The learning curve in blind bedside postpyloric placement of spiral tubes: data from a multicentre, prospective observational study

Abstract

OBJECTIVE: This study sought to quantify the learning curve for the blind bedside postpyloric placement of a spiral tube in critically ill patients. METHODS: We retrospectively analysed 127 consecutive experiences of three intensivists who performed comparable procedures of blind bedside postpyloric placement of a spiral tube subsequent to failed self-propelled transpyloric migration in a multicentre study. Each intensivist's cases were divided chronologically into two groups for analysis. The assessment of the learning curve was based on efficiency and safety outcomes. RESULTS: All intensivists achieved postpyloric placement for over 80% of their patients. The junior intensivist showed major improvement in both efficiency and safety outcomes, and the learning curve for both outcomes was approximately 20 cases. The junior intensivist showed a significant increase in the success rate of proximal jejunum placement and demonstrated a substantial decrease in the major adverse tube-associated events rate. The time to insertion significantly decreased in each intensivist as case experience accumulated. CONCLUSIONS: Blind bedside postpyloric placement of a spiral tube involves a significant learning curve, indicating that this technique could be readily acquired by intensivists with no previous experience using an adequate professional training programme.