Postpyloric Feedings

For patients intolerant of gastric feedings or in whom the risk of aspiration is high, feedings delivered with the tip of the tube past the pylorus into the duodenum or, preferably, the jejunum are preferred. Feeding in this manner bypasses the problem of poor gastric emptying and adds another barrier (the pyloric sphincter) through which tube feedings must traverse before they are aspirated into the lungs. It should be noted that postpyloric feedings do not preclude the possibility of aspiration. Many patients with this complication are not aspirating tube feeding formula but rather their own nasopharyngeal secretions.

ND and NJ feeding tubes can be placed by trained, experienced nurses at the bedside. Although such placements typically take more time than NG or OG placements, this is still a relatively inexpensive method of placement. However, many institutions have not been able to achieve placements consistently at the bedside. In many institutions, ND or NJ placements are done in the radiology suite by a radiologist using fluoroscopy to visualize tube advancement to the appropriate area. This procedure increases the cost of EN therapy. NJ tubes generally are preferred over ND tubes; placement of the tip of the tube distal to the ligament of Treitz (located near the junction of the duodenum and the jejunum) may reduce risk of aspiration further. Alternatively, during a laparotomy, the surgeon can place an ND or NJ tube.

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