[Visual ultrasound guided naso-jejunal tube replacement in situ]

Abstract

To address the problems of traditional naso-jejunal tube replacement in post-pyloric feeding, such as high blind insertion failure rate, high radiation exposure and high risk of complications, this study proposed a naso-jejunal tube replacement technique with real-time ultrasound guidance and zebra guide wire, and applied it to the clinical practice of a 67-year-old male patient with severe traumatic brain injury. The patient needed long-term post-pyloric enteral nutrition support due to severe traumatic brain injury, but blind tube insertion was difficult (the first tube insertion was assisted by gastroscope), which increased the difficulty of regular replacement of the tube. By using the modified Seldinger technique and zebra guide wire with flexible and hydrophilic coating characteristics, the changes of duodenal horizontal image characteristics were dynamically monitored by visual ultrasound, and the naso-jejunal tube was accurately replaced in situ. The key imaging steps for ultrasound-guided duodenal horizontal part evaluation include: "double-track sign" after the verification of the former tube patency; After the guide wire is placed, the real-time image changes into "five-line sign". The "bright strip sign" when the original tube is withdrawn and the "five-wire sign" after the new tube is placed and the "double-track sign" when the guide wire is removed. Position verified by abdominal X-ray. The whole course took about 10 minutes. The catheter tip was precisely positioned behind the pylorus. There were no complications such as bleeding and perforation, and the enteral nutrition was well tolerated. The technique is able to effectively reduce or replace X-ray verification through ultrasonic dynamic visualization navigation, and zebra guide wire can effectively reduce the risk of tissue damage.