4-Point ultrasonography to confirm the correct position of the nasogastric tube in 114 critically ill patients
Tóm tắt
Nasogastric feeding tube is routinely positioned in intensive care units. The complications of misplacement are rare but very dangerous for the patients. The aim of this study is to estimate the diagnostic accuracy of this new technique, 4-point ultrasonography to confirm nasogastric tube placement in intensive care. One hundred fourteen critical ill patients monitored in ICU were included. The intensivist provided in real time to perform the exam in four steps: sonography from either the right or left side of the patient’s neck to visualize the esophagus, sonography of epigastrium to confirm the passage through the esophagogastric junction and the positioning in antrum, sonography of the fundus. Finally, gastric placement of the nasogastric feeding tube was confirmed with thorax radiograph. One hundred fourteen of the gastric tubes were visualized by sonography in the digestive tract and all were confirmed by radiography (sensitivity 100%). The entire sonographic procedure, including the longitudinal and transversal scan of the esophagus, the esophagogastric junction, the antrum and the fundus, took 10 min. Our pilot study demonstrated that not weighted-tip gastric tube routinely used in Intensive Care is visible with the sonography. The pilot study confirmed the high sensitivity of the sonography in the verify correct positioning of gastric tube in the adult ICU patients. The ultrasound examination seems to be easy and rapid even when performed by a intensivist whit a sonographic training of only 40 h. The sonographic exam at the bedside was performed in a shorter time than the acquisition and reporting of the X-ray.
Tài liệu tham khảo
Gubler C, Bauerfeind P, Vavricka SR, Mullhaupt B, Fried M, Wildi SM (2006) Bedside sonographic control for positioning enteral feeding tubes: a controlled study in intensive care unit patient. Endoscopy 38(12):1256–1260
Bankier AA, Wiesmayr MN, Henk C et al (1997) Radiographic detection of intrabronchial malposition of nasogastric tubes and subsequent complications in intensive care unit patients. Intensive Care Med 23:406–410
Harris MR, Huseby JS (1989) Pulmonary complications from nasoenteral feeding tube insertion in an intensive care unit: incidence and prevention. Crit Care Med 17:917–919
Miller KS, Tomlison JR, Sahn SA (1985) Pleuropulmonary complications of enteral tube feedings. Chest 88:230–233
Duthorn L, Steinberg HS, Hauser H, Neeser G, Pracki P (1998) Accidental intravascular placement of a feeding tube. Anesthesiology 89:251–253
Merchant FJ, Nichols RL, Bombeck CT (1977) Unusual complication from insertion of nasogastric esophageal intubation-erosion into an aberrant right subclavian artery. J Cardiovasc Surg 18:147–150
Fremstad JD, Martin SH (1978) Lethal complication from insertion of nasogastric tube after severe basilar skull fracture. J Trauma Inj Infect Crit Care 18:820–822
Gregory JA, Turner PT, Reynolds AF (1978) A complication of nasogastric intubation: intracranial penetration. J Trauma Inj Infect Crit Care 18:823–824
Chaney JC (2002) Derdak. Minimally invasive hemodynamic monitoring for the intensivist: current and emerging technology. Crit Care Med 30:2338–2345
Lichtenstein D, Meziere G, Bidermann P, Gepner A (1999) The comet-tail artifact: an ultrasound sign ruling out pneumothorax. Intensive Care Med 25:383–388
Timsi JF, Farkas JC, Boyer JM, Martin JB, Misset B, Renaud B, Carlet J (1998) Central vein catheter-related thrombosis in intensive care patients: incidence, risks factors, and relationship with catheter-related sepsis. Chest 114:2017–2213
Greenberger M, Bejar R, Asser S (1993) Confirmation of transpyloric feeding tube placement by ultrasonography. J Pediatr 122:413–415
Maruyama K, Shiojima T, Koizumi T (2003) Sonographic detection of a malpositioned feeding tube causing esophageal perforation in a neonate. J Clin Ultrasound 31:108–110
Metheny N (1993) Minimizing respiratory complications of nasoenteric tube feedings: state of science. Heart Lung 22:213–233
Metheny NA, Stewart BJ, Smith L, Yan H, Diebold M, Clouse RE (1999) PH and concentration of bilirubin in feeding tube aspirates as predictors of tube placement. Nurs Res 48:189–197
Christen S, Hess T (1996) Genügt eine klinische Lagekontrolle nasogastraler Sonden? Dtsch Med Wschr 121:1119–1122
Galbois A et al (2011) Colorimetric capnography, a new procedure to ensure correct feeding tube placement in the intensive care unit: an evaluation of a local protocol. J Crit Care 26:411–414
Metheny NA, McSweeney CT, Wehrle MA, Wiersema L (1990) Effectivness of the auscultatory method in predicting feeding tube location. Nurs Res 39(5):262–267
National Patient Safety Agency (Patienty Safety Alert 2011) Reducing the harm caused by misplaced nasogastric feeding tubes in adults, children and infants (online). Available from: http://www.nrls.npsa.nhs.uk/alerts/?entryd45=129640. Accessed 10 Mar 2011
Stroud M, Duncan H, Nightingale J (2003) Guidelines for enteral feeding in adult hospital patients. Gut 52(Suppl VII):vii–vii12
Law RL, Pullybank AM, Eve Ieigh M, Stack N (2013) Avoiding never events: improving nasogastric intubation practice and standards. Clin Radiol 68:239–244
Taylor SJ (2013) Confirming nasogastric feeding tube position versus the need to feed. Intensive Crit Care Nurs 29:59–69
Law R (2014) Radiographers, “never events” and the nasogastric tube. Radiography 20:1–92
Royal College of Radiologists. Chest X-ray confirmation of nasogastric tube placement: radiographer responsibility. http://www.rcr.ac.uk/audittemplate.aspx?PageID=1020&AuditTemplateID=258. Accessed 6 Jan 2014
Haas LEM, Tjan DHT, van Zaten ARH (2006) “Nutrothorax” due to misplacement of a nasogastric feeding tube. Neth J Med 64(10):385–386
Nguyen L, Lewiss RE, Drew J, Saul TA (2012) Novel approach to confirming nasogastric tube placement in the ED. Am J Emerg Med 30:1662.e5–1667.e7
Hernandez-Socorro CR, Marin J, Ruiz-Santana S, Santana S, Manzano JL (1996) Bedside sonographic-guided versus blind nasoenteric feeding tube placement in critically ill patients. Crit Care Med 24:160–1694
Lock G, Reng CM, Köllinger M, Rogler G, Schölmerich J, Schlottmann K (2003) Sonographische Kontrolle von Magensonden bei Intensivpatienten. Intensivmed 40:693–697
Vigneau C, Baudel J, Guidet B, Offenstadt G, Maury E (2005) Sonography as an alternative to radiography for nasogastric feeding tube location. Intensive Care Med 31:1570–1572
Gok F, Kilicaslan A, Yosunkaya A (2015) Ultrasound-guided nasogastric feeding tube placement in critical care patients. Nutr Clin Pract 30(2):257–260
Chenaitia H, Brun P, Querellou E, Leyral J, Bessereau J, Aimè C, Bouaziz R, Georges A, Lousi F (2012) Ultrasound to confirm gastric tube placement in prehospital management. Resuscitation 83:447–451
Kim HM, So BH, Jeong WJ, Choi SM, Park KN (2012) The effectiveness of ultrasonography in verifying the placement of a nasogastric tube in patients with low consciousness at an emergency centre. Scand J Trauma Resusc Emerg Med 20:38