The Feasibility of postpyloric feeding tube placement in thrombocytopenic +/- anticoagulated patients on the intensive care unit CORTRAK in thrombocytopenic patients.

PURPOSE Enteral nutrition (EN) is considered as a cornerstone in the management of critically ill patients. However, its successful initiation is frequently hampered by various complications occurring in patients treated in the ICU. Successful placement of a nasojejunal tube by Cortrak enteral access system (CEAS) has been reported to be a simple bedside tool for placing the postpyloric (PP) feeding tube. PATIENTS AND METHODS We evaluated the efficacy and side effects using CEAS to establish EN in critical ill, thrombocytopenic and/or anticoagulated patients. RESULTS Fifty-six mechanically ventilated patients were analysed, 24 of them underwent prior haematopoietic stem cell transplantation (SCT). Sixteen patients received ECMO treatment due ARDS. The median platelet count at PP placement was 26 G/l (range: 4 - 106 G/l); 16 patients received therapeutic anticoagulation (aPTT 50-70 s.). CEAS assisted placement of a PP nasojejunal tube was performed successfully in all patients . The most frequent adverse event was epistaxis in 27 patients (48.2%) which was mostly mild (CTCAE grade 1, n = 21 (77.8%); grade 2, n = 6). A significant association between a low platelet count and bleeding complications was observed (p <0.001). CONCLUSIONS Performed by an experienced operator, CEAS is a simple, rapid available and effective bedside tool for safely placing PP feeding tubes for enteral nutrition in thrombocytopenic patients, even when showing an otherwise caused coagulopathy in the ICU. Higher grade bleeding complications were not observed despite their obvious correlation to thrombocytopenia. A prospective study is in preparation. This article is protected by copyright. All rights reserved.