PASSAGE OF FEEDING TUBE FROM THE SPHINCTER OF PYLOR: COMBINING USE OF METOCLOPRAMIDE AND RIGHT LATERAL DECUBITUS POSITION
Abstract
Introduction. Early enteral feeding reduce the mortality and morbidity of head-Injured patients. However, many of these patients have atonic stomach and do not tolerate early gastric feeding. It is suggested that small bowel feeding will improve the patient"s tolerance of early enteral feeding.
Methods. In a randomized clinical trial, sixty patients with moderate and severe head injury were divided in two equal groups. In experimental group, a feeding tube with a length, equal to distance from nose to earlobe and umblicus was inserted and interavenous metuclopramide was injected every 6 hours (10 mg in adults, 5mg in children between 6-14 years old and 0.1 mg/kg in children less than 6 years old). These patients also were placed in right lateral decubitus position. In control group, only a tube with a length equal to experimental group"s tube was inserted. After 48 hours, with injection of barium sulfate into the feeding tube and plain radiography of abdomen, the position of the tip of the feeding tube was determined (Prepyloric VS. Postpyloric).
Results. The rate of passage of feeding tube from the sphincter of pylor was 63.3 percent in experimental group and 6.7 percent in control group (P < 0.001).
Discussion. This study introduces a new safe method for bypassing the atonic stomach in patients with moderate and severe head injury.
Methods. In a randomized clinical trial, sixty patients with moderate and severe head injury were divided in two equal groups. In experimental group, a feeding tube with a length, equal to distance from nose to earlobe and umblicus was inserted and interavenous metuclopramide was injected every 6 hours (10 mg in adults, 5mg in children between 6-14 years old and 0.1 mg/kg in children less than 6 years old). These patients also were placed in right lateral decubitus position. In control group, only a tube with a length equal to experimental group"s tube was inserted. After 48 hours, with injection of barium sulfate into the feeding tube and plain radiography of abdomen, the position of the tip of the feeding tube was determined (Prepyloric VS. Postpyloric).
Results. The rate of passage of feeding tube from the sphincter of pylor was 63.3 percent in experimental group and 6.7 percent in control group (P < 0.001).
Discussion. This study introduces a new safe method for bypassing the atonic stomach in patients with moderate and severe head injury.
Keywords
Head trauma, Head injury, Metoclopramide, early enteral feeding, right lateral decubitus