• Sabry Gabriel, Richard Ackermann, Samy Gabriel, Caleb Ackermann, and Leslie Swadener-Culpepper.
• Sabry Gabriel and Richard Ackerman are professors of family medicine at Medical Center Navicent Health and Mercer University School of Medicine, Macon, Georgia.
• Crit Care Nurse. 2020 Feb 1; 40 (1): 37-44.

BackgroundEnteral feeding is essential for critically ill, head trauma, and burn patients who are unable to swallow.ObjectiveTo evaluate a new nasoenteral feeding tube with distal tip balloon designed to facilitate post-pyloric migration and avoid misplacement in the trachea.MethodsA case series was conducted in 50 critically ill patients aged 19 to 89 years receiving mechanical ventilation and requiring enteral nutrition in a teaching hospital. Patients received a soft, flexible, kink-resistant nasoenteral feeding tube with a balloon near the distal tip to enhance postpyloric migration by peristalsis. The feeding tube was inserted with a novel thread technique to reduce posterior nasopharyngeal trauma and tube misplacement. Pulse oximetry provided early detection of misplacement into the trachea. Placement was verified by abdominal radiography performed shortly after the procedure and repeated within 24 hours if needed.ResultsPostpyloric placement was achieved at 30 minutes in 24% of patients and by the following morning in 70% of patients. Tracheal intubation occurred in 1 patient but was recognized and corrected without injury. No tube occlusion from kinking occurred.ConclusionsEarly gastric or postpyloric feeding can be provided with this novel feeding tube. Its use facilitates quick bedside recognition of accidental misplacement in the trachea, reducing the chance of pneumothorax. The tip balloon reduces deeper placement into a lung and promotes distal migration into the small intestine. The design prevents occlusion from kinking, which is common with conventional feeding tubes. Nurses easily adopted the tube and insertion technique.©2020 American Association of Critical-Care Nurses.

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