Accuracy of the combined method (auscultation and pH measurement) and ultrasonography for confirmation of gastric tube placement: a study protocol for a prospective study

Abstract

IntroductionPatients using a nasogastric tube (NGT) are vulnerable to adverse events, therefore proper assessment of these patients, verification of the correct tube placement and constant monitoring by the nursing staff are strategies that can reduce adverse events and risks associated with the care. The aim of this study will be to assess the accuracy of the combined method (auscultation and pH measurement) and ultrasonography for confirmation of gastric tube placement compared with the X-ray method. A further aim will be to measure and provide evidence for the direct costs of each method of confirming NGT placement and to evaluate the impact of each method on the mean direct cost of the patient.Methods and analysisThis is a prospective, single-centre study of diagnostic accuracy. Data will be collected in the clinical and surgical wards, intensive care unit and coronary care unit of a Brazilian teaching hospital. The sample will consist of 385 assessments, performed in adult patients that agree to participate in the study and that receive an NGT. The combined method and the ultrasound will be the index tests and will be performed on all study participants for later comparison with an X-ray examination, considered the reference standard and the gold standard to distinguish between gastric and pulmonary placement. Sensitivity, specificity, positive predictive value and negative predictive value will be calculated to assess the diagnostic accuracy of the methods investigated in this study, with Cohen’s kappa analysis used to evaluate the degree of concordance.Ethics and disseminationThe study was approved by the Research Ethics Committee of the University of São Paulo at Ribeirão Preto College of Nursing, registration number: 83087318.4.0000.5393. The findings will be reported through academic journals, seminars and conference presentations, social media, print media, the internet and community/stakeholder engagement activities.

For Better Patient Safety

“…Given the serious complications of misinterpreting a wrong placement as a correct placement, this study clearly showed that it is difficult to determine the position of the gastric tube by ultrasonography alone. Regarding need for further research in this area, there is a lack of data in creating a comprehensive framework, considering the linkage of testing, interventions, and outcomes, 10 to determine whether ultrasound test combined with other tests 11 reduces complications and accidents caused by an incorrect tube placement. Moreover, the research excluded pregnant, pediatric, and tracheotomized patients, as well as those with anatomical abnormalities, caustic substance ingestion, neck surgery, and head or nose fractures.…”

Acurácia e custo de métodos utilizados por enfermeiros na confirmação do posicionamento de sondas nasoenterais recém inseridas às cegas à beira leito

“…Esse aspecto também destaca o caráter inédito deste estudo e a importância dessa análise, considerando a crise econômica que o Brasil vive. Os resultados dessa análise permitirão às instituições de saúde brasileiras escolher métodos mais seguros para os pacientes em uso de SNG e SNE, com custo mais acessível(RIGOBELLO et al, 2020).Diante dos métodos para confirmação do posicionamento da SNG e SNE encontrados na revisão da literatura, neste estudo optou-se por avaliar apenas o método da ausculta epigástrica, que ainda é empregado com frequência na prática clínica no Brasil, o método da medição do pH do aspirado gástrico, em combinação com a ausculta epigástrica, e a ultrassonografia, por se tratar de um método com potencial para reduzir os impactos negativos de sondas mal posicionadas.Logo, o presente estudo foi delineado para responder às seguintes perguntas: a) qual a acurácia dos métodos (ausculta epigástrica, medição do pH do resíduo aspirado e ultrassonografia) utilizados por enfermeiros na confirmação do posicionamento de sondas nasoenterais inseridas às cegas à beira leito, em pacientes adultos hospitalizados, em comparação com a radiografia? b) qual a concordância entre tais métodos e a radiografia, que é considerada padrão-ouro na confirmação do posicionamento de sonda nasoenteral?…”