Nasogastric Tube Insertion Research Articles

Incidence and Predictors of Aspiration Pneumonia Among Traumatic Brain Injury in Northwest Ethiopia.

BackgroundA significantly greater proportion of patients who die due to aspiration pneumonia were diagnosed with in-hospital aspiration pneumonia (19%). The incidence and major predictors are not known clearly, especially in Ethiopia.ObjectiveTo determine the incidence and predictors of aspiration pneumonia among adult traumatic brain injury patients at Felege Hiwot comprehensive specialized hospital, Bahir Dar, North west Ethiopia, in 2021.MethodsAn institution-based retrospective study was conducted from all admitted adult traumatic brain injury patients at Felege Hiwot comprehensive specialized hospital from January 1, 2015 to December 31, 2020 for 51 days of survival. Descriptive statistics, Kaplan–Meier survival curve log rank test, and the Cox proportional hazard regression model were used.ResultsA total of 396 adult patients diagnosed and admitted with traumatic brain injury in the past 5 years were included. Seventy patients (17.67%) developed aspiration pneumonia, providing an incidence rate of 32.39 (95% CI=25-62–40.94) per 1,000 person days of observation. Independent predictors were being referred for AHR (2.43; 95% CI=1.12–5.25), nasogastric tube insertion AHR (3.02; 95% CI=1.43–6.39), and baseline Glasgow coma scale <8 AHR (3.88; 95% CI=1.42–10.062).ConclusionHaving a nasogastric tube and low baseline Glasgow coma scale were significant predictors. This improves prehospital and hospital care during transportation and admission time.

Practices of Procedural Pain Management in Neonates through Continuous Quality Improvement Measures.

Objective Although the benefits of pain control measures in neonates are well known, the actual usage was not optimal in our unit. Therefore, we implemented a quality improvement project to improve pain management practices through multiple Plan-Do-Study-Act (PDSA) cycles. Method Our project included hemodynamically stable newborns weighing ≥1300 g. We identified four common procedures: intravenous cannulation, venous sampling, heel prick, and nasogastric tube insertion. The selected pain control measures were skin-to-skin contact, breastfeeding, expressed breast milk orally, and oral sucrose. Between April 2019 and September 2019, we intervened multiple times and reassessed shortcomings. We encouraged evidence-based practices and gave solutions for shortcomings. Data were interpreted weekly to assess the compliance to pain control interventions. Results Minimal pain control measures (3-4%) were utilized for identified procedures before the project began. We could improve the use of pain control measures steadily and achieve the target of 80% of procedures after seven different interventions over five months. There was a retention of the effect on reassessing twice at second and fourth months of stopping further intervention once the target got achieved. Conclusion Quality Improvement science can identify the shortcomings and help to improve the compliance for pain control practices in neonates, as demonstrated in this neonatal unit.

Use of the McGRATH™ MAC videolaryngoscope to evaluate the ability of anesthetists to give effective cricoid pressure: An interventional study.

The application of cricoid pressure (CP) for rapid sequence induction is questioned on two grounds: its effectiveness in clinical settings and its impact on the laryngeal view. The main reason cited for its ineffectiveness is the lack of knowledge and training in its correct application. This study assessed, the performance of anesthetists in applying effective CP in a clinical setting. Eighty-five ASA I/II adult patients posted for elective surgery requiring oral endotracheal intubation with nasogastric tube (NGT) placement participated in the study. Eighty-five anesthetists divided into five groups based on their level of experience were randomly chosen to apply CP after induction of anesthesia. An experienced anesthetist performed videolaryngoscopy and attempted NGT insertion. The primary outcome was effectiveness of CP defined as the inability to pass the NGT into the esophageal opening. We also noted that the glottic view with and without CP and the effectiveness of CP across different levels of experience of anesthetists. Of the 85 anesthetists, 61 (71.8%) applied effective CP. The effectiveness improved with experience (first-year residents-11/17 [64.7%], second-year residents-11/17 [64.7%], third-year residents-10/17 [58.8%], senior residents-13/17 [76.5%], and consultants-16/17 [94.1%]) (P = 0.157). Post hoc analysis showed higher effectiveness among anesthetists with >3 years of experience (85.3%) compared with <3 years of experience (62.7%) (P = 0.024). CP did not always impede the laryngeal view, rather it has no effect or actually improves the glottic view in many instances (81%). CP is effective in occluding the esophageal lumen without hampering glottic view in the majority of the cases, and its effectiveness improves with experience.

