TP Tube

[Love_2_Learn]

It's been several years since I have worked with transpyloric tubes; however, we always used tubes called "weighted transpyloric tubes", measured them from mouth/nose to ear to umbilicus, inserted them and then got an x-ray within the next 1 to 3 hours before using them (to allow time for peristalsis to take the tube down to the place where it should be and not too far.)

I recently had a neonatologist ask us to place a regular og/ng tube to the length that a transpyloric tube would be and to use it as a transpyloric tube after an x-ray was obtained. Our ng/og tubes are the very soft, slippery ones which can be left in place for up to one month when used as ng/og tubes, so they are very soft (not implying the tube would be left in the pylorus that long!). We have the weighted transpyloric tubes in our unit stock, so it's not like we don't have them to use, and they are much softer than even these very soft ng/og tubes.

I understand that there have been complications from transpyloric tubes like intestinal perforation, pneumoperitoneum, etc. and that their benefits do not outweigh their potential problems (per a Cochran review) so they are generally not used as much as they were several years ago.

Have you ever had a physician ask you to use a gastric tube as a transpyloric tube? Do you think it would make any difference?

Thanks for any replies. I'm very curious about this subject.

[EricJRN, MSN, RN]

On my unit, we use the same type of tube for NG and ND. The depth of insertion is the only difference. We haven't had any problems with that.

[Love_2_Learn]

Thanks Eric!!

[lovemyjob]

hmmm, we measure from nose to ear to knee and that is the legnth. Put the kid in right sidelying position, get the tube to the stomach and then using a 10ml syringe, push air while advancing to open the sphincter and then immediately do an xray to confirm. Not sure about letting the tube find its way through the sphincter...

We also use the same tube for both, 30 day tubes with radiopaque ends..... not weighted.

As far as its use and safety, it is not a p[referred method of feeding, but for a kiddo who cant tolerate gastric feeds, benefit outweighs risk. Only other option is to decrease or stop gastric feeds, increase TPN, and increase risk of increased direct bili, hepatomegaly, and liver failure, plus less than optimal nutrition leading to metabolic bone disease, poor growth, and all of the other side effects of sub-optimal nutrition that is provided by TPN.

HTH!