Using color flow detection of air insufflation to improve accuracy in verifying nasogastric tube position

Wong, K. Y.; Chan, Hok Hang; Wong, Chi Pang; Chan, Ming Yin; Chau, Jeffrey Cheuk Wai; Wong, Tai Wai

doi:10.1016/j.ajem.2016.12.046

Cited by 10 publications

(25 citation statements)

References 9 publications

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“…To counter the problem of introducing fluids before NGT placement has been confirmed, a study used a color Doppler ultrasound whereby a color Doppler flow signal would be detected by a probe placed at the epigastrium when 20 mL of air is injected into the NGT. 19 The sensitivity was 90% (95% CI 83.7%–96.2%) and specificity 80% (95% CI 55.2%–100%). 19 However, false positives may occur due to breathing artefacts of patients or if the NGTs were in the lower esophagus and the injected air flows from the esophagus into the stomach.…”

Section: Discussionmentioning

confidence: 96%

“…19 However, false positives may occur due to breathing artefacts of patients or if the NGTs were in the lower esophagus and the injected air flows from the esophagus into the stomach. 19…”

Section: Discussionmentioning

confidence: 99%

“…6 In less extreme situations, NGTs which did not pass the esophagogastric junction (resting in the esophagus) increased the risk of aspiration of feeds into the lungs. 7 Methods of NGT placement confirmation reported in the literature include X-ray, 5 observation for presence of bubbling, 8 auscultation with insufflation of air, 5 litmus paper test, 9 pH paper test, 5,[8][9][10][11][12][13] use of biochemical markers, 14,15 capnography/colorimetric capnometry, 16 ultrasound, [17][18][19][20] electromagnetic (EM) tracing, [21][22][23][24][25] visualization, 26 and manometer techniques. 27,28 This paper aims to discuss the advantages and limitations of these methods and identify directions for future research.…”

Section: Introductionmentioning

confidence: 99%

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Nasogastric tube placement confirmation: where we are and where we should be heading

Fan

Tan

Ang

2017

Proceedings of Singapore Healthcare

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Background: Insertion of a tube via the nasal passage is a common procedure which has been practiced for many years. There are various ways to assess the position of the nasogastric tube (NGT). Objectives: The objective of this study was to discuss the advantages and limitations of each method of NGT placement confirmation, to identify gaps in literature, and provide suggestions for future research. Methods: A search was performed with Pubmed, CINAHL, and Embase. The following keywords were used: "nasogastric," "tube," "placement," "insertion," and "measurement." The results were narrowed down to those with full text available, published in the English language, those published within the last 10 years, and those studies done in the adult population. The reference lists of those articles were also referred to and relevant articles were retrieved. A final 26 relevant articles were included in this review, including six that were published more than 10 years ago but still relevant in this review. Results: A method to confirm NGT placement that is accurate, affordable, does not require gastric aspirates, and is able to be used not only upon insertion but also at regular intervals is lacking. Conclusions: This article provides a summary of the different methods of NGT placement confirmation and discusses their advantages and limitations. Gaps in literature and suggestions for future research were also deliberated.

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Section: Discussionmentioning

confidence: 96%

“…19 However, false positives may occur due to breathing artefacts of patients or if the NGTs were in the lower esophagus and the injected air flows from the esophagus into the stomach. 19…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Nasogastric tube placement confirmation: where we are and where we should be heading

Fan

Tan

Ang

2017

Proceedings of Singapore Healthcare

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“…Secondly, the transducer was angled lightly towards to the subcostal region, and the gastric body was imaged. At this time, by the visualizing the hyperechogenic line parallel to each other, GT was detected ( Figure 2) [18].…”

Section: Gastric Usgmentioning

confidence: 99%

“…In addition, direct visualization of stomach as a definitive verification method can be difficult due to interposition, gastric content and patients' characteristics (obese or excessively mobile) [11][12][13][14]. Therefore, additional methods, such as combining different scanning points and visualization of dynamic fogging or Doppler signal due to air insufflation can be used to improve the accuracy of diagnosis [15][16][17][18]. In our previous study, we revealed that passing of GT through the esophagus could be visualized at a higher rate in real time with USG [19].…”

Section: Introductionmentioning

confidence: 99%

The evaluation of efficacy of three different ultrasonography methods for verification of gastric tube placement in intensive care unit patients

Gök¹

2017

Med-Science

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Gastric tube (GT) placement is a routine procedure in critically ill patients. Improper placement of GT could lead to severe complications. Radiography remains as the gold standard test to confirm tube position. The study aim is to estimate diagnostic accuracy of three different ultrasonography (USG) methods to verify GT placement in intensive care units (ICU). Twenty-five mechanically ventilated patients were included in this prospective and observational study. All real time US examinations were performed by an intensivist in three steps: sonography ofneck for visualizing esophagus and upper abdominal quadrant for visualizing stomach, and visualisation of dynamic fogging during water and air insufflations in gastric area. Finally, gastric placement of GT was confirmed with abdominal radiography. USG visualized GT in esophagus in 24 (96 %) patients. GT was directly visualized in stomach in 16 (64%) patients and dynamic fogging occurred in 20 (80 %) in the first attempt and in 23 (92 %) patients after tube removal. Because gastric tube was not seen in stomach in nine cases, dynamic fogging allowed to confirm intragastric position in seven cases. In two cases, no dynamic fogging was observed, and radiography confirmedtube malposition in esophagus. Entire sonographic procedure took 7.24±2.58 minutes. Visualization of the esophagus and dynamic fogging improves the diagnostic accuracy of USG in verifying GT position. Confirming correct GT placement by USG has the potential to reduce X-ray usage and save time. However, X-ray remains the gold standard in cases in which USG cannot verify placement of the GT.

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Ultrasonography for confirmation of gastric tube placement

Tsujimoto,

Kataoka,

Banno

et al. 2024

Cochrane Database of Systematic Reviews

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Using color flow detection of air insufflation to improve accuracy in verifying nasogastric tube position

Cited by 10 publications

References 9 publications

Nasogastric tube placement confirmation: where we are and where we should be heading

Nasogastric tube placement confirmation: where we are and where we should be heading

The evaluation of efficacy of three different ultrasonography methods for verification of gastric tube placement in intensive care unit patients

Ultrasonography for confirmation of gastric tube placement

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