Ultrasonography for nasogastric tube placement verification: an additional reference

Abstract

<jats:p> Nasogastric tube (NGT) insertion is a common procedure performed by community nurses, but verifying correct placement can be challenging due to the limitations of conventional methods. This study aimed to investigate the effectiveness of point-of-care ultrasonography (POCUS) for verifying NGT placement and to explore the feasibility of using this imaging modality as the first-line reference for NGT placement verification. The validity of the gastric aspirate pH test was also evaluated. This was a single-centre, retrospective, single-blind study using a convenience sample of patients who required NGT placement in home settings. POCUS was performed by a trained community nurse, and the pH test was performed after tube insertion. The results of the POCUS and pH test were compared. A total of 68 patients with a mean age of 82.13±9.43 years were included. The sensitivity and specificity were found to be 95.45% and 100%, respectively, for POCUS, and 90.91% and 100%, for the pH test. POCUS can provide accurate diagnostic imaging of nasogastric tube position and avoid X-ray controls. This imaging modality can complement pH testing in community settings where X-ray scans are not readily available. </jats:p>

Ultrassonografia à beira do leito para localização da sonda nasoenteral: concordância entre enfermeiro e médico

“…Para atenuar esta limitação,tem sido sugerida comoestratégia para melhoria de qualidade das imagens, o uso de injeção de solução salina (9) ou de ar que geram uma imagem dinâmica na US, facilitando a visualização (10) . Devido à heterogeneidade dos estudos incluídos nas revisões sistemáticas, evidenciou-se que a US ainda não dispõe de estudos robustos que embasem sua utilização como técnica única de verificação de posicionamento da sonda enteral (9,18) . Neste sentido, a instilação de solução salina, sem que se tenha certeza do posicionamento anatômico da sonda,constitui-se como um risco adicional e, por isso, não foi utilizada por neste estudo.…”

“…Em seguida, o enfermeirorealizou cinco avaliações supervisionadas pelo médico e foi considerado como"apto" para o início da coleta de dados. Essa estratégia de capacitação foi idealizada a partir da vivência dos profissionais em outros treinamentos, e também em experiências descritas na literatura, embora não haja uma estratégia formalmente recomendada (18)(19)(20) .…”

Bedside ultrasonography for the confirmation of nasogastric tube placement: agreement between nurse and physician

“…Next, the nurse performed five assessments supervised by the physician and was considered "able" for the beginning of data collection. This training strategy was designed based on the experience of professionals in other training courses, and also on experiences described in the literature, although there is no formally recommended strategy (18)(19)(20) .…”

“…To reduce this limitation, it has been suggested the use of saline solution (9) which generate a dynamic image at US, making it easier to visualization (10) . Due to the heterogeneity of the studies included in the systematic reviews, it became evident that US still does not have robust studies that support its use as a unique technique for verifying the placement of the enteral tube (9,18) . In this sense, the instillation of saline solution, without being sure of the anatomical positioning of the tube, constitutes an additional risk and, therefore, was not used in this study.…”

Biologically transparent illumination is a safe, fast, and simple technique for detecting the correct position of the nasogastric tube in surgical patients under general anesthesia

“…Measuring the pH of aspirates or CO 2 from the NGT are alternative techniques, but these techniques have lower sensitivity and specificity than X-ray examination [4,5]. Ultrasonography is another alternative but requires special training for NGT visualization [6]. Because of the abovementioned limitations of these methods, X-ray examination is recognized as the gold standard for confirming the correct position of the NGT; however, X-ray examination also has problems, including delayed verification, radiation exposure, and the burden on medical staff [7].…”