Inserting guidewires

We were very concerned that part of the procedure described in the article, “Bedside Placement of Small-Bowel Feeding Tubes in the Intensive Care Unit” (February 2003:16–24), involves removing the stylet, flexing it to an angle, and reinserting the stylet to complete the placement, because this is not an accepted technique. In researching the question, we can find no support for reinserting the stylet after removal other than the research referenced. In fact, the standard procedure is for the stylet to remain in place until tube confirmation can be achieved radiographically. In our opinion, the first red flag should have been the fact that the researchers acknowledge that the technique is contrary to the manufacturer’s recommendations. In addition, numerous other sources note that removal of the stylet (or guidewire) should not occur until confirmation of tube placement. In addition, the only research we could locate that supported the researchers’ method was...