Routine intraoperative insertion of both nasogastric and nasojejunal tubes in patients undergoing emergency laparotomy: an underutilised technique?

Routine intraoperative insertion of both nasogastric and nasojejunal tubes in patients undergoing emergency laparotomy: an underutilised technique?

Longitudinal survey of self-reported level of entrustment across the first year of clinical practice

Background. Newly graduated medical students often report that they lack the skills required to care for patients, and feel unprepared for clinical practice. However, little is known about when, and if, they acquire these skills in practice. The aim of this study was to assess self-reported level of entrustment in, and frequency of performance of, the seven Entrustable Professional Activities (EPAs) comprising the EPA framework for interns in Ireland. EPAs describe discrete activities that are essential to a particular profession. Methods. Self-report survey data were collected from doctors in the Republic of Ireland during their first year of clinical practice at four different time points during 2020/21. Results. Response rates to the survey varied from 73.3% (126/172) at Time 1 to 25.6% (44/172) at Time 4. After three months, the respondents reported that they could execute all of the EPAs, inclusive of 12 essential procedural skills, with indirect supervision. As the year progressed there was an increase in the proportion of respondents reporting that they performed the EPAs at least once a week. However, the proportion of respondents performing five of the essential procedural skills (e.g. nasogastric tube insertion) remained low across all time points. Conclusion. Consideration should be given as to how to better prepare medical students to execute these EPAs, how the interns can be better supported during the first quarter of internship. The findings from this research are positive. However, there is an urgent need to carry out formal assessments of entrustability, rather than relying on self-report.

Oropharyngeal suctioning and nasogastric tube insertion with a new mask for reduction of droplet dispersion: a proposal for a new preventive strategy during the coronavirus disease pandemic

Coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is spread via respiratory droplets in close contact [1]. Healthcare workers (HCWs) are at increased risk of COVID-19 as compared with the general community. The risk is highest among those working in the inpatient setting and nursing homes because their work requires close personal exposure to patients with SARS-CoV-2 [2]. Use of personal protective equipment (PPE), including gloves, masks, goggles or face shields, and gowns, can reduce nosocomial transmission, whereas inadequate PPE is considered to be a risk factor for acquiring COVID-19 [2,3].

Improve Physical Fitness and Reduce Nasogastric Tube Insertions: Working to Achieve a 'No Tube' Life

It is common in clinical settings for patients to suffer from dysphagia-related malnutrition and coughing-related aspiration pneumonia because of reduced levels of food intake. Nasogastric tube feeding provides nutrition and water and prevents choking related to oral feeding. Although dysphagia is often treated using medical and surgical treatments, degenerative-disease-related dysphagia is currently widely treated using nutritional support and rehabilitation to enhance muscle strength and coordination and reduce the risk of nasogastric tube placement in the future. Generally, the focus of muscle strength training for dysphagia is on muscle training related to swallowing and breathing. However, the process of eating requires the coordinated operation of the muscles of the lower limbs and the trunk to support the body's physical weight and maintain stable posture. When consuming food, an individual must rely on the activities of the upper limb muscles. Therefore, training the relevant muscles may effectively reduce the eating difficulties caused by muscle strength loss. In this article, empirical literature evidence related to improving frailty is collected and principles and practical suggestions are provided for improving physical fitness programs, including breathing muscle strengthening training, sitting and balance training, upper limb muscle strength training, and lower limb muscle strength training. It is hoped that the findings will be used as a guide in clinical practice.

Longitudinal survey of self-reported level of entrustment across the first year of clinical practice.

Background. Newly graduated medical students often report that they lack the skills required to care for patients, and feel unprepared for clinical practice. However, little is known about when, and if, they acquire these skills in practice. The aim of this study was to assess self-reported level of entrustment in, and frequency of performance of, the seven Entrustable Professional Activities (EPAs) comprising the EPA framework for interns in Ireland. EPAs describe discrete activities that are essential to a particular profession. Methods. Self-report survey data were collected from doctors in the Republic of Ireland during their first year of clinical practice at four different time points during 2020/21. Results. Response rates to the survey varied from 73.3% (126/172) at Time 1 to 25.6% (44/172) at Time 4. After three months, the respondents reported that they could execute all of the EPAs, inclusive of 12 essential procedural skills, with indirect supervision. As the year progressed there was an increase in the proportion of respondents reporting that they performed the EPAs at least once a week. However, the proportion of respondents performing five of the essential procedural skills (e.g. nasogastric tube insertion) remained low across all time points. Conclusion. Consideration should be given as to how to better prepare medical students to execute these EPAs, how the interns can be better supported during the first quarter of internship. The findings from this research are positive. However, there is an urgent need to carry out formal assessments of entrustability, rather than relying on self-report.

