Nasogastric tube insertion using conventional versus bubble technique for its confirmation in anesthetized patients: a prospective randomized study

Sharma, Aruna; Vyas, Varuna; Goyal, Shilpa; Bhatia, Pradeep; Sethi, Priyanka; Goel, Akhil Dhanesh

doi:10.1016/j.bjane.2021.01.011

Cited by 2 publications

(2 citation statements)

References 16 publications

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“…According to earlier studies, the sensitivity of the traditional approach was 60%, whereas the sensitivity of POCUS in confirming NGT was around 90% [11,12]. There was a 20% permitted difference between two techniques for NGT confirmation with an 80% power and 5% alpha error level.…”

Section: Methodsmentioning

confidence: 99%

Point-of-care ultrasonography-assisted nasogastric tube placement in the emergency department: a randomized controlled trial

Mohd.

Kumar

Bhoi

et al. 2022

European Journal of Emergency Medicine

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BackgroundThe complications of a blind procedure for gastric tube placement are well documented. POCUS has been widely used to confirm the position of blindly inserted gastric tubes, and it does not prevent complications caused by the blind method. We performed a randomized controlled trial to compare gastric tube insertion with real-time oesophagus visualization using POCUS to the standard technique.Objective The primary goal of this study was to compare the accuracy of real-time POCUS-guided nasogastric tube (NGT) insertion and confirmation to that of the standard technique.Methods It was a prospective, parallel-group, openlabel randomized controlled trial with a superiority design. All patients requiring NGT were screened for inclusion and exclusion criteria, and 120 patients were randomly assigned to one of two groups: POCUS (n = 60) or control (n = 60). Following the procedures, confirmatory chest radiographs were obtained in both groups. ResultsAs per protocol, 118 patients were analyzed. In POCUS group, the oesophagus was visualized on POCUS in 56 of 58 patients (96.5%). In 55 of 58 cases (94.8%), an NGT was inserted in real time. Despite visualizing the oesophagus, we fail to insert the tube in one (1.8%). The oesophagus could not be seen on the scan in two cases (3.4%). Chest radiographs confirmed the tube in the stomach in 55 (98.2%). The chest radiograph revealed the tip of the NGT in the stomach in 52 of 60 (86.6%) patients. In seven cases (11.7%), we were unable to insert NGT. On a chest radiograph, one (1.6%) tip of the tube was seen in the right lung and was safely removed. The ultrasound-guided gastric tube insertion had a sensitivity of 96.5% (95% CI, 88-99.6%) and a positive predictive value (PPV) of 98.2% (95% CI, 98.1-98.3%). The conventional technique had 88% (95% CI, 77-95%) sensitivity and a PPV of 98% (95% CI, 97.9-98.2%). ConclusionPOCUS enables real-time insertion of a gastric tube with high sensitivity, in a short time with high first-attempt success rate and limited passagerelated complications. POCUS should be utilized for NGT insertion whenever expertise is available on the bedside.

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Section: Methodsmentioning

confidence: 99%

Point-of-care ultrasonography-assisted nasogastric tube placement in the emergency department: a randomized controlled trial

Mohd.

Kumar

Bhoi

et al. 2022

European Journal of Emergency Medicine

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“…A novel “bubble technique” was adopted to minimize repeated attempts and trauma. [ 4 5 ] Lignocaine jelly was applied to the proximal end of the NG tube prior to its insertion, and as soon as it entered the gastroesophageal junction, the intragastric gas caused a huge bubble spring up at the proximal end of NG tube, confirming its accurate placement in the first attempt [ Figure 2 ]. Had it been coiled in the oral cavity, no bubble would have appeared and small-sized, repeated bubbles would have suggested intratracheal placement.…”

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confidence: 99%