BACKGROUND: Multiple techniques are available for postpyloric placement of feeding tubes. Administration of metoclopramide and air insufflation are easily accomplished at the bedside. Variable success rates have been reported for both procedures. OBJECTIVES: To determine which method, administration of 10 mg of metoclopramide or gastric insufflation of 350 mL of air, is superior for successful postpyloric placement of feeding tubes at the bedside. METHODS: A prospective trial consisting of 60 adult patients randomized to have a feeding tube placed by 1 of 2 methods, either after intravenous administration of 10 mg of metoclopramide or via gastric insufflation of 350 mL of air. Placement results were confirmed by radiography. RESULTS: Among patients receiving narcotics, the 72% successful placement rate with insufflation was significantly better than the 11% success rate achieved with metoclopramide (P < .001). Among the narcotic-free patients, the 83% success rate with metoclopramide was not significantly better than the 58% success rate with insufflation (P = .37). The difference in treatment effect between narcotic and narcotic-free groups was significant (P < .001). CONCLUSION: Patients receiving narcotics should have feeding tubes placed via the air insufflation technique. The use of continuous or regularly scheduled administration of narcotics significantly decreases the effectiveness of metoclopramide in successful placement of feeding tubes.
RCT Entities:
BACKGROUND: Multiple techniques are available for postpyloric placement of feeding tubes. Administration of metoclopramide and air insufflation are easily accomplished at the bedside. Variable success rates have been reported for both procedures. OBJECTIVES: To determine which method, administration of 10 mg of metoclopramide or gastric insufflation of 350 mL of air, is superior for successful postpyloric placement of feeding tubes at the bedside. METHODS: A prospective trial consisting of 60 adult patients randomized to have a feeding tube placed by 1 of 2 methods, either after intravenous administration of 10 mg of metoclopramide or via gastric insufflation of 350 mL of air. Placement results were confirmed by radiography. RESULTS: Among patients receiving narcotics, the 72% successful placement rate with insufflation was significantly better than the 11% success rate achieved with metoclopramide (P < .001). Among the narcotic-free patients, the 83% success rate with metoclopramide was not significantly better than the 58% success rate with insufflation (P = .37). The difference in treatment effect between narcotic and narcotic-free groups was significant (P < .001). CONCLUSION:Patients receiving narcotics should have feeding tubes placed via the air insufflation technique. The use of continuous or regularly scheduled administration of narcotics significantly decreases the effectiveness of metoclopramide in successful placement of feeding tubes.
Authors: Leonid Koyfman; Andrei Schwartz; Yair Benjamin; Alexander Smolikov; Moti Klein; Evgeni Brotfain Journal: J Crit Care Med (Targu Mures) Date: 2016-08-10