scholarly journals Nasogastric Tube Placement: A Cross-Comparison of Verification Methods Used in Pennsylvania Hospitals and How They Align With Guidelines

2021 ◽  
pp. 36-45
Author(s):  
Lea Gardner ◽  
Susan Wallace
Keyword(s):  
Simple Procedure ◽  
Stomach Contents ◽  
Tube Placement ◽  
X Rays ◽  
Healthcare Facilities ◽  
Nasogastric Tubes ◽  
Verification Methods ◽  
Reduction Strategies ◽  
One Year ◽  
Nasogastric Tube Placement

Nasogastric tubes (NGTs) are used as an alternative approach to deliver nutrition and medications, or a method to remove stomach contents. Insertion of these tubes is considered a simple procedure; however, wrong placement or dislodged tubes can lead to patient harm and possibly death. The risk of harm and death increases when misplaced or dislodged tubes are not identified prior to using them. We queried the Pennsylvania Patient Safety Reporting System for events that occurred between January 1, 2017, and June 30, 2020. We analyzed those reports that provided supplemental information describing NGT placement verification methods to determine how these activities aligned with NGT guidelines. The use of X-rays and pH aspirate, guideline-approved verification methods, were identified in 90.8% (544 of 599) of the reports. In 9.2% (55 of 599) of the reports, the use of non-recommended verification methods (e.g., insertion of air bolus/auscultation, were identified). Reports indicated that patients aged less than one year old experienced a higher percentage of non-recommended verification methods being used when compared to all other patients. Interviews with staff at three healthcare facilities discussed their approach to verifying NGT placement. Risk reduction strategies comprise using the guideline recommendations to verify NGT placement and avoiding the use of non-recommended verification methods.

Examining the Safety of Nasogastric Tube Placement after Endoscopic Sinus Surgery

1998 ◽  
Vol 107 (8) ◽  
pp. 662-664 ◽  
Author(s):  
Neil Bhattacharyya ◽  
Harsha V. Gopal
Keyword(s):  
Nasogastric Tube ◽  
Endoscopic Sinus Surgery ◽  
Sphenoid Sinus ◽  
Middle Turbinate ◽  
Sinus Surgery ◽  
Tube Placement ◽  
Nasogastric Intubation ◽  
Nasogastric Tubes ◽  
Fresh Cadaver ◽  
Nasogastric Tube Placement

Several cases of intracranial injury during the placement of nasogastric tubes have been reported, usually in the setting of anterior skull base fractures. The fovea ethmoidalis and sphenoid sinus are often exposed after endoscopic sinus surgery, so that these structures are potentially placed in the line of contact during nasogastric tube placement. In order to evaluate the ability of the fovea ethmoidalis and roof of the sphenoid sinus to withstand penetration from possible contact during nasogastric tube placement, 12 fresh cadaver heads were studied. After complete endoscopic ethmoidectomy and wide sphenoidotomy, standard 18F and 16F nasogastric tubes were inserted to produce deliberate direct contact with both the fovea ethmoidalis and the sphenoid sinus roof. No penetrations of the fovea occurred in 20 specimen sides with the 18F tube; penetration did occur with the 16F tube in 1 of 13 sides (7.7%). With respect to the sphenoid sinus, no intracranial penetrations occurred in 16 and 11 sides for the 18F and 16F tubes, respectively. The sphenoid sinus was easily entered even in the presence of an intact middle turbinate. These data suggest that although intracranial penetration during nasogastric intubation after endoscopic sinus surgery is an unlikely event, there is a non-negligible risk of such injury. Nasogastric intubation should be performed with caution in patients with a history of sinus surgery.

scholarly journals Immediate chest radiograph interpretation by radiographers improves patient safety related to nasogastric feeding tube placement in children

2021 ◽  
Author(s):  
Emily Keyte ◽  
Gillian Roe ◽  
Annmarie Jeanes ◽  
Jeannette K. Kraft
Keyword(s):  
Patient Safety ◽  
Nasogastric Tube ◽  
Improve Patient Safety ◽  
Feeding Tube ◽  
Practice Change ◽  
Tube Placement ◽  
Nasogastric Feeding ◽  
Nasogastric Tubes ◽  
National Patient ◽  
Nasogastric Tube Placement

