[Is a clinical positional control for nasogastric tubes good enough? A prospective study of 43 patients]

4-Point ultrasonography to confirm the correct position of the nasogastric tube in 114 critically ill patients

PURPOSE

Nasogastric feeding tube is routinely positioned in intensive care units. The complications of misplacement are rare but very dangerous for the patients. The aim of this study is to estimate the diagnostic accuracy of this new technique, 4-point ultrasonography to confirm nasogastric tube placement in intensive care.

METHODS

One hundred fourteen critical ill patients monitored in ICU were included. The intensivist provided in real time to perform the exam in four steps: sonography from either the right or left side of the patient's neck to visualize the esophagus, sonography of epigastrium to confirm the passage through the esophagogastric junction and the positioning in antrum, sonography of the fundus. Finally, gastric placement of the nasogastric feeding tube was confirmed with thorax radiograph.

RESULTS

One hundred fourteen of the gastric tubes were visualized by sonography in the digestive tract and all were confirmed by radiography (sensitivity 100%). The entire sonographic procedure, including the longitudinal and transversal scan of the esophagus, the esophagogastric junction, the antrum and the fundus, took 10 min.

CONCLUSIONS

Our pilot study demonstrated that not weighted-tip gastric tube routinely used in Intensive Care is visible with the sonography. The pilot study confirmed the high sensitivity of the sonography in the verify correct positioning of gastric tube in the adult ICU patients. The ultrasound examination seems to be easy and rapid even when performed by a intensivist whit a sonographic training of only 40 h. The sonographic exam at the bedside was performed in a shorter time than the acquisition and reporting of the X-ray.

Nursing care of patients with nasogastric feeding tubes

Nasogastric tubes are commonly used for patients as a short-term method of providing continuous, pre-packed liquid feed. In order to explore how evidence-based practice is being incorporated into care, we conducted a survey investigating the views and practices of nutrition specialist nurses in acute trusts across the UK. A postal questionnaire comprising 35 questions considered the role of the nutrition specialist nurse, care of patients with nasogastric tubes, and training and education of nurses in the care of these patients. Results of this small study indicate differences in the education and practice of nursing care for patients with nasogastric tubes. Therefore, it is vital that evidence and good practice is disseminated both locally and nationally by benchmarking practice and by sharing knowledge and experiences in both journals and conferences. Nurses also need support in practising their skills to ensure they feel confident in caring for patients with nasogastric tubes.