- After the catheter tip is in the antrum,
gently push it forward to see if it will cross the pylorus into the
duodenal bulb. If the catheter will not pass the pylorus, turn the
patient into a steep left posterior oblique (LPO) position.
Insufflate the stomach with 100-200 ml of air from a syringe attached to
the stylet hub. After the antrum and duodenal bulb are filled with air
and can be identified fluoroscopically, push the catheter across the
pylorus and into the distal duodenum or proximal jejunum, if possible.
Torque the hub of the catheter/stylet as necessary to aid transpyloric
passage.
(Drawings
modified from pamphlet, "Duodenal Intubation, A 5-Minute Method",
Cook, Inc., Bloomington, IN,
copyright 1985)
- If, as sometimes happens, the catheter
coils in the fundus of the stomach, withdraw the catheter to the
gastroesophageal junction and again advance it as in steps 5 and 6. If
this fails, instill a small amount of barium through the catheter to
provide a radiopaque marker of the gastroduodenal anatomy.
- After the catheter tip has been advanced into the 4th
part of the duodenal loop, return the patient to the supine position.
The final placement of tip of the catheter should be in the region of
the ligament of Treitz, either in the distal duodenal loop or the
proximal jejunum.
- Remove the stylet by gentle traction. If the stylet
has been indwelling for an appreciable time and resists removal,
reactivate the Hydromer lubricant with another 10 cc of water before
attempting to pull the stylet out.
- Tape the catheter to the patient's nose to prevent
migration of the tube. If the patient is likely to pull out the tube,
placement of a nasal bridle should be strongly considered.
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