2 = 0.21). An environmental factor regression model demonstrates a guidewire being inside the tube or not during X-ray as a predictor for a conclusive visibility on X-ray. Conclusions: High body mass index, male sex, and the absence of a guidewire inside the nasogastric tube at the time of chest X-ray are associated with a risk of insufficient visibility of the tube on X-ray. Patient profiles can be defined in which supplementary attention is needed when obtaining chest X-rays whose purpose is to confirm nasogastric tube positioning. Key Points: • The quality of chest X-rays to confirm the positioning of nasogastric tubes in adults can be improved considerably. • There are several factors influencing the confirmation of nasogastric tube positioning on X-ray. • Defining patient profiles at risk for an insufficient visibility of the tube on X-ray will indirectly contribute to an improvement of the chest X-ray quality.

In Pereira et al letter "Misplacement of a nasogastric feeding tube: a case report" we found some debatable concepts about the frequency of pleural and pulmonary injuries due to accidental access of the feeding tubes in the airway and techniques for placing feeding tubes. We clarify that the frequency of injuries due to accidental entry into the airway is not as low as the authors state and that blind placement should be avoided.

Phlegmonous gastritis is a rare but often fatal acute pyogenic infection of the stomach. We herein report three cases of phlegmonous gastritis with different causes: the long-term placement of a nasogastric feeding tube, bacteremia associated with cellulitis in a diabetic patient, and an adverse reaction to paclitaxel/carboplatin chemotherapy for cancer of unknown primary cause, which were classified as primary, secondary, and idiopathic types, respectively. Coping with the increasing morbidity rate associated with the diverse background of such patients requires a thorough understanding of the clinical features and image findings associated with this entity.

OBJECTIVE The purpose of this study was to analyze the outcomes of surgically salvaged early glottic cancer (EGC) recurrences after initial radiotherapy (RT) or transoral laser microsurgery (TLM). METHODS A matched pair analysis by recurrent tumor-node-metastasis stage (rTNM) considering 27 patients who had TLM as initial treatment and 54 patients who failed after primary RT was performed. Post-recurrence overall and disease-specific survival (DSS) were evaluated. RESULTS The RT-failed group showed worse post-recurrence overall survival (P < .001) and DSS (P = .005) compared to TLM-first group despite the same rTNM stage. The RT failed patients also showed more postoperative complications (longer mean decannulation time, P = .005; nasogastric feeding tube dependence, P = .012) and a higher rate of second locoregional recurrences (P = .004). CONCLUSION The RT-failed EGC showed worse outcomes in terms of survival, complications, and locoregional recurrences compared to same recurrent TNM stage TLM-failed cases. LEVEL OF EVIDENCE 3 Laryngoscope, 129:2328-2333, 2019.

Background Several studies have shown that the nose‐earlobe‐xiphoid distance (NEX) is inadequate to estimate the insertion length of nasogastric tubes. An alternative approach tested in these studies, which leads to > 90% well‐placed nasogastric tubes, used a corrected calculation of the NEX: (NEX × 0.38696) + 30.37. The primary aim of this study was to determine whether using the corrected NEX was more successful than the NEX in determining the insertion length. The secondary aim was to investigate the likelihood to successfully obtain gastric aspirate. Methods Adult patients in a general hospital (N = 215) needing a nasogastric tube were randomized to the control (NEX) or intervention group (corrected NEX). Tip positioning was verified using X‐ray. Correct tip positioning was defined as between 3 and 10 cm under the lower esophageal sphincter (LES). Results In >20% of all patients, both methods underestimated the required tube length for correct positioning. The NEX showed an overestimation (17.2%) of the insertion length (>10 cm under the LES) compared with the corrected NEX (4.8%). There was no difference (P = 0.938) between the 2 groups in obtaining gastric aspirate (55.6% vs 56%). However, correct tip positioning resulted in a fourfold increase of obtaining gastric aspirate. Conclusions Both methods resulted in a high risk of incorrectly placed tubes due to malposition of the tip near the LES or distal esophagus. This may increase the risk of reflux and pulmonary aspiration. Based on these results, the development of more reliable methods requires consideration. ispartof: NUTRITION IN CLINICAL PRACTICE vol:33 issue:6 pages:843-850 ispartof: location:United States status: published

Intermediate incisions are considered necessary to pass a catheter tube from the head to the abdomen in ventriculo-peritoneal (VP) shunting via a frontal bur hole. However, an intermediate incision can sometimes become dehiscent, resulting in CSF leakage or infection of the shunt system in the early period after shunt implantation, particularly in infant patients. In this article, the authors describe a novel method of VP shunt insertion that does not require an intermediate incision. This nonintermediate-incision VP shunt procedure was performed in 3 infant patients with hydrocephalus and was not associated with any complications. This method can eliminate the intermediate incision, which is a disadvantage of VP shunt insertion via a frontal bur hole.

