The “Silk Road”: A Novel Method for Inserting Transpyloric Feeding Tubes in Low Resource Settings
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Read the article on jpedsurg.org ↗Article · Sep 2019 · 1 min read
In brief
In brief
Novel bedside technique using silk sutures to weight feeding tube tips achieves 88% successful transpyloric placement in infants with refractory vomiting. Method requires only basic supplies and plain radiography, making it practical for resource-limited settings where fluoroscopy is unavailable.
Written by the GCMD Library team from the article.
Introduction
Transpyloric tube (TPT) feeding is used in a multitude of conditions including gastroesophageal reflux disease. We here describe a new simple method to insert TPTs.
Methods
6 French feeding tube is premeasured nose to xiphisternum, and then another 7cm of length is added and 3-5 silk (4-0) ties are applied to the end of the tube spaced 0.5–1cm apart. The knots are placed in different radial directions, and multiple throws are placed on each knot so as to add bulkiness. The tube is then inserted transnasally to the premeasured length and secured. The child is given a single dose of metoclopramide and placed on his right side for 4h. A plain abdominal x-ray is then performed to confirm adequate TP placement. Following correct placement the patient is tube fed with small volumes every 15–20min. Descriptive data was prospectively collected.
Results
34 patients were recruited, median age 3.5months. All presented with vomiting, and 26 had failure to thrive. 24had successful TP tube placement from the first attempt, 6 from the second attempt, 2 on third attempt, and in 2 placement was unsuccessful. In 28 patients vomiting almost stopped completely. 9 patients had fundoplication, and 1 had gastrostomy placement. 3 patients died during the study because of unknown reasons.
Conclusion
The silk tie technique is a safe and simple way to treat persistent vomiting and may prove useful in low resourced environments.
Level of evidence
IV