Placement Confirmation of a Blindly Inserted Nasogastric Tube (2014)

Rodolfo C. Borromeo, RN, Ed.D.; Maria Linda G. Buhat, RN, Ed.D.; Andre Lew D. Collado, RN

 

Background

Nasogastric tube insertion has been a clinical practice done mostly by nurses. Albeit in recent years, methods of confirming the nasogastric tube has evolved from auscultatory to radiologic imaging, little study has been done to find out which among these practices have been proven effective and cost efficient in the Philippine setting.

 

Objectives

Despite the complications that may arise if a nasogastric tube has been inserted improperly, the dilemma for this paper is to ascertain which of the acceptable methods are cost effective for the practicing nurses in the Philippines to perform, without compromising the safety of the patient,  and ensuring that the blindly inserted nasogastric tube properly serves its purpose. Given a wide array of current literature, records of actual experience of practicing nurses in the hospital setting and the existing hospital standards for the procedure, a consensus statement that is both feasible, attainable and applicable for the Filipino nurse amongst these practice guidelines should be evident if be given enough careful scrutiny and analysis in the process of establishing an new clinical practice guideline for the nasogastric insertion procedure.

 

Methodology

The study employed focused group discussions among nurses with at least 2 years of tenure among four level 3 hospitals within Metro Manila. Systematic review of literature was also done to compare methods alongside the ones retrieved from the respondents in the discussions. Review of existing stands of practice from the previously mentioned hospitals were also done as part of the comparison with the previously mentioned sources of data.

 

Results

There were eight identified methods of placement confirmation, classified as either imaging (chest x-ray, ultrasonography, electromagnetic device) or non-imaging methods (auscultation, submergence, litmus paper, pH paper, capnography). There were a total of 20 respondents from the group discussions and their responses were classified according to their knowledge of methods under investigation. Majority of the respondents identified obtaining chest x-ray’s and auscultation methods in confirming tube placement. Institutional policies revealed that chest x-rays, use of ausculatatory method and pH testing of nasogastric aspirate as primary methods of confirmation. Thirty-one (31) literatures were studied based on their relevance to the study. Studies revealed radiographic confirmation remained the gold standard for placement confirmation, and that auscultation and submergence were no longer recommended to use. Majority of the methods recommend the use of pH paper, and capnography  as safer and more cost-efficient methods compared to chest x-rays, while emerging methods such as ultrasonography and electromagnetic devices were also identified.

 

Keywords: nasogastric tube, NGT placement confirmation, pH paper, ANSAP