Successful treatment of an 82-year-old COVID-19 delta variant-infected patient with haemorrhagic stroke and active prostate cancer brain metastasis.

Successful treatment of an 82-year-old COVID-19 delta variant-infected patient with haemorrhagic stroke and active prostate cancer brain metastasis.

Bedside ultrasonography for the confirmation of nasogastric tube placement: agreement between nurse and physician.

To evaluate the agreement between nurse and physician in verifying the positioning of the nasogastric tube by ultrasonography and describe the difficulties faced by nurse in performing the technique. Cross-sectional study conducted in 2021, including critical patients after nasogastric tube insertion who were independently evaluated by a nurse and physician, using bedside ultrasonography. The tube was considered adequately positioned when viewed in infradiaphragmatic location in the topography of the stomach. In the 30 peer evaluations there was almost perfect agreement (k = 0.93; 95%CI: 0.65 - 0.99). In only one case the nurse was uncertain about the positioning. Some difficulties were reported: abdominal distention (n=2), gas interposition (n=3) and patient movement during the exam (n=2). A trained nurse obtained very similar results to those found by a physician in identifying the nasogastric tube placement by means of ultrasonography, suggesting a reproducible and safe technique.

Correlation Between Prolonged Nasogastric Feeding and Temporomandibular Joint Dysfunction

Background: Nutrition is administered via enteral feeding in the form of fluid supplements to overcome malnutrition in hospitalized patients, or enteral tubes are intubated into the stomach and small bowel if the patient is unable to feed orally. The most common procedure performed by doctors across all medical specialties is nasogastric intubation. However, it has its own complications such as nasopharyngeal pain, aspiration, and trauma while insertion of the tube, but the impact of prolonged nasogastric tube feeding on temporomandibular joint (TMJ) is unknown. There is paucity of literature focusing on the TMJ; therefore, this study focuses on the correlation of prolonged nasogastric tube feeding and temporomandibular joint dysfunction. Materials and Methods: This was an observational study conducted among 59 participants. Patients undergoing nasogastric feeding for more than a week and having pain during mouth opening and left right lateral excursion were included in the study. Subjects with previous trauma to TMJ were excluded from study. Patients who were unconscious or uncooperative, had previous trauma to TMJ, and had facial surgery were excluded from the study. Result: Multivariate analysis revealed that there was no significant limitation of range of motions (ROMs; mouth opening [P = 0.232, t = 8.800], protrusion [P = 0.315, t = 17.130], right lateral excursion [P = 0.511, t = 16.768], and left lateral excursion [P = 0.5108, t = 18.143]) when compared to the ROMs at the time of insertion of nasogastric tube and 5–14 days after the removal of nasogastric tube. Also, there was significant TMJ pain. Conclusion: The study concludes that there was a significant correlation between duration of intubation and pain in masticatory muscles such as the temporalis and masseter, and medial and lateral pterygoid muscles and weak correlation between prolonged nasogastric intubation and TMJ movements.

The Effect of Intravenous Metoclopramide on Pain, Nausea, Discomfort, and Ease of Insertion of Nasogastric Tube in Emergency Department: A Double-blind Randomized Clinical Trial