Abstract Background Despite the publication of a national patient safety alert in 2016, inadvertent feeding through misplaced nasogastric tubes continues to occur, either through failure to review the radiograph, misinterpretation of it, or failure to communicate the results. Objective The objectives were to determine whether training in a new pathway introduced to avoid these “never events” was followed and whether radiographer comments and prompt communication of results could reduce risk and improve patient safety in relation to nasogastric tube placement in children. Materials and methods Following radiographer training in interpretation of nasogastric tube position and use of a commenting proforma and communication pathway, we reviewed all radiographs obtained to check nasogastric tubes performed over a 13-month period in children 0–16 years of age. Then we assessed accuracy of the radiographer comments, adherence to the pathway, and any practice change in children with misplaced nasogastric tubes. Results We reviewed 282 nasogastric tube check radiographs. For 262 radiographs (92.9%) the pathway was followed correctly. Of the total 282 radiographs, 240 (85%) were immediately reported using the standardised commenting proforma, and 235 radiographer comments were affirmed by the radiologist (97% accuracy, confidence interval 0.95–0.99). Of the immediately reported radiographs, 213 (88.8%) nasogastric tubes were considered to be safe for use. Four (1.7%) of the immediately reported nasogastric tubes were misplaced in a bronchus, and the report communicated to the clinical team resulted in removal or re-siting of the tubes. Conclusion Nasogastric tube check radiographs in children can be reported accurately by radiographers trained in their interpretation and the results promptly communicated to clinical staff, improving safety in relation to nasogastric tube placement in children.

The Pharyngostomy Tube: Indications, Technique, Efficacy, and Safety in Modern Surgical Practice

2016 ◽  
Vol 66 (05) ◽  
pp. 390-395
Author(s):  
Jonathan Berger ◽  
Rafael Andrade ◽  
Eitan Podgaetz ◽  
Rafael Garza-Castillon
Keyword(s):  
Tube Placement ◽  
Nasogastric Tubes ◽  
Tube Removal ◽  
Gastric Decompression ◽  
Enteral Access ◽  
The Mean ◽  
Nasogastric Tube Placement ◽  
Mean Time ◽  
Straightforward Approach

Background Long-term nasogastric tubes are uncomfortable and associated with complications such as impairment with speech and swallowing, septum trauma, epistaxis, alar necrosis, and intubation of the trachea among others. Pharyngostomy tubes (PTs) are an alternative for prolonged enteral feeding, transluminal drainage of collections, and gastric decompression in patients with an intestinal obstruction and an inoperable abdomen. Patients and Methods This is a retrospective analysis of patients who had a PT placed at our institution from May 2005 to March 2015. The primary end point of the study was to establish the type and rate of complications and aspiration events related to PT use. Results During the specified period, a total of 84 PTs were placed. The most common indication for PT placement was enteric decompression in 65 (77.4%), followed by transluminal collection drainage in 12 (14.3%), and enteral access for nutrition in 7 (8.3%) patients. The mean time to tube removal was 17.8 days ± 17.1 (range, 2–119). We encountered 10 (11.2%) complications related to PT placement, including 7 cases of cellulitis, 2 superficial abscesses, and 1 patient with pharyngeal hemorrhage. Conclusion PTs are a relatively simple, safe, and straightforward approach to achieve long-term enteral decompression, access for feeding or transluminal drainage, avoiding the complications associated with prolonged nasogastric tube placement. The complication rate is low and patient satisfaction and compliance appear to be higher than with nasogastric tubes. Modern surgeons should be familiar with the procedure and technique. PTs should be part of every surgeon's armamentarium.

Nasendoscopically-assisted placement of a nasogastric feeding tube

1999 ◽  
Vol 113 (9) ◽  
pp. 839-840 ◽  
Author(s):  
Gerard Kelly ◽  
Patrick Lee
Keyword(s):  
Parenteral Nutrition ◽  
Nasogastric Tube ◽  
Feeding Tube ◽  
Oral Feeding ◽  
Tube Placement ◽  
Nasogastric Feeding ◽  
Nasogastric Tubes ◽  
Term Administration ◽  
Enteral Access ◽  
Nasogastric Tube Placement

