The Necessity of Post-Pyloric Feeding Tube Placement
Nutrition is the keystone to the holistic approach to healing, and healing should begin as soon as possible via immediate nutrition. Any delay in proper nutrition also delays the patient's healing. When nutrition fails or is not delivered to the body because of illness, pathology, or incapacitation, nutrition still must continue-the sooner the better.
When indicated, nutrition delivery is best done via a post-pyloric feeding tube. ENvizion Medical has invented its ENvue system for correct and efficient insertion to expedite the insertion process and facilitate needed nutrition as soon as possible.
This innovation defines a new paradigm in real-time visualization as the procedure progresses. It was developed specifically to remove the most-feared risk of pneumothorax and to ensure nutrition delivery in the post-pyloric area as soon as possible.
Post Pyloric Nutrition Is Superior to Nasogastric Tube Feeding
A feeding tube is necessary for a patient unable to feed, swallow, and consume the appropriate diet. Inserting a post-pyloric feeding tube establishes full nutrition via a natural process. It utilizes that portion of the small intestines best suited to absorption of nutrients.
Alternatively, nutrition via delivery to the stomach results in incomplete absorption of nutrients and an increased risk of aspiration of stomach contents. A post-pyloric feeding tube reduces the risk of aspiration and pneumonitis.
For proper placement into the gastrointestinal tract, a feeding tube must avoid entering the trachea. Only recently have safeguards been established to ensure proper post-pyloric feeding tube placement, such as verification with an X-ray after insertion. Even this gold standard takes time, however; also, it is done after the tube has already been placed. During this time, pneumothorax endures as a time-sensitive emergency. This delay, from minutes to even hours, is unacceptable and dangerous.
Blind insertion raises the risk of misplacement into the bronchial tree by 2-5% or higher. Of those, almost a third result in pneumothorax with a mortality rate of up to 0.4%. Any delay in recognizing misplacement represents how long a life-threatening complication can continue undiagnosed.
What Could Go Wrong?
Placing anything past the nasopharynx, because of the proximity of the entrances of both the trachea and the esophagus is not a benign procedure. Even when an X-ray is used to confirm proper post-pyloric feeding tube placement, this does not prevent entrance into the bronchial tree. It only delays the diagnosis.
Possible missteps include:
Engaging in a difficult procedure or taking too long to accomplish insertion, which risks
laryngopharyngeal injury.
The tip of the post-pyloric feeding tube could enter the trachea instead of the esophagus.
If left there, The nutritional substance can enter the lungs instead of the gastrointestinal tract, preventing adequate oxygenation.
The tube can progress through the lining of the lung, creating a hole through which air could escape into the chest cavity. A pressure could build to the point of collapsing that lung-tension pneumothorax, which is the leading cause of death from inserting feeding tubes.
The tube could fall short of its post-pyloric target and remain in the stomach.
This increases the risk of aspiration of non-sterile gastric contents.
Gastric mucosa would have only limited absorptive capabilities, resulting in incomplete nutrition.
The unused villi of the duodenum, which function as the primary absorptive mechanism of nutrition, could atrophy and weaken the barrier to bacteria entering the bloodstream.
How to Safely Place a Post-Pyloric Feeding Tube
Safely placing a post-pyloric feeding tube requires bypassing the entrance of the trachea and correctly inserting the tube into the esophagus. From there, it must enter the stomach, through the pyloric sphincter, and enter the duodenum of the small intestines or beyond.
Unfortunately, the above ideal description is successfully accomplished only as well as the skill of the person doing the procedure. The insertion, instead, might be attempted by inexperienced persons or the facility could lack a competency program for the procedure. Additionally, safe insertion is confirmed only with confirmation of successful and accurate placement.
Safety requires knowing any deviation into the lungs as soon as possible, and ENvizion Medical's ENvue system makes immediate recognition possible instead of the delay that waiting for X-ray confirmation creates. Also, beyond successfully entering the esophagus, navigating through the pyloric sphincter is technically difficult and is the main reason for failure in blind insertion. Without visual guidance, the person inserting the feeding tube cannot know the tube's pathway. The ENvue System provides this advantage-visual guidance-not present with blind insertion.
The ENvue system's advantage in accuracy and timeliness provides the safety that clinical staff needs to feel confident. Confidence comes from competence.
Reducing the Risk of Lung Collapse Following Post-Pyloric Feeding Tube Insertion
The medical knowledge for safe post-pyloric feeding tube insertion is well established. Feeding tube insertion has pitfalls that create life-threatening complications, so an appropriate insertion and placement methodology is required.
Any deviation is unacceptably dangerous. In 2020, there were over 27 million feeding tube placements worldwide, of which a million entered the lungs. This has resulted in considerable morbidity and mortality, as well as medicolegal expenses.
The new technology in a feeding tube navigation system, as is the ENvue system, guarantees proper insertion and placement. This precludes the most feared complications, pneumothorax (lung collapse) or iatrogenic aspiration pneumonia .
Besides accurate placement, the key to reducing the risks, like lung collapse, is to eliminate any delay in recognition of improper placement. The ENvue system eliminates delay by displaying the correct progress of the tube tip in real-time.
Confirming Proper Post Pyloric Feeding Tube Placement-the Rest of the Story
Auscultation is unreliable. X-ray confirmation is not immediate. Fluoroscopic imaging during the procedure adds the risk of unnecessary radiation exposure and typically requires moving the patient to the interventional radiology suite. Ultrasound is cumbersome. Capnography, i.e., monitoring the concentration of CO2 that would indicate tracheal placement, is not a sensible first-choice verification method. Validation of endoscopic camera technology is still in progress for small bowel insertion.
The ideal navigation system should be usable at bedside and identify potential misplacement during the procedure, with real-time confirmation as the insertion progresses.
The Newest Technology to Avoid Lung Collapse
ENvizion Medical's solution guides post-pyloric feeding tube placement via an electromagnetic placement device (EMPD) to prevent pneumothorax. It also confirms proper post-pyloric placement as "part" of the procedure itself, not after.
An external field generator integrates navigation sensors and body mapping to effect safe, progressive placement and immediate placement feedback in three dimensions. It displays real-time feeding tube insertion progress overlaying anatomical landmarks, including the gastrointestinal tract, pulmonary tree, and the patient body map.
The system employs both graphical and textual alerts to instantaneously highlight critical deviations in the tube route before they happen.
The Bottom Line on Lung Collapse from Feeding Tube Insertion
Done correctly, post-pyloric feeding tube placement allows natural nutrition in those unable to feed normally. Healing won't begin until this happens. Doing it incorrectly risks lung collapse, tension pneumothorax, iatrogenic aspiration, serious infection, and possibly death. Doing it in a timely way is crucial when needed.
The time to assess correct navigation is during the insertion, not after. With total medical knowledge doubling every 73 days, an explosion in technology has resulted in devices using electromagnetic technology to avoid feeding tube complications.
ENvizion Medical's ENvue system propels electromagnetic placement science to previously unachievable levels.
Patients deserve state-of-the-art technology to safeguard their survival and perfect their healing.
