Ultrasound-guided Bedside Placement of Nasojejunal Feeding Tubes for Critically Ill Patients

Xiong Lei; Chi Huang; Boming Xia; Ming Yan; Pengpeng Chen; Zhongheng Zhang

doi:10.3791/71745

A subscription to JoVE is required to view this content. Sign in or start your free trial.

Method Article

Ultrasound-guided Bedside Placement of Nasojejunal Feeding Tubes for Critically Ill Patients

141 views

⸱

DOI:

10.3791/71745

⸱

July 21st, 2026

Xiong Lei¹ , Chi Huang² , Boming Xia¹ , Ming Yan¹ , Pengpeng Chen¹ , Zhongheng Zhang¹^,³^,⁴^,⁵

¹Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, ²Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, ³Provincial Key Laboratory of Precise Diagnosis and Treatment of Abdominal Infection, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, ⁴School of Medicine, Shaoxing University, ⁵Key Laboratory of Emergency and Trauma of Ministry of Education, Engineering Research Center for Hainan Biological Sample Resources of Major Diseases, The First Affiliated Hospital, Hainan Medical University

Summary

Bedside ultrasound-guided nasojejunal tube placement enables real-time visualization of the catheter trajectory and supports confirmation of post-pyloric positioning in the duodenum or jejunum.

Abstract

In critically ill patients, postpyloric feeding via a nasojejunal (NJ) tube is essential for those at high risk of aspiration. However, traditional blind insertion techniques are associated with high failure rates and complications. This study aims to establish a standardized, bedside ultrasound-guided protocol for NJ tube placement to enhance safety and efficacy. The procedure involves real-time tracking of the NJ tube from the esophagus to the jejunum using both linear and curvilinear probes. Key technical steps include pre-procedural assessment of the gastric antral area and motility, cervical verification, and dynamic guidance through the pylorus. The protocol identifies specific sonographic markers for confirmation: the 'Double-Track Sign' serves as the static indicator of tube presence in the gastrointestinal tract, while the dynamic ‘Cloud Sign’ confirms tube patency and tip location. Real-time visualization enables immediate correction of complications, such as pharyngeal coiling or tracheal deviation. The method facilitates passage through the pylorus by synchronizing advancement with peristalsis. Ultrasound-guided NJ tube placement provides a bedside, radiation-free approach for visualizing tube trajectory and identifying malposition during the procedure. This protocol article presents representative sonographic findings during NJ tube progression; comparative outcomes such as first-attempt success rate, procedure time, and adverse event rates were not evaluated.

Introduction

Enteral nutrition (EN) is widely recognized as the preferred route for nutritional support in critically ill patients, offering significant advantages over parenteral nutrition by preserving gut mucosal integrity, modulating the immune response, and reducing infectious complications¹. For patients at high risk of aspiration or those with severe gastric intolerance, post-pyloric feeding via NJ tube is often indicated to ensure safe and effective nutrient delivery². However, the bedside placement of NJ tube remains a formidable clinical challenge. Traditional blind insertion techniques are associated with high failure rate....