Effects of implementation strategies aimed at improving high-value verification methods of nasogastric tube placement: A systematic review

Abstract

BackgroundX-ray and pH testing, which clinical practice guidelines have proven to be effective in determining nasogastric tube (NGT) placement, were named the high-value methods. Implementation strategies can help to integrate high-value methods into particular contexts. The aim of this systematic review was to summarize the evidence of implementation strategies aimed at improving high-value verification methods of NGT placement.MethodsPubMed, ProQuest, and CINAHL were searched until June 2022. The Cochrane Effective Practice and Organization of Care (EPOC) taxonomy was used to categorize implementation strategies.ResultsThe initial search identified 1,623 records. Of these, 64 full-text studies were reviewed. Finally, 12 studies were included and used for qualitative synthesis. Eleven studies used an education component as an implementation strategy. Only one study based their implementation strategy on a barriers and facilitators assessment. None of the studies reported enough detail of the implementation strategy used in their studies. Seven studies were eligible for inclusion in the meta-analysis. Three of these seven studies revealed a significant improvement of the high-value method after strategy implementation. As heterogeneity was present in the high level, the pooled effect estimated was not calculated.ConclusionMost studies used an implementation strategy with an educational component. Unfortunately, no conclusion can be drawn about which strategy is most effective for improving high-value verification methods of NGT placement due to a high level of heterogeneity and a lack of studies. We recommend that future studies fully connect their implementation strategies to influencing factors and better report the details of implementation strategies.Systematic review registration[www.crd.york.ac.uk/PROSPERO/], identifier [CRD42022349997].

A prospective observational study of pH testing to confirm ongoing nasogastric tube position

“…To date, there have been no specific studies focusing on the long-term compliance with NGT position testing guidelines. There are several studies which measure change in NGT guideline compliance pre-and post-implementation strategies but none reported longer term follow-up post initial implementation (Li et al, 2022).…”

A new approach of estimating insertion length for intermittent orogastric tube feeding in adult patients

“…It should be noted that a supine position should be adopted when NU is measured to ensure accuracy. Currently, different researchers hold different opinions regarding whether the tip of the tube should be placed in the middle of the esophagus, lower part of the esophagus, or stomach body [9][10][11] . In addition, a Chinese guideline for tube feeding in adults recommends that for participants with aspiration or GER, the feeding gastric tube should be extended until the tip is located behind the pyloric 14 .…”

“…Proper insertion of the gastric tube is important to ensure safe and effective feeding. Currently, the estimates of gastric tube insertion length are roughly made based on the "distance from the tip of the nose to the lower edge of the earlobe to the xiphoid, NEX" which refers to the distance from the tip of the nose to earlobe to xiphoid [8][9][10] . However, this method ignores individual variation (eg, height and weight) and has been criticized for its inaccuracy in estimating the appropriate insertion length of the orogastric tube 11,12 .…”