Nasogastric tube placement under sonographic observation: A comparison study of ultrasound and chest radiography in mechanically ventilated patients |
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| Affiliation: | 1. Department of Intensive Care, Nambour General Hospital, 26 Hospital Road, Nambour, Sunshine Coast, Queensland, 4560, Australia;2. Department of Intensive Care, Sunshine Coast University Hospital, 6 Doherty Street, Birtinya, Sunshine Coast, Queensland, 4575, Australia;3. School of Medicine Griffith University, 170 Kessels Road, Brisbane, Queensland, 4111, Australia;4. Faculty of Medicine, University of Queensland, St Lucia, Queensland, 4072, Australia;5. Sunshine Coast Research Institute Research Activity Group, Sunshine Coast University Hospital, 6 Doherty Street, Birtinya, Sunshine Coast, Queensland, 4575, Australia;1. Intensive Care Clinical Unit, University Hospital Virgen Macarena, Dr. Fedriani St., 3, 41009, Seville, Spain;2. Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Avenzoar St., 6, 41009, Seville, Spain;1. Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia;2. Emergency Services, Illawarra Shoalhaven Local Health District, Wollongong Hospital, Crown St, Wollongong NSW, Australia;3. Illawarra Health and Medical Research Institute, Building 32 University of Wollongong, Northfields Avenue, Wollongong NSW, Australia;4. Emergency Department, St George Hospital, Kogarah, NSW, Australia;5. St George Clinical School, Faculty of Medicine, University of New South Wales, NSW, Australia;6. School of Medicine, Medicine and Health, University of Wollongong, Wollongong 2522, NSW, Australia;7. School of Nursing and Midwifery and Centre for Quality and Patient Safety Experience in the Institute for Health Transformation, Deakin University, Geelong, VIC, Australia;8. Centre for Quality and Patient Safety Experience – Eastern Health Partnership, Box Hill, VIC, Australia;9. University of Technology Sydney Faculty of Health, NSW, Australia;10. Northern Sydney Local Health District, NSW, Australia;11. Nursing Research Institute, St Vincent''s Health Network Sydney, St Vincent''s Hospital Melbourne and Australian Catholic University, NSW Australia;12. Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, NSW 2113;13. Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Camperdown, NSW 2006, Australia;14. Department of Infection Prevention and Control, Division of Infectious Diseases and Sexual Health, Westmead Hospital and Western Sydney Local Health District, Westmead, NSW, 2145, Australia;15. New South Wales Biocontainment Centre, Western Sydney Local Health District and New South Wales Health, NSW, 2145, Australia;p. South West Sydney Clinical School, Faculty of Medicine, University of New South Wales, NSW 2006, Australia;1. Service de Médecine Intensive Réanimation, Centre Hospitalier Régional d’Orléans, Orléans, France;2. Ecole Universitaire de Kinésithérapie Centre Val de Loire, Orléans, France;1. Swallowing Neurorehabilitation Research Lab, Speech Pathology, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Australia;2. Department of Speech Pathology, Bendigo Health, Bendigo, Victoria, Australia;3. Department of Finance and Resources, Bendigo Health, Bendigo, Victoria, Australia;4. Department of Intensive Care Medicine, Bendigo Health, Bendigo, Victoria, Australia;5. Department of Intensive Care Medicine, Goulburn Valley Health, Shepparton, Victoria, Australia;6. Department of Medicine University of Queensland, Australia;7. Department of Medicine University of Melbourne, Australia;1. Speech Pathology, Concord Repatriation General Hospital, NSW, Australia;2. Burns Unit, Concord Repatriation General Hospital, NSW, Australia;3. Intensive Care Unit, Concord Repatriation General Hospital, NSW, Australia;4. School of Health and Rehabilitation Sciences, University of Queensland, QLD, Australia;5. Faculty of Health Sciences, University of Sydney, NSW, Australia;6. Centre for Functioning and Health Research, Queensland Health, QLD, Australia;7. Department of Nutrition and Dietetics, Concord Repatriation General Hospital, NSW, Australia;8. Physiotherapy Department, Concord Repatriation General Hospital, NSW, Australia;9. Department of Nursing, Concord Repatriation General Hospital, NSW, Australia;10. Faculty of Medicine, University of Sydney, NSW, Australia |
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| Abstract: | BackgroundNasogastric tube insertion in the intensive care setting is common. Placement verification is required to avoid complications of bronchotracheal misplacement that range from aspiration of infused contents to death from associated causes. The gold standard of practice is chest radiography. Ultrasound is a growing modality and is readily available in most intensive care units.ObjectiveThe objective of this study was to examine the diagnostic accuracy of ultrasound imaging of nasogastric tube placements by nonradiologists compared with chest radiography in mechanically ventilated patients.MethodsThis is a dual-centre prospective, single-blind study. Correct placement was captured with a hyperechoic ultrasound image of a nasogastric tube in the oesophagus and epigastrium, which was compared with chest radiography. Patient enrolment included general adult intensive care unit admissions who were mechanically ventilated and required a nasogastric tube for either the treatment or monitoring of their illness.ResultsA total of 25 patients were enrolled (15 men, 10 women), and their mean age was 68.1 ± 13.8 years. Outcome measures were the percentage of correctly identified nasogastric tubes in the oesophagus and epigastrium. The sensitivity of oesophagus ultrasound was 88%, and the positive predictive value was 100%. The subxiphoid sensitivity was 64%, and the positive predictive value was 100%. Comparison sensitivity and specificity of oesophagus versus subxiphoid ultrasound was 64% and 33%, respectively. There was a positive predictive value of 88% and a negative predictive value of 11%. The results showed a variance in detection sensitivity in the ultrasound scans of the oesophagus (0.88) and subxiphoid (0.64) (N = 25, p = 0.012).ConclusionNasogastric tube placement verification via ultrasound in critically ill mechanically ventilated patients conducted by nonradiologists with minimal training is associated with diagnostic accuracy. These results add to the limited evidence in the current literature; however, they should be considered with awareness that placement in the stomach in this study was detected in 64% of cases, alongside the missed captured evidence of the sonographer's ability to identify misplacement. |
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| Keywords: | Intensive care Mechanical ventilation Nasogastric tube Radiography Ultrasound |
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