1
|
Mancin S, Stallone P, Siro V, Pastore M, Cattani D, Lopane D, Dacomi A, Tartaglia FC, Bellone A, Serazzi F, Laffoucriere G, Coldani C, Tomaiuolo G, Mazzoleni B. Validating nasogastric tube placement with pH testing: A randomized controlled trial protocol. Contemp Clin Trials Commun 2024; 39:101312. [PMID: 38845620 PMCID: PMC11153049 DOI: 10.1016/j.conctc.2024.101312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/21/2024] [Indexed: 06/09/2024] Open
Abstract
Background Enteral nutrition (EN) is preferred when oral feeding is not possible. The use of the Nasogastric Tube (NGT) ensures rapid and low-risk nutrient administration. However, confirming the placement through chest radiography, besides delaying the initiation of nutritional therapy, exposes patients to radiation. The pH test of gastric aspirate provides a quicker check for NGT placement, but its reliability is compromised by challenges related to aspirating gastric secretions. Study objective The main objective of this study is to assess the high-performance placement of NGTs for nutritional purposes, optimizing the evaluation of correct insertion through pH testing using an electronic pH meter. Additionally, the study aims to evaluate patient tolerance to the intervention. Materials and methods This single-center RCT will include 150 EN candidate patients divided into three groups. Each group will use distinct NGTs, evaluating placement through pH testing and chest radiography for safety. Tolerance, complications related to NGT placement, and costs will be assessed, with data collected anonymously through a secure electronic database. Ethical considerations authorization no. 3624, Territorial Ethical Committee Lombardy 5, October 20, 2023. Implications and perspectives This protocol introduces innovative technologies, such as advanced NGTs and an electronic pH meter, aiming to optimize enteral nutrition management. This RCT focuses on replacing X-rays as the primary method for verifying NGT placement, thereby reducing costs, time, and patient exposure to radiation. Data analysis may provide insights into managing patients on pH-altering medication. Implementing innovative technologies has the potential to reduce errors and improve economic efficiency and process sustainability.
Collapse
Affiliation(s)
- Stefano Mancin
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Rome, Italy
| | - Pietro Stallone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Valeria Siro
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Manuela Pastore
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Daniela Cattani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Diego Lopane
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Alessandra Dacomi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Alessandro Bellone
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Francesca Serazzi
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Georges Laffoucriere
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Chiara Coldani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giuseppina Tomaiuolo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Beatrice Mazzoleni
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| |
Collapse
|
2
|
Edalatifard M, Roostaei G, Rahimi B, Abtahi H, Kazemizadeh H, Asadi S, Khoshnam Rad N. Respiratory symptoms due to a twisted nasogastric tube: A case report. Nurs Crit Care 2024. [PMID: 38593266 DOI: 10.1111/nicc.13073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 03/18/2024] [Accepted: 03/21/2024] [Indexed: 04/11/2024]
Abstract
Insertion of a nasogastric tube (NGT) is generally considered safe; however, it is not without risk, and in cases of misplacement, complications and even death may occur. In this article, we reported a case of NGT misplacement in a 75-year-old male, which resulted in aspiration pneumonia. We also reviewed published cases of NGT misplacement. Clinicians should pay enough attention to the confirmation of the proper placement of an NGT. A systematic approach for NGT insertion and confirmation is required to prevent misplacement.
