Techniques for Placement

Nasoenteric tubes are placed anywhere distal to the pylorus, while nasojejunal tubes specifically are placed distal to the ligament of Treitz. Both may be placed at the bedside, endoscopically, or fluoroscop-ically, but typically nasojejunal tubes require endoscopic or fluoroscopic placement. Bedside placement requires an experienced clinician most commonly using the technique described by Zaloga [31]. In this method, the patient lies in the right lateral decubitus position, and the feeding tube with the distal tip angulated is advanced slowly using air insufflation, tube rotation, and auscultation as guidance. Erythromycin and metoclopramide are often used as prokinetic pharmacologic agents for advancement of feeding tubes from the stomach to the small intestine. Their use has been met with variable success [32].

Endoscopic and fluoroscopic placement may be performed at the bedside, thus eliminating the need for transport to the endoscopy or radiology suite, but depends on local availability. Multiple endoscopic methods have been described including: drag and pull, over the wire, and through the scope [33]. These methods require sedation and/or oronasal transfer of the initially orally placed tube. More recently, an over the wire technique using an ultrathin transnasal endoscope has been described that does not require sedation or oronasal transfer [34, 35]. The success rates for all these endoscopic techniques range from 84-95% [36]. Fluoroscopic placement is similar to that of bedside nasal tube placement, but the location of the tube is monitored fluoro-scopically as the tube and/or guidewire is advanced into position. This method generally requires no sedation, but it may require patient travel to the radiology suite and exposure to radiation. Success rates are high and similar to endoscopic placement. Overall success rates for nasogastric and nasoenteric feeding tube placement, regardless of placement method, exceed 90%, with decreasing success with more distal placement (84-90% success in the distal duodenum and as low as 25-50% distal to the ligament of Treitz) [36].

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Good Carb Diet

Good Carb Diet

WHAT IT IS A three-phase plan that has been likened to the low-carbohydrate Atkins program because during the first two weeks, South Beach eliminates most carbs, including bread, pasta, potatoes, fruit and most dairy products. In PHASE 2, healthy carbs, including most fruits, whole grains and dairy products are gradually reintroduced, but processed carbs such as bagels, cookies, cornflakes, regular pasta and rice cakes remain on the list of foods to avoid or eat rarely.

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