A virtual reality based simulator for learning nasogastric tube placement

Abstract

Nasogastric tube (NGT) placement is a common clinical procedure where a plastic tube is inserted into the stomach through the nostril for feeding or drainage. However, the placement is a blind process in which the tube may be mistakenly inserted into other locations, leading to unexpected complications or fatal incidents. The placement techniques are conventionally acquired by practising on unrealistic rubber mannequins or on humans. In this paper, a virtual reality based training simulation system is proposed to facilitate the training of NGT placement. It focuses on the simulation of tube insertion and the rendering of the feedback forces with a haptic device. A hybrid force model is developed to compute the forces analytically or numerically under different conditions, including the situations when the patient is swallowing or when the tube is buckled at the nostril. To ensure real-time interactive simulations, an offline simulation approach is adopted to obtain the relationship between the insertion depth and insertion force using a non-linear finite element method. The offline dataset is then used to generate real-time feedback forces by interpolation. The virtual training process is logged quantitatively with metrics that can be used for assessing objective performance and tracking progress. The system has been evaluated by nursing professionals. They found that the haptic feeling produced by the simulated forces is similar to their experience during real NGT insertion. The proposed system provides a new educational tool to enhance conventional training in NGT placement.

Nasogastric tube insertion in anaesthetized patients: a comprehensive review

“…The implementation of nursing education policy as a vehicle for achieving a better balance between the qualifications of nurses and national health care needs could result in great return on investment. 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.…”

Novel Visual Nasogastric Tube Insertion System: A Feasibility and Efficiency Study in a Manikin

“…Simulation technologies for NGT insertion are widely accepted for use in educational applications [28–31]. The present research also evaluated whether training in nasogastric tube insertion with visual guidance versus blind insertions could result in different perceptions of insertions or skill acquisition in NGT insertion.…”

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

“…The method proposed here is compared with a physics-based model developed based on nonlinear FEM [4], where the insertion forces of a tube being inserted from the nostril to the laryngopharynx at a constant speed is simulated offline, and the wall of the passage is modeled as rigid body. In Fig.…”

“…Besides, the computation also needs to be fast enough, at a refresh rate of 1 kHz, in order to simulate the haptic feedback in a smooth and natural way. Nevertheless, haptic simulation using computation-intensive methods like FEM can be achieved in real time with the better hardware available nowadays or using alternative approaches [4]. Despite the theoretical rigor, the physics-based approaches still require accurate identification of the model parameters for realistic simulation.…”

“…it is difficult to measure the insertion force data on patients in vivo during the NGT placement process. In our previous work [4], an offline simulation approach was adopted to obtain the relationship between the insertion depth and insertion force based on a non-linear FEM. The pre-computed data were then used to generate the forces in real-time simulation.…”