Validation of a blind transpyloric feeding tube placement technique in pediatric intensive care: Rapid, simple, and highly successful
Bibliographic record
Abstract
OBJECTIVE: Nasogastric feeding in intensive care is poorly tolerated as a result of gastroparesis. Transpyloric (TP) feeding has been limited by difficulty in tube placement. This study was to independently validate the success rate of a previously published bedside TP feeding tube (FT) placement technique. DESIGN: Prospective interventional study. SETTING: Tertiary pediatric intensive care unit (PICU) in a university hospital. PATIENTS: Children whose intensivist requested TP feeding, and who were without known fundoplication, pharyngeal trauma, or gastric ulceration. INTERVENTIONS: After informed consent, an unweighted polyurethane feeding tube with a flexible wire stylet was inserted using a standard technique with metoclopramide, right lateral position, and air insufflation during advancement until <2 mL air could be aspirated after insufflation of 5-10 mL air. The tubes were inserted by one of the authors, whose training was only to observe one insertion, then perform one insertion with supervision. MEASUREMENTS AND MAIN RESULTS: Patient demographics, procedural data, and success rate based on radiography were prospectively recorded. There were 71 insertions on 38 patients from February 1999 to October 1999. Patients were aged 56 +/- 69.8 months, weighed 17.8 +/- 18 kg, 69% were ventilated, and 56% received procedural sedation. Success rate for TP-FT placement was 63/71 insertions (88.7%) in an average of 7.43 +/- 6.85 mins (median, 5 mins; range, <1-45 mins); of 38 patients, 36 had a successful TP- FT (95%). Insertion was well tolerated. Of the successful TP-FTs, on day 1 (n = 63) the FT was in distal duodenum or jejunum in 51% and by days 3-5 (n = 51), this increased to 75%. CONCLUSIONS: Bedside placement of a TP-FT with this technique is simple, rapid, well tolerated, and highly successful with little training. Immediate radiograph to confirm TP placement may not always be necessary. In our experience, this technique has obviated the need to search for another method to achieve a transpyloric feeding tube.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.042 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".