Journal of Ultrasound

, Volume 20, Issue 1, pp 53–58 | Cite as

4-Point ultrasonography to confirm the correct position of the nasogastric tube in 114 critically ill patients

Original Article

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Enteral nutrition Nasogastric tube Sonography 

Sommario

Obiettivo

Il sondino nasogastrico viene posizionato routinariamente in Terapia Intensiva. Le complicanze del malposizionamento sono rare ma estremamente pericolose per il paziente. Lo scopo del nostro studio è stimare l’accuratezza diagnostica di una nuova tecnica ecografica a 4 punti per confermare il posizionamento del sondino nasogastrico in Terapia Intensiva.

Metodi

Nello studio sono stati inclusi 114 pazienti ricoverati in Terapia Intensiva. L’intensivista ha provveduto in tempo reale all’esecuzione dell’esame ecografico in 4 punti: ecografia della parte destra e sinistra del collo del paziente per visualizzare l’esofago, ecografia dell’epigastrio per confermare il passaggio attraverso la giunzione esofagogastrica ed il posizionamento nell’antro, infine ecografia del fondo gastrico. Il posizionamento veniva confermato attraverso l’esecuzione della lastra del torace.

Risultati

L’ecografia ha visualizzato 114 sondini nasogastrici nel tratto digestivo e tutti sono stati confermati dalla lastra del torace (sensitività del 100%). L’intera procedura ecografica, inclusa la scansione longitudinale e trasversale dell’esofago, della giunzione esofagogastrica, dell’antro e del fondo ha necessitato di 10 minuti.

Conclusioni

Il nostro studio pilota ha dimostrato che il sondino nasogastrico non pesato in punta utilizzato routinariamente in Terapia Intensiva è visibile con l’ecografia. Lo studio pilota ha confermato l’alta sensitività dell’ecografia nella verifica del corretto posizionamento del sondino nei pazienti adulti di Terapia Intensiva. L’esame ecografico si è dimostrato facile e rapido anche se eseguito da un intensivista con un training ecografico di sole 40 ore. L’intero esame ecografico al letto del paziente è stato eseguito in un tempo minore rispetto all’acquisizione e alla refertazione della lastra del torace.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    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):1256–1260CrossRefPubMedGoogle Scholar
  2. 2.
    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 23:406–410CrossRefPubMedGoogle Scholar
  3. 3.
    Harris MR, Huseby JS (1989) Pulmonary complications from nasoenteral feeding tube insertion in an intensive care unit: incidence and prevention. Crit Care Med 17:917–919CrossRefPubMedGoogle Scholar
  4. 4.
    Miller KS, Tomlison JR, Sahn SA (1985) Pleuropulmonary complications of enteral tube feedings. Chest 88:230–233CrossRefPubMedGoogle Scholar
  5. 5.
    Duthorn L, Steinberg HS, Hauser H, Neeser G, Pracki P (1998) Accidental intravascular placement of a feeding tube. Anesthesiology 89:251–253CrossRefPubMedGoogle Scholar
  6. 6.
    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 18:147–150Google Scholar
  7. 7.
    Fremstad JD, Martin SH (1978) Lethal complication from insertion of nasogastric tube after severe basilar skull fracture. J Trauma Inj Infect Crit Care 18:820–822CrossRefGoogle Scholar
  8. 8.
    Gregory JA, Turner PT, Reynolds AF (1978) A complication of nasogastric intubation: intracranial penetration. J Trauma Inj Infect Crit Care 18:823–824CrossRefGoogle Scholar
  9. 9.
    Chaney JC (2002) Derdak. Minimally invasive hemodynamic monitoring for the intensivist: current and emerging technology. Crit Care Med 30:2338–2345CrossRefPubMedGoogle Scholar
  10. 10.
    Lichtenstein D, Meziere G, Bidermann P, Gepner A (1999) The comet-tail artifact: an ultrasound sign ruling out pneumothorax. Intensive Care Med 25:383–388CrossRefPubMedGoogle Scholar
  11. 11.
    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 114:2017–2213Google Scholar
  12. 12.
    Greenberger M, Bejar R, Asser S (1993) Confirmation of transpyloric feeding tube placement by ultrasonography. J Pediatr 122:413–415CrossRefGoogle Scholar
  13. 13.
    Maruyama K, Shiojima T, Koizumi T (2003) Sonographic detection of a malpositioned feeding tube causing esophageal perforation in a neonate. J Clin Ultrasound 31:108–110CrossRefPubMedGoogle Scholar
  14. 14.
    Metheny N (1993) Minimizing respiratory complications of nasoenteric tube feedings: state of science. Heart Lung 22:213–233PubMedGoogle Scholar
  15. 15.
    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 48:189–197CrossRefPubMedGoogle Scholar
  16. 16.
    Christen S, Hess T (1996) Genügt eine klinische Lagekontrolle nasogastraler Sonden? Dtsch Med Wschr 121:1119–1122CrossRefPubMedGoogle Scholar
  17. 17.
    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 26:411–414CrossRefPubMedGoogle Scholar
  18. 18.
    Metheny NA, McSweeney CT, Wehrle MA, Wiersema L (1990) Effectivness of the auscultatory method in predicting feeding tube location. Nurs Res 39(5):262–267CrossRefPubMedGoogle Scholar
  19. 19.
    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
  20. 20.
    Stroud M, Duncan H, Nightingale J (2003) Guidelines for enteral feeding in adult hospital patients. Gut 52(Suppl VII):vii–vii12Google Scholar
  21. 21.
    Law RL, Pullybank AM, Eve Ieigh M, Stack N (2013) Avoiding never events: improving nasogastric intubation practice and standards. Clin Radiol 68:239–244CrossRefPubMedGoogle Scholar
  22. 22.
    Taylor SJ (2013) Confirming nasogastric feeding tube position versus the need to feed. Intensive Crit Care Nurs 29:59–69CrossRefPubMedGoogle Scholar
  23. 23.
    Law R (2014) Radiographers, “never events” and the nasogastric tube. Radiography 20:1–92CrossRefGoogle Scholar
  24. 24.
    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
  25. 25.
    Haas LEM, Tjan DHT, van Zaten ARH (2006) “Nutrothorax” due to misplacement of a nasogastric feeding tube. Neth J Med 64(10):385–386PubMedGoogle Scholar
  26. 26.
    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.e7CrossRefGoogle Scholar
  27. 27.
    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 24:160–1694CrossRefGoogle Scholar
  28. 28.
    Lock G, Reng CM, Köllinger M, Rogler G, Schölmerich J, Schlottmann K (2003) Sonographische Kontrolle von Magensonden bei Intensivpatienten. Intensivmed 40:693–697CrossRefGoogle Scholar
  29. 29.
    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 31:1570–1572CrossRefPubMedGoogle Scholar
  30. 30.
    Gok F, Kilicaslan A, Yosunkaya A (2015) Ultrasound-guided nasogastric feeding tube placement in critical care patients. Nutr Clin Pract 30(2):257–260CrossRefPubMedGoogle Scholar
  31. 31.
    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 83:447–451CrossRefPubMedGoogle Scholar
  32. 32.
    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 20:38CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2016

Authors and Affiliations

  1. 1.Department of Intensive CareRegional Hospital of BolzanoBolzanoItaly
  2. 2.Department of RadiologyRegional Hospital of BolzanoBolzanoItaly

Personalised recommendations