A New Critical Care Catheter Gabriel Feeding Tube
A New Critical Care Catheter Gabriel® Feeding Tube With Balloon Sabry Gabriel, M. D. Development of this feeding tube supported by DOD Award# W 81 XWH-09 -20097
Advantages of enteral feeding • • • More physiologic. Maintains intestinal mucosal barrier. Stimulates the immune system. Provides high calories at a small volume. High nutrition value at lower cost. Improves renal perfusion.
Advantages of enteral feeding • • • More physiologic. Maintains intestinal mucosal barrier. Stimulates the immune system. Provides high calories at a small volume. High nutrition value at lower cost. Improves renal perfusion.
Gut Permeability • Channels between epithelial cells have a very dynamic function, and after a major insult, they open, increasing permeability • Can cause ARDS via inflammatory cytokine movement through gut lymphatics, to the thoracic duct, to the left subclavian vein, into the heart, and through the pulmonary artery to the 1 st capillary bed, the LUNGS! Gut Thoracic Duct Left Subclavian Vein Heart Pulmonary Artery Lungs
Advantages of enteral feeding • • • More physiologic. Maintains intestinal mucosal barrier. Stimulates the immune system. Provides high calories at a small volume. High nutrition value at lower cost. Improves renal perfusion.
Time to Feed is Limited! • Enteral feeding used to modulate immune system during stress or sepsis. • The “window of opportunity” to modulate immune system is limited – e. g. In burn victims this window is only 3 to 6 hours!
Advantages of enteral feeding • • • More physiologic. Maintains intestinal mucosal barrier. Stimulates the immune system. Provides high calories at a small volume. High nutrition value at lower cost. Improves renal perfusion.
Risks of Enteral Feeding Ø Aspiration Pneumonia Ø Placement in Lungs
Feeding tubes insertion problems Problem Resulting complication • Poor success rate in post pyloric placement • Inadvertent placement of feeding tubes into trachea & lungs (2%) of all feeding tubes • 125, 000 cases of aspiration pneumonia annually • 21, 000 pneumothorax annually • 4, 000 death per year in the US
Options Method Cost Repeat blind placement Three attempts cost $465 with X-ray confirmation. Over 36 h to 3 days Each X-ray = $155 Fluroscopy $430 Endoscopy $650
Benzocaine gel 20% & Q tip
• Apply Benzocaine gel 20%
Gabriel Feeding Tube does not occlude by kinking Gabriel feeding tube wall is wire enforced Other feeding tubes occlude by kinking
KUB 30 -60 minutes after insertion
KUB 24 hours after insertion
EN-Fit Connector
EN-Fit Lopez Valve
Reimbursement • AMA • CPT code: 43761
Tube migration Day 1 Day 2
Day 1 Day 2
August 2 nd August 3 rd
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