Gastric tube insertion under direct vision using the King Vision™ video laryngoscope: a randomized, prospective, clinical trial

Abstract

BackgroundThe frequency of malpositioning of gastric tubes in the trachea has been reported to be 0.3–15%, which may cause severe complications, such as pneumonia, if not detected promptly. If a gastric tube can be guided into the esophagus under direct vision with a video laryngoscope, misplacement of the gastric tube into the trachea can be avoided. We compared gastric tube insertion under direct vision using a video laryngoscope with the conventional method of blind insertion.MethodsWe enrolled 60 patients who required a transnasal gastric tube to facilitate elective abdominal surgery under general anesthesia. The participants were recruited consecutively into one of two groups, a group of 30 patients in whom a gastric tube was inserted using a King Vision™ video laryngoscope (KV group), and a group of 30 patients who underwent conventional blind insertion of the gastric tube (Blind group). The success rate, the time taken to insert the gastric tube, and the incidence of complications were compared.ResultsIn the KV group, the time required for gastric tube placement was 52.5 ± 17.1 seconds, with a success rate of 100%. Slight oral hemorrhage occurred in two participants and slight epistaxis in one participant. In the Blind group, the time required for gastric tube placement was 65.9 ± 39.9 seconds, with a success rate of 90% (27 out of 30 patients). Slight oral hemorrhage occurred in two participants, slight epistaxis occurred in two participants, and tracheal malposition occurred in one participant but was detected promptly and corrected using the video laryngoscope. There were no significant differences in the time required for placing the gastric tube, the success rate, or the incidence of complications between the groups.ConclusionsGastric tube insertion using a King Vision video laryngoscope was straightforward, and was particularly useful for detecting and correcting tracheal malpositioning.Trial registrationTrial registry number: UMIN000011014.

Intraoperative Gastric Tube Intubation: A Summary of Case Studies and Review of the Literature

“…Several articles depict methods that employ specialized equipment with or without tube modifications or replacements. The Glidescope and King Vision video laryngoscopes corroborated higher success rates when used to facilitate placement compared to controls [ 50 ] [ 51 ]. Despite encouraging success rates, having to re-instrument the oropharynx due to first attempt failures is not without its own attendant risks.…”

Malposition of a Nasogastric Feeding Tube Into the Right Pleural Cavity of a Nasopharyngeal Carcinoma Patient After Radiotherapy and Chemotherapy: A Case Report

“…Fortunately, misplacement of the gastric tube into the lung or trachea will be avoided under direct visualization using a video laryngoscope. Video laryngoscope-assisted nasogastric tube placement enables the operator to see if the tube has or has not entered the esophagus and to correct any nonesophageal placement, and this way helps advance the tube correctly into the esophagus [33]. Especially for patients with nasal contraindications who are in uenced by physiological and pathological factors, traditional methods are not easy to succeed.…”

Videolaryngoscopy, the Current Role in Airway Management

“…Videolaryngoscopy can be particularly useful for guiding and correcting malposition of different devices through oropharynx such as nasogastric or orogastric tube [49], esophagoscopes, gastroscopes, or transesophageal echocardiography probe [50]. In addition, it can be useful when placing throat packs in oral and maxillofacial surgery.…”