Aim. To explore individual quality of life in patients with head and neck cancer from diagnosis up to 3 months after termination of radiotherapy. Research questions: 1) Which areas in life are important to quality of life, and which are influenced by the disease and by having oral or enteral nutrition; and 2) Which areas in life are influenced by having a nasogastric feeding tube (NGT) or a percutaneous endoscopic gastrostomy (PEG) tube? Material and methods. Data were collected in 36 patients. Semi-structured interviews were conducted using an extended version of the Schedule for the Evaluation of Individual Quality of Life (SEIQoL) and analysed with content analysis. Results. Negative and positive experiences of quality of life in general were about relation to family, own health, and leisure activities. Negative impacts on physical, psychological, existential and social problems, but also positive experiences are described by the patients related to the disease. More than half expressed eating-related problems. Enteral nutrition entailed negative and positive experiences, and no greater variations were described by the patients with NGT or PEG tube. Overall, there were interindividual variations. Conclusions. The patients’ perception of general or disease-related quality of life was not affected by whether they had enteral nutrition or not. From the patients’ perspective neither of the two feeding tubes (NGT or PEG) was clearly in favour. We suggest that more studies are needed on how the choice of enteral feeding tube can be evidence-based, and incorporating the patients’ perspective.

Introduction Maintaining placement of the nasogastric feeding tube (NGT) is imperative in the double stage laryngotracheoplasty (dsLTP) patient because of concerns for adequate nutrition and hydration in the postoperative period. Additionally, multiple reinsertions due to displacement potentiate surgical morbidities. The purpose of this study was to compare NGT dislodgment rates in children with and without a commercial nasal bridle following a dsLTP surgical procedure and to determine if the use of a commercial nasal bridle decreases accidental tube dislodgements. Methods Medical records of pediatric patients with NGT insertion for dsLTP between Jan 1, 2012 and June 15, 2018 were reviewed for nasal bridle use, demographics, feeding tube and bridle complications, x-rays to check NGT placement, length of stay (LOS), length of bridle use and accidental feeding tube dislodgements. Results A total of 67 patients (34 unbridled and 33 bridled) received an NGT after dsLTP. No differences in demographics were noted, except the bridled group was older (median age 6.5 [IQR: 3.7, 14.3] than the unbridled group (median age 3.2 [IQR: 2.2, 6.8], p = 0.05). There were 24 episodes of NGT dislodgement in 16 patients in the unbridled group and zero displacements in the bridled patients resulting in an incidence of 9.4 [95%CI: 6.0, 14.0] and 0.0 [95%CI: 0.0, 1.9] pullouts per 100 days for unbridled versus bridled patients, respectively. Those with displacement had significantly more x-rays to check placement (p = 0.0004) and LOS was longer (p = 0.06) with a mean (SD) of 10.9 (7.0) vs. no displacement 7.0 (3.6) days. Of those bridled, 67% were discharged with a bridle and 86% returned with the NGT and bridle in place (mean bridle placement of *** ± days) at the time of stent removal. No feeding tube or bridle complications were reported for either group. Conclusion The commercial nasal bridle significantly reduced NGT displacements without complication in the examined pediatric sample s/p dsLTP. Bridle use was associated with decreased radiology exposure and LOS and was successfully used in the outpatient setting.

Purpose The aim of this retrospective study was to compare the effectiveness of nasogastric tube (NGT) feeding of a semisolid diet versus a liquid diet after orthognathic surgery. Patients and Methods The orthognathic surgery patients were relatively young and generally healthy, without severe medical disease. Of the patients, 26 received liquid feeding (liquid diet group [LG], with an administration rate of 100 mL/hour), 30 received semisolid feeding at a high administration rate (semisolid diet–rapid administration group [SSRAG], 200 to 500 mL/hour), and 33 received semisolid feeding at a slower rate (semisolid diet–slow administration group [SSSAG], 100 mL/hour). We retrospectively investigated the complications of NGT feeding in each group. Results The incidence of diarrhea was clearly lower in the SSRAG than in the LG. Among patients with lower–gastrointestinal tract symptoms, stool form scale scores and maximum defecation frequency per day were significantly lower in the SSRAG than in the LG (P = .001 for both). Rapid administration of a semisolid diet via an NGT resulted in fewer complications and shorter feeding times for orthognathic surgery patients. Conclusions The rapid administration of a semisolid diet via an NGT should decrease the complications of NGT feeding and improve the quality of the perioperative period for patients. The findings of this study will help clinicians select NGT diets for relatively young, healthy patients, such as orthognathic surgery patients.

