Gastrointestinal Radiology > Procedures > Feeding Tube > Feeding Tube (3)


Feeding Tube Placement

Procedure (cont.)

  1. After the catheter tip is in the antrum, gently push it forward to see if it will cross the pylorus into the duodenal bulb. If the catheter will not pass the pylorus, turn the patient into a steep left posterior oblique (LPO) position. Insufflate the stomach with 100-200 ml of air from a syringe attached to the stylet hub. After the antrum and duodenal bulb are filled with air and can be identified fluoroscopically, push the catheter across the pylorus and into the distal duodenum or proximal jejunum, if possible. Torque the hub of the catheter/stylet as necessary to aid transpyloric passage.

   (Drawings modified from pamphlet, "Duodenal Intubation, A 5-Minute Method",

Cook, Inc., Bloomington, IN, copyright 1985)
 

  1. If, as sometimes happens, the catheter coils in the fundus of the stomach, withdraw the catheter to the gastroesophageal junction and again advance it as in steps 5 and 6. If this fails, instill a small amount of barium through the catheter to provide a radiopaque marker of the gastroduodenal anatomy.
     
  2. After the catheter tip has been advanced into the 4th part of the duodenal loop, return the patient to the supine position. The final placement of tip of the catheter should be in the region of the ligament of Treitz, either in the distal duodenal loop or the proximal jejunum.
     
  3. Remove the stylet by gentle traction. If the stylet has been indwelling for an appreciable time and resists removal, reactivate the Hydromer lubricant with another 10 cc of water before attempting to pull the stylet out. 
     
  4. Tape the catheter to the patient's nose to prevent migration of the tube. If the patient is likely to pull out the tube, placement of a nasal bridle should be strongly considered.
 


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