Background: Placement of nasogastric tube (NGT) is a routine procedure in the emergency departments, which can be uncomfortable, painful, and cause nausea. The aim of this study was to investigate the effect of intravenous metoclopramide on the ease of NGT insertion, as well as reduction of patients’ pain, nausea, and discomfort during NGT insertion in the emergency department.&#x0D; Methods: In this randomized, double-blind, placebo-controlled trial, 80 patients referred to Imam Khomeini Hospital, Mazandaran Province, Iran were enrolled. Data were collected from December 2015 to March 2016. Participants were selected via convenience sampling and randomly divided into two equal groups (placebo and intervention groups). In metoclopramide and placebo groups, 10 mg of metoclopramide and 10 mg of normal saline solution were administered, respectively. All of the NGT was inserted 15–20 mins after the intravenous infusion. Patient-reported pain, discomfort, and nausea were evaluated using visual analogue scale (VAS), at four time points including before (T0), immediately (T1), 30 min after (T2), and 1 hr after the NGT placement (T3). The ease of NGT insertion was evaluated as easy, moderate, and difficult to pass.&#x0D; Results: None of the patients had pain, nausea, and discomfort in T0. Additionally, for those who received intravenous metoclopramide, pain intensity significantly decreased compared with the placebo group in T1 (37.7 vs 55.0), T2 (26.2 vs 41.7), and T3 (20.5 vs 33.7), respectively (P &lt; 0.001). Nausea intensity decreased significantly over time among patients in the intervention group compared with the placebo group in T1 (32.7 vs 43.2), T2 (19.5 vs 31.2), and T3 (9.0 vs 21.7), respectively (P &lt; 0.001). The intensity of patients’ discomfort decreased significantly among patients in the intervention group compared with the placebo group in T1 (39.5 vs 54.0), T2 (28.7 vs 40.2), and T3 (26.2 vs 39.6), respectively (P &lt; 0.001). Patients in the intervention group had easier placement of NGT compared with the placebo group (Easy: 40.0% vs 0.0%, Moderate: 45.0% vs 62.5%, and Difficult: 15.0% vs 37.5%; P &lt; 0.001).&#x0D; Conclusion: Based on the results of the present study, it seems that intravenous metoclopramide can be used as a promising modality for improving the ease of NGT placement and reducing patients’ pain, nausea, and discomfort during NGT insertion in the emergency department.

Are Differences in Dysphagia Assessment, Oral Care Provision, or Nasogastric Tube Insertion Associated with Stroke-Associated Pneumonia? A Nationwide Survey Linked to National Stroke Registry Data

Introduction: Stroke-associated pneumonia (SAP) is a common complication associated with poor outcomes. Early dysphagia screening and specialist assessment is associated with a reduced risk of SAP. Evidence about oral care and nasogastric tube (NGT) placement is equivocal. This study aimed to expose variations in dysphagia management practices and explore their associations with SAP. Participants and Methods: Speech pathologists from 166 stroke units in England and Wales were surveyed about dysphagia assessment and management, oral care, and NGT placement. Survey data were then linked to the Sentinel Stroke National Audit Programme (SSNAP), the national register of stroke. Univariable and multivariable linear regression models were fitted to estimate the association between dysphagia management practices and SAP incidence. Results: 113 hospitals completed the survey (68%). Variation was evident in dysphagia screening protocols (DSPs), oral care, and NGT practice while specialist swallow assessment data patterns were more consistent. Multivariable analysis showed no evidence of an association in incidence of SAP when using a water-only hospital DSP compared to a multiconsistency DSP (B −0.688, 95% CI: −2.912 to 1.536), when using written swallow assessment guidelines compared to not using written guidelines (B 0.671, 95% CI: −1.567 to 2.908), when teams inserted NGTs overnight compared to teams which did not (B −0.505, 95% CI: −2.759 to 1.749), and when teams had a written oral care protocol compared to those which did not (B −1.339, 95% CI: −3.551 to 0.873). Discussion and Conclusion: Variation exists in dysphagia screening and management, but there was no evidence of an association between clinical practice patterns and incidence of SAP. Further research with larger sample sizes is needed to examine association with SAP.

Nonoperative management without nasogastric tube decompression for adhesive small bowel obstruction

BackgroundAlthough nasogastric tube (NGT) decompression is widely used in nonoperative management for adhesive small bowel obstruction (SBO), robust evidence is lacking to support this routine practice. MethodsPatients who received nonoperative management with a diagnosis of adhesive SBO were retrospectively reviewed. Those who received NGT or long-tube decompression at admission were categorized into the NGT group, while those who initially had no NGT placement were categorized into the non-NGT group. The incidence of vomiting after admission, pneumonia after admission, and the need for surgery were compared. ResultsAmong 288 patients, 148 (51.3%) had non-NGT conservative treatment. There were no significant differences in the incidence of vomiting (NGT vs non-NGT: 12.9% vs 18.9%, p = 0.16), pneumonia (1.4% vs 0%, p = 0.235), or need for surgery (12.9% vs 7.4%, p = 0.126). ConclusionsWhile NGT decompression is a standard of care for adhesive SBO, selective NGT insertion for patients with persistent nausea or vomiting can become an option.

Comparison of four different methods of nasogastric tube insertion with double-lumen tracheal tube in situ: A randomised clinical trial.