ObjectivesThe existing British National Patient Safety Agency (NPSA) safety guideline recommends testing the pH of nasogastric (NG) tube aspirates. Feeding is considered safe if a pH of 5.5 or lower has been observed; otherwise chest X-rays are recommended. Our previous research found that at 5.5, the pH test lacks sensitivity towards oesophageal placements, a major risk identified by feeding experts. The aim of this research is to use a decision analytic modelling approach to systematically assess the safety of the pH test under cut-offs 1–9.Materials and methodsWe mapped out the care pathway according to the existing safety guideline where the pH test is used as a first-line test, followed by chest x-rays. Decision outcomes were scored on a 0–100 scale in terms of safety. Sensitivities and specificities of the pH test at each cut-off were extracted from our previous research. Aggregating outcome scores and probabilities resulted in weighted scores which enabled an analysis of the relative safety of the checking procedure under various pH cut-offs.ResultsThe pH test was the safest under cut-off 5 when there was ≥30% of NG tube misplacements. Under cut-off 5, respiratory feeding was excluded; oesophageal feeding was kept to a minimum to balance the need of chest X-rays for patients with a pH higher than 5. Routine chest X-rays were less safe than the pH test while to feed all without safety checks was the most risky.DiscussionThe safety of the current checking procedure is sensitive to the choice of pH cut-offs, the impact of feeding delays, the accuracy of the pH in the oesophagus, as well as the extent of tube misplacements.ConclusionsThe pH test with 5 as the cut-off was the safest overall. It is important to understand the local clinical environment so that appropriate choice of pH cut-offs can be made to maximise safety and to minimise the use of chest X-rays.Trial registration numberISRCTN11170249; Pre-results.

A newborn presents with a thin hairlike fiber connecting the medial aspect of her upper and lower eyelids vertically (Fig 1). Figure 1. The infant was doing well on nasal CPAP upon arrival to the NICU. However, she would develop respiratory distress upon discontinuation of CPAP mask. The nursing staff reported difficulty passing a nasogastric feeding tube, raising a suspicion of choanal atresia. The admitting house staff and nurse noted a thin threadlike tissue connecting the eyelids vertically. This was initially thought to be a strand of hair, but could not be rubbed off by wiping. ### Vital Signs ### Physical Examination

Key Clinical Message Nasogastric tubes (NGT) are extensively used and generally harmless, yet loop formation and malpositioning are often reported especially when using thin NGT for enteral feeding which placed blindly; therefore, diligent follow‐up of NGT is required with confirmation of right placement, changing it to PEG if long use of NGT needed.

Introduction The exposed section of a traditional nasogastric (NG) tube can interfere with patients' social activities and thereby result in distress. This study was conducted to evaluate the feasibility and safety of a novel two-piece NG tube for patients with dysphagia. Methods Ten patients with dysphagia were recruited between November 2011 and May 2012. Patients who were unconscious or in critical condition, had a traditional NG tube 60 cm in fixed length, or were unable to follow instructions or sign consent forms were excluded. The two-piece NG tube, which was placed in the patients for one week, comprised a removable external tube that can be joined to an internal tube via a T-connector, which was placed close to the naris. Events related to safety (e.g. nasal pressure sores, number of unplanned extubation, displacement and spontaneous migration of the NG tube, other unpredictable injuries) and effectiveness (e.g. liquid food spills, tube obstruction, perfusion rate, other adverse circumstances) were assessed daily. Results All patients received feeding without complication using the two-piece NG tube and none experienced premature removal of the tube. No serious NG tube complications or malfunctions were observed. Conclusion The results of this study indicate that the two-piece NG feeding tube is a feasible option for patients with dysphagia. Future improvements to the connector may help enhance its performance. A rigorous randomised controlled trial to examine the effects of the two-piece NG tube on patients' quality of life and quality of medical care is being planned.

