A Heuristic Force Model for Haptic Simulation of Nasogastric Tube Insertion Using Fuzzy Logic

Abstract

Nasogastric tube (NGT) placement is an essential clinical skill. The training is conventionally performed on rubber mannequins albeit practical limitations. Computer simulation with haptic feedback can potentially offer a more realistic and accessible training method. However, the complex interactions between the tube and the nasogastric passage make it difficult to model the haptic feedback during NGT placement. In this paper, a fuzzy-logic-based approach is proposed to directly transfer the experience of clinicians in NGT placement into the simulation system. Based on their perception of the varying tactile sensation and the conditions during NGT placement, the membership functions and fuzzy rules are defined to develop the force model. Forces created using the model are then combined with friction forces to drive the haptic device and render the insertion forces in real time. A prototype simulator is developed based on the proposed force model and the implementation details are presented. The usability of the prototype is also evaluated by clinical teachers. The proposed methodology has the potential for developing computerized NGT placement training methods for clinical education. It is also applicable for simulation systems involving complicated force interactions or computation-expensive models.

Nasogastric tube insertion in anaesthetized patients: a comprehensive review

“…Choi et al [98] in their study proposed a reality-based training simulation of tube insertion to facilitate NGT placement and showed that this system provides a new educational tool in order to enhance conventional NGT placement. The same group, in another study, explained a method for developing a computerized NGT placement training method for clinical education [99] Reisenberg et al [100] used a modified Delphi method to create a checklist for education and the assessment of NGT insertion and showed that using a validated checklist could decrease costs and complications while increasing the quality of health care. Binstadt et al [101] used a simulation-based module for integration in emergency departments.…”

Evaluation of a virtual reality based interactive simulator with haptic feedback for learning NGT placement

“…Conventionally, NGT insertion techniques are initially practised on low-fidelity mannequins, and subsequently human subjects. The prototype of a virtual reality -(VR-) based and haptic simulator for NGT insertion (Choi, He, Chiang & Deng, 2015;and Choi, He, Chiang, Deng & Qin, 2016) was created to facilitate the education and training of NGT placement for nursing students. The system is equipped with physical makeup of a NGT and human head, and an interactive graphic user interface (GUI) that provides high-fidelity and realistic simulation of tube insertion with unique feedback forces through the built-in haptic device (Picture 1).…”