From the Department of Anesthesiology & Critical Care, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India Correspondence to Dr Satyajeet Misra, MD, DNB, PDCC, TOE (EACVI), Additional Professor, Anesthesiology, AIIMS Bhubaneswar, Bhubaneswar 751019, Odisha, India Tel: +91 9438884048; e-mail: [email protected]

Endotracheal tube mal-insertion via Zenker’s diverticulum to trachea

An 86-year-old woman with chronic respiratory failure was under endotracheal tube insertion and mechanical ventilator support for 2 months due to previous intra-cranial hemorrhage. She presented with difficult nasogastric (NG) tube insertion after changing endotracheal tube and was transferred to our emergency room. The initial vital signs were blood pressure: 136/85 mmHg, heart rate: 100 bpm, respiratory rate: 20 cpm, body temperature: 36.5o c, and SpO2 : 100% under ventilator support, and stupor consciousness was remained as usual. The physical examination showed bilateral clear breath sound. We tried the NG tube insertion again but in vain; therefore, the esophagogastroduodenoscopy (EGD) was performed for NG tube insertion and revealed malposition of the endotracheal tube over upper esophagus and Zenker’s diverticulum with ulcerations (Panel A). Endotracheal tube was inserted to the esophagus, via the Zenker’s diverticulum, and then to the trachea. The neck CT confirmed the diagnosis (Panel B). After endotracheal tube replacement via bronchoscopy and supportive care with antibiotics treatment, the patient was discharged after admission for two weeks.

A safe and simple technique for nasogastric tube insertion in patients with thoracic esophageal cancer surgery

BackgroundRisk factors for anastomotic leakage include local factors such as excessive tension across anastomosis and increased intraluminal pressure on the gastric conduit; therefore, we consider the placement of a nasogastric tube to be essential in reducing anastomotic leakage. In this study, we devised a safe and simple technique to place an NGT during an end-to-side, automatic circular-stapled esophagogastrostomy.MethodsFirst, a 4-0 nylon thread is fixed in the narrow groove between the plastic and metal parts of the tip of the anvil head. After dissecting the esophagus, the tip of the NGT is guided out of the lumen of the cervical esophageal stump. The connecting nylon thread is applied to the anvil head with the tip of the NGT. The anvil head is inserted into the cervical esophageal stump, and a purse-string suture is performed on the esophageal stump to complete the anvil head placement. The main unit of the automated stapler is inserted through the tip of a reconstructed gastric conduit, and the stapler is subsequently fired and an end-to-side esophagogastrostomy is achieved. The main unit of the automated stapler is then pulled out from the gastric conduit, and the NGT comes out with the anvil head from the tip of the reconstructed gastric conduit. Subsequently, the nylon thread is cut. After creating an α-loop with the NGT outside of the lumen, the tip of the NGT is inserted into the gastric conduit along the lesser curvature toward the caudal side. Finally, the inlet of the automated stapler on the tip of the gastric conduit is closed with an automated linear stapler, and the esophagogastrostomy is completed.ResultsWe utilized this technique in seven patients who underwent esophagectomy for esophageal cancer; smooth and safe placement of the NGT was accomplished in all cases.ConclusionOur technique of NGT placement is simple, safe, and feasible.

69-Year Old Man With Dysphagia and Nasal Regurgitation

69-Year Old Man With Dysphagia and Nasal Regurgitation

EP.FRI.828 Accidental Placement of Nasogastric Tube into the brain

Abstract The nasogastric tube (NGT) plays a very vital role in the early resuscitation of head injury patients for various reasons. Though considered a simple procedure, it can be associated with multiple dreadful complications. Our patient was a 44-year-old male, referred from a peripheral health center for further management of severe head and faciomaxillary injuries following a motor vehicular accident. On arrival at the hospital, the endotracheal tube and NGT were in situ. A computed tomography scan of the brain revealed the NGT piercing through the cribriform plate of ethmoid and coiling into the cranial cavity with pneumocephalus. The NGT was retrieved under C-arm guidance and his injuries were managed respectively. The patient was discharged after prolong hospitalization with an acceptable outcome. With this case report, we want to remind emergency health care providers to avoid this catastrophic complication of NGT insertion in a faciomaxillary trauma patient by doing it transorally. We report a novel method of safely removing NGT which has not been reported in the past.

Rhinoplasty and Nasogastric Tube insertion in the Emergency Department

Rhinoplasty and Nasogastric Tube insertion in the Emergency Department