Background Establishing postnatal nutrition delivery is challenging in neonates with immature sucking and swallowing ability. Enteral feeding is the gold standard for such patients, but their small size and fragility present challenges in nasogastric (NG) feeding tube placement. Feeding tubes are typically placed with x-ray guidance, which provides minimal soft tissue contrast and exposes the baby to ionizing radiation. This research investigates magnetic resonance (MR) guidance of NG feeding tube placement in neonates to provide improved soft tissue visualization without ionizing radiation. Materials and methods A novel feeding tube incorporating 3 solenoid coils for real-time tracking and guidance in the MR environment was developed. The feeding tube was placed 5 times in a rabbit with conventional x-ray guidance to assess mechanical stability and function. After x-ray procedures, the rabbit was transferred to a neonatal MR system, and the tube was placed 5 more times. Results In procedures guided by x-ray and MR, the feeding tube provided sufficient mechanical strength and functionality to access the esophagus and stomach of the rabbit. MR imaging provided significantly improved soft tissue contrast versus x-ray, which aided in proper tube guidance. Moreover, MR guidance allowed for real-time placement of the tube without the use of ionizing radiation. Conclusions The feasibility and benefits offered by an MR-guided approach to NG feeding tube placement were demonstrated. The ability to acquire high-quality MR images of soft tissue without ionizing radiation and a contrast agent, coupled with accurate 3-dimensional device tracking, promises to have a powerful impact on future neonatal feeding tube placements.

Objective Pulmonary misplacement during the blind insertion of enteral feeding tubes is frequent, particularly in ventilated and neurologically impaired patients. This is probably the first clinical study using the Kangaroo Feeding Tube with IRIS technology (IRIS) which incorporates a camera designed to provide anatomic landmark visualization during insertion. The study aim was to evaluate IRIS performance during bedside gastric placement. Methods This is the first prospective study to collect data on the use of IRIS. Twenty consecutive unconscious patients requiring enteral nutrition were recruited at a single center. IRIS placement was considered complete when a clear image of the gastric mucosa appeared. Correct placement was confirmed using a contrast-enhanced abdominal X-ray. To evaluate the device performance over time, the camera was activated every other day up to 17 d postplacement. Results In 7 (35%) patients, the trachea was initially visualized, requiring a second placement attempt with the same tube. The IRIS camera allowed recognition of the gastric mucosa in 18 (90%) patients. The esophagogastric junction was identified in one patient, while in a second patient the quality of visualization was poor. Contrast-enhanced X-ray confirmed the gastric placement of IRIS in all patients. IRIS allowed identification of gastric mucosa in 14 (70%) patients 3 d after placement. Performance progressively declined with time (P = 0.006, chi-square for trend). Conclusion IRIS placement could have spared X-ray confirmation in almost all patients and prevented misplacement into the airway in about one third. Visualization quality needs to be improved, particularly after the first week.

Epidermolysis bullosa (EB) is an inherited skin disease with four main subtypes that cannot be distinguished clinically at birth. All subtypes may present with widespread life-threatening blisters and fragile skin, making treatment and handling of the newborn with EB challenging. The prognosis of EB depends on the subtype, and therefore maximum treatment is necessary until the final diagnosis is known. In this case, it took 2 weeks before a final diagnosis was reached. In the meantime, we had several ethical discussions on the treatment level. The most important issues were management of pain and nutrition. For immediate pain relief, intranasal fentanyl worked best and gabapentin was successfully used for chronic pain. The feeding difficulties were handled first by a nasogastric feeding tube. Later a normal feeding bottle proved to be adequate.

Introduction: Preliminary study on the evaluation of weight restoration by using a nasogastric feeding tube begun in hospital, for ambulatory anorexia nervosa treatment Methods: A retrospective review of patients’ folders from outpatient department of eating disorders of the Pellegrin University Hospital Center, has been performed. The study includes the adults from April 2015 to January 2016, who had a low BMI (, Introduction : Étude préliminaire sur l’évaluation du gain de poids par l’utilisation d’une sonde nasogastrique à domicile, instaurée initialement à l’hôpital, comme thérapie de renutrition chez des patients souffrant d’anorexie mentale. Méthode : Un examen rétrospectif des dossiers des patients, consultant dans le service des troubles du comportement alimentaire du Centre Hospitalier Universitaire de Pellegrin, d’avril 2015 à janvier 2016, a été réalisé. Les patients inclus avaient un IMC < 15 kg/m² et une perte de poids très rapide. Étaient exclus les patients ayant des troubles du comportement alimentaire atypique, une autre affection psychiatrique chronique sévère non traitée, une maladie somatique responsable d’une dénutrition, ou les patients refusant le traitement. Le critère d’évaluation principal était le gain de poids hebdomadaire. Résultats : 7 patients ont été inclus. La population était composée exclusivement de femmes, d’une moyenne d’âge de 28 ans, ayant un IMC moyen à 12,81 kg/m². Il y a eu un refus de poursuivre le traitement. 6 patients ont donc été étudiés. La durée moyenne d’hospitalisation était de 39 jours, avec une sortie acceptée pour un IMC moyen à 15,03 kg/m². Le gain moyen hebdomadaire était de + 1,25 kg/semaine (écart-type : 0,51). À domicile, le gain de poids moyen était de + 0,84 kg/semaine, avec une durée moyenne de 38,8 jours, la sonde étant retirée à un IMC moyen à 16,16 kg/m². Au total un gain de poids hebdomadaire de +0,86 kg a été obtenu, pour une durée totale de traitement par SNG de 77,8 jours. Le gain moyen d’IMC sur la durée totale du traitement était de +3,24 kg/m². Aucun syndrome de renutrition inapproprié n’a été observé. Conclusion : La nutrition entérale à domicile a permis un gain de poids régulier, en accord avec les recommandations internationales et les dernières données de la science, chez des patients souffrant d’anorexie mentale, sans augmenter le risque de syndrome de renutrition inapproprié, et en réduisant de façon importante la durée d’hospitalisation.

