"Trans-pyloric tube placement Follow the steps below for placement of trans-pyloric tube. 1. A weighted tube is required for trans-pyloric placement (white Vygon paediatric duodenal tube with weighted tip, 6 Fr or Corpak Jejunal weighted tube). These do not harden over time and may be left in situ for several weeks. 2. Length for tube insertion is measured from as per gastric placement with a further length from the xiphoid to the left or right costal margin. 3. The tube is allowed to cool in the refrigerator for an hour; this reduces the chance of it coiling during insertion. 4. Swaddle infant to provide comfort 5. With the infant lying supine at a 15o-40o angle, insert the tube to the stomach as normal. 6. Check stomach positioning by aspirating and testing on a pH strip (reading of 5 or less) 7. Place the infant into a right lateral position 8. Advance the tube 1 cm at a time while instilling up to 2-3 ml of air and auscultate the abdomen 9. Transpyloric placement is characterised by high pitch crackles and the inability to withdraw air ('snap test') 10. Insert further length (as measured) to ensure distal duodenal or proximal jejunal placement. 11. Give a 3 ml feed and remove stylet (if present with brand). 12. The infant should then be placed right side down for 1-1.5 hours 13. Confirmation of placement will then be made by a radiograph. 14. Secure tubing to infant's cheek in same manner as gastric tubes 15. Insertion should be documented in the infant's caremap (equipment section) and in the clinical notes"