Collapse
Affiliation(s)
- Maryam Edalatifard
- Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghazal Roostaei
- Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Besharat Rahimi
- Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Abtahi
- Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Kazemizadeh
- Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Sanaz Asadi
- Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Niloofar Khoshnam Rad
- Thoracic Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
3
|
Chew C, O’Dwyer PJ, Young D, Banziger C, Hope S, Rodolfo S, Obaro AE. Mal-positioned nasogastric feeding tubes: are medical students safe to identify them? Br J Radiol 2024; 97:640-645. [PMID: 38335146 PMCID: PMC11027244 DOI: 10.1093/bjr/tqae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/08/2023] [Accepted: 01/10/2024] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVES Nasogastric tube (NGT) placement is listed against Clinical Imaging in the upcoming Medical Licensing Assessment-compulsory for every graduating UK medical student from 2025. This study aims to establish the ability of medical students to correctly identify the position of an NGT on Chest X-ray (CXR) and to evaluate a learning tool to improve student outcome in this area. METHODS Fourth-year (MB4) and fifth-year (MB5) medical students were invited to view 20 CXRs with 14 correctly sited and 6 mal-positioned NGT. MB5 students (Intervention) were exposed to an online interactive learning tool, with MB4 students kept as control. One week later, both groups of students were invited to view 20 more CXRs for NGT placement. RESULTS Only 12 (4.8%) of 249 MB5 students and 5 (3.1%) of 161 MB4 students correctly identified all the NGTs on CXRs. The number of students misidentifying 1 or more mal-positioned NGT as "safe to feed" was 129 (51.8%) for MB5 and 76 (47.2%) for MB4 students. This improved significantly (P < .001) following exposure to the learning tool with 58% scoring all CXRs correctly, while 28% scored 1 or more mal-positioned NGT incorrectly. Students struggled to determine if the NGT tip had adequately passed into the stomach. However, they failed to identify an NG tube in the lung ("never event") in just one out of 1,108 opportunities. CONCLUSION Medical students' ability to determine if the NGT was in the stomach remains suboptimal despite exposure to over 60 CXRs. Feeding NGT should be formally reported before use. ADVANCES IN KNOWLEDGE This is the first attempt at quantifying graduating medical students', and by inference junior doctors', competence in safely identifying misplaced nasogastric feeding tubes. An online, experiential learning resource significantly improved their ability.
Collapse
Affiliation(s)
- Cindy Chew
- Undergraduate School of Medicine, University of Glasgow, Glasgow, G12 8QQ, United Kingdom
- Department of Radiology, University Hospital Hairmyres, NHS Lanarkshire, East Kilbride, G75 8RG, United Kingdom
| | - Patrick J O’Dwyer
- Undergraduate School of Medicine, University of Glasgow, Glasgow, G12 8QQ, United Kingdom
| | - David Young
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, G1 1XQ, United Kingdom
| | - Carina Banziger
- Department of Radiology, University Hospital Hairmyres, NHS Lanarkshire, East Kilbride, G75 8RG, United Kingdom
| | | | | | - Anu E Obaro
- Omelea Ltd, London, United Kingdom
- St Mark’s Academic Institute, St Mark’s Hospital, Harrow, United Kingdom
| |
Collapse
|
4
|
Boeykens K, Holvoet T, Duysburgh I. Nasogastric tube insertion length measurement and tip verification in adults: a narrative review. Crit Care 2023; 27:317. [PMID: 37596615 PMCID: PMC10439641 DOI: 10.1186/s13054-023-04611-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/11/2023] [Indexed: 08/20/2023] Open
Abstract
Nasogastric feeding tube insertion is a common but invasive procedure most often blindly placed by nurses in acute and chronic care settings. Although usually not harmful, serious and fatal complications with misplacement still occur and variation in practice still exists. These tubes can be used for drainage or administration of fluids, drugs and/or enteral feeding. During blind insertion, it is important to achieve correct tip position of the tube ideally reaching the body of the stomach. If the insertion length is too short, the tip and/or distal side-openings at the end of the tube can be located in the esophagus increasing the risk of aspiration (pneumonia). Conversely, when the insertion length is too long, the tube might kink in the stomach, curl upwards into the esophagus or enter the duodenum. Studies have demonstrated that the most frequently used technique to determine insertion length (the nose-earlobe-xiphoid method) is too short a distance; new safer methods should be used and further more robust evidence is needed. After blind placement, verifying correct gastric tip positioning is of major importance to avoid serious and sometimes lethal complications.
Collapse
Affiliation(s)
- Kurt Boeykens
- Nutrition Support Team, VITAZ Hospital, Moerlandstraat 1, 9100, Sint-Niklaas, Belgium.
| | - Tom Holvoet
- Nutrition Support Team, VITAZ Hospital, Moerlandstraat 1, 9100, Sint-Niklaas, Belgium
| | - Ivo Duysburgh
- Nutrition Support Team, VITAZ Hospital, Moerlandstraat 1, 9100, Sint-Niklaas, Belgium
| |
Collapse
|