Complications from a prolonged nasogastric tube intubation, though seldom reported, are well described. Herein we describe the first two reported cases of velopharyngeal insufficiency secondary to velopharyngeal scarring and immobility from repetitive nasogastric tube insertions and prolonged use. Differing only in location, the proposed pathophysiologic mechanism of injury is identical to that of the nasogastric tube syndrome, a rare and serious, well described entity consisting of bilateral vocal fold paralysis due to pressure-induced ulceration of the posterior cricoarytenoid musculature.

Background: The objective of the present study is to observe the effect of frequency of changing nasogastric feeding tube (NG-FT) on microbial growth in relation to development of neonatal sepsis in premature newborns. The study is prospective observational study in its nature. Neonatal intensive care unit (NICU) of a tertiary care teaching hospital of western Gujarat, India, from December 2016 to November 2017.Methods: Eighty-five preterm newborns admitted to NICU for feeding support were randomly divided into three groups depending on frequency of changing nasogastric feeding tubes (Group I, II and III with NG-FT changed every 12, 24 and 48 hourly respectively). In Groups I, II and III, the first NG-FT cultures were sent at the end of 12, 24, 48 hours of NG-FT insertion respectively. The second and third NG-FT cultures were sent after 7 and 14 days respectively. Microbial growth pattern was observed and correlated with development of necrotizing enterocolitis (NEC), neonatal sepsis and mortality.Results: Microbial growth on first NG-FT culture significantly increased when frequency of changing nasogastric feeding tube was reduced from every 12 to 24 or 48 hours {p = 0.0432 (Group I vs II) and 0.0001 (Group I vs III)}. Microbial growth increased on second (24.1%, 87% and 85% in groups I, II and III respectively) and third NG-FT culture (44% in group I and 100% in groups II and III); this was significantly high in group II and III as compared to group I (p = 0.0001). Common organisms isolated were Klebsiella pneumonia (63.28%), Pseudomonas aeruginosa (32%) and Escherichia coli (21%). No significant difference was noted in incidences of feeding intolerance, necrotizing enterocolitis (NEC), neonatal sepsis and mortality among the three groups.Conclusions: Organism growth in nasogastric feeding tube culture increases significantly when frequency of changing NG-FT is beyond 12 hours. However, there is no increase in episodes of feeding intolerance, necrotizing enterocolitis (NEC), neonatal sepsis and mortality.

Summary Background & aims The reported incidence of nasogastric feeding tube dislodgement is 40%. In many cases, repeated tube dislodgements result in having to initiate gastrostomy feeding or total parenteral nutrition. To address this problem we sourced a tube-securing device (nasal bridle) and commenced its insertion. In a prospective study we aimed to measure the success of bridle insertion and to assess its effectiveness in preventing inadvertent feeding tube removal. Methods 26 patients with a history of repeated tube dislodgement had their nasogastric feeding tube secured with a bridle. In addition, 2 patients commencing nasojejunal feeding had their tubes secured as a prophylactic measure against dislodgement. Subjects were selected based on clinical judgement by the dietitian and doctor. A DVD demonstrating insertion technique was viewed by the practitioner prior to insertion. Results The majority of tubes (84.8%) were successfully secured. In those with a history of tube dislodgement, the mean number of dislodged tubes prior to bridle insertion was 3.6 (range 1–6). Bridle insertion prevented further tube dislodgement in 85.8% of cases. Minor bleeding occurred in 18.2% of insertions. Conclusions Bridles can be safely used to secure feeding tubes and can reduce the incidence of tube dislodgement. Bridle use has the potential to save valuable hospital resources.