Abstract
BackgroundThe “Rusch” intubation stylet is used to make endotracheal tube intubation easy. We designed this study to evaluate the usage of this equipment in the guidance of nasogastric tube (NGT) insertion.MethodsA total of 103 patients, aged 23 to 70 years, undergoing gastrointestinal or hepatic surgeries that required intraoperative NGT insertions were enrolled into our study. The patients were randomly allocated to the control group (Group C) or the stylet group (Group S) according to a computerized, random allocation software program. In the control group, the NGT was inserted with the patient’s head in an intubating position. In the stylet group, the NGT was inserted with the assistance of a “Rusch” intubation stylet tied together at the tips by a slipknot. The success rates of the two methods, the durations of the insertions, and the occurrences of complications were recorded. All of the failed cases in the control group were subjected to the new technique used in the stylet group, and the successful rescue rate was also evaluated.ResultsSuccessful insertions were recorded for 52/53 patients (98.1%) in Group S and for 32/50 patients (64%) in Group C. The mean insertion times were 39.5 ± 19.5 seconds in Group C and 40.3 ± 23.2 seconds in Group S. Successful rescues of failure cases in Group C were achieved in 17/18 patients (94.4%) with the assistance of a “Rusch” intubation stylet.ConclusionsThe “Rusch” intubation stylet-guided method is reliable with a high success rate of NGT insertion in anesthetized and intubated patients.Trial registrationInstitutional Review Board of Chang Gung Memorial Hospital (IRB: 98-2669B) and Australian New Zealand Clinical Trials Registry (ACTRN12611000423910)
Highlights
The “Rusch” intubation stylet is used to make endotracheal tube intubation easy
We introduce a new and simple technique with a high success rate for nasogastric tube (NGT) insertions overall and for first attempts in particular
Kinking of the NGT occurred in 9 patients (18%) in Group C but in no patients in Group S, resulting in a significantly higher kinking rate in Group C compared to Group S (p = 0.0001)
Summary
The “Rusch” intubation stylet is used to make endotracheal tube intubation easy. We designed this study to evaluate the usage of this equipment in the guidance of nasogastric tube (NGT) insertion. Inserting a nasogastric tube (NGT) into a paralyzed and intubated patient is sometimes difficult and frustrating. The most common sites of impaction are the piriform sinus, the arytenoids cartilage [6,7], and the esophagus, which becomes compressed by the inflated cuff of an endotracheal tube. Another important issue concerns the material properties of the NGT. There are four non-opposing lateral eyes on the distal part of a common NGT These eyes result in an incomplete caliber, as there are weak points on the distal end. Sometimes the NGT is already slightly folded by the package or is compressed by the outer caliber segments rolled up in a storage bag which contributes to weak points during placement
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