AbstractNasogastric tube placement is desirable for the short-term administration of calories when oral feeding is not possible. Enteral nutrition is superior to parenteral nutrition. In some patients this method of feeding is impossible because of repeated failure of nasogastric tube placement, necessitating either general anaesthesia for enteral access, or total parenteral nutrition. We describe a new method for nasogastric tube placement aided by a fibre-optic nasendoscope which has resulted in the successful placement of over 20 nasogastric tubes in our unit and the avoidance of more invasive methods of establishing nutrition with their associated complications.

scholarly journals Verifying the Placement of Nasogastric Tubes at an Emergency Center: Comparison of Ultrasound with Chest Radiograph

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Çağdaş Yıldırım ◽  
Selçuk Coşkun ◽  
Şervan Gökhan ◽  
Gül Pamukçu Günaydın ◽  
Ayhan Özhasenekler ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Nasogastric Tube ◽  
Predictive Value ◽  
Standard Technique ◽  
Tube Placement ◽  
Water Mixture ◽  
Neck Ultrasound ◽  
Nasogastric Tubes ◽  
Direct Radiography ◽  
Nasogastric Tube Placement

The objective of this study was to verify the nasogastric tube position with neck ultrasound and subxiphoid ultrasound, by giving air-water mixture and auscultation and to compare the effectiveness of these methods with chest radiography. This is a single-center, prospective, single-blind study. Patients who were admitted to our emergency department and had an indication of nasogastric tube placement were included. Nasogastric tube localization was verified with neck ultrasound and subxiphoid ultrasound, by giving air-water mixture, auscultation, and direct radiography that was accepted as the ‘gold standard technique’. A total of 49 patients (27 Male, 22 Female) with a mean age of 58.3±22.7 years were included. Sensitivity of neck ultrasound was 91.5%, and positive predictive value was 100%. As for the subxiphoid ultrasound sensitivity was 78.72%. When neck ultrasound + subxiphoid ultrasound and giving water-air mixture were combined sensitivity reached 95.74%. Sensitivity of neck ultrasound + subxiphoid ultrasound + air-water mixture + auscultation was 97.87% and positive predictive value was 100%. In the light of our results, neck and subxiphoid ultrasound seem to be an alternative method for verifying nasogastric tube localization. Combination of the air-water mixture and auscultation with ultrasound improves the sensitivity.

scholarly journals Clinical and Nonclinical Implications of Misplaced Nasogastric Tubes: Tools for Implementation of Standardized Best Practices

2020 ◽  
pp. 64-67
Author(s):  
Olivia Lounsbury ◽  
Jennifer Tatro ◽  
Beth Lyman ◽  
Donna Prosser ◽  
Haylie Coffey
Keyword(s):  
Patient Safety ◽  
Best Practices ◽  
Nasogastric Tube ◽  
Systematic Approach ◽  
Tube Placement ◽  
Economic Stability ◽  
Nasogastric Tubes ◽  
Never Events ◽  
Nasogastric Tube Placement ◽  
Nasogastric Tube Insertion

The consequences of misplaced nasogastric tubes extend far beyond the clinical setting and have implications for the hospital’s reputation and economic stability. A systematic approach for nasogastric tube insertion and verification is necessary in order to prevent misplaced nasogastric tubes which are, indeed, “never events.” The Actionable Patient Safety Solutions (APSS) from the Patient Safety Movement Foundation outline best practices for implementation of nasogastric tube placement protocols in hospitals to ensure consistency across the organization and preserve patient safety at the forefront of all clinical endeavors.

Osteosynthesis at pelvic injuries in toy-breed dogs

2020 ◽  
pp. 32-33
Author(s):  
Nikolay I. Antonov ◽  
Keyword(s):  
Surgical Treatment ◽  
Urban Environment ◽  
Pelvic Trauma ◽  
X Rays ◽  
Skeletal Trauma ◽  
Companion Dogs ◽  
Pelvic Injuries ◽  
Behavioral Features ◽  
Osteosynthesis Techniques ◽  
One Year

Pelvic injuries account for 16 to 25% of all skeletal trauma in small pets. Small dogs as companion dogs are now widespread. Unusual exterior and behavioral features have made them popular and at the same time vulnerable in the modern urban environment. The author defined the nature of injuries and adapted technique of transosseous osteosynthesis for the treatment of toy-breed dogs with pelvic trauma. The study of the X-rays in 226 dogs with pelvic injuries demonstrated that toy-breed dogs accounted for 16% of the total