Modified gastric biopsy forceps as a flexible stylet-assisted nasogastrictube insertion in anesthetized and intubated patients: a prospective randomized controlled study

Abstract

Background Insertion of a nasogastric tube in an anesthetized intubated patient may be difficult. A nasogastric tube is prone to coil and kink during insertion. We hypothesize that gastric biopsy forceps can be used as a flexible stylet-assisted nasogastric tube insertion. It can improve the first-attempt success rate over the conventional blind technique during nasogastric tube insertion in the anesthetized intubated patient. Methods Eighty adult patients who required intraoperative nasogastric tube insertions were randomized to the gastric biopsy forceps assisted technique (stylet group) or the conventional blind technique (control group) for insertion of a nasogastric tube. The success rates, the duration of insertion, the incidences of coiling and kinking of a nasogastric tube, and the occurrences of complications were recorded. Results The first-attempt success rate was 92.5% in the stylet group compared with 65% in the control group (P = 0.013). The overall success rate was higher in the stylet group (100% vs 85%; P = 0.026). The mean time required to insert the nasogastric tube was shorter in the stylet group (24.85 ± 9.62 vs 62.4 ± 59.38 seconds; P = 0.002). The incidences of coiling and kinking were lower in the stylet group (7.5% vs 32.5%; P = 0.005). The incidence of minor bleeding was lower in the stylet group, but not statistically significant (2.5% vs 17.5%; P = 0.057). No other complications were observed in either of the groups. Conclusion The gastric biopsy forceps-assisted nasogastric tube insertion resulted in a higher success rate, less time for insertion, and lower incidence of coiling and kinking of a nasogastric tube than the conventional blind technique in anesthetized intubated patients without serious complications. Trial registration: Thai Clinical Trials Registry (www.clinicaltrials.in.th), TCTR20141018001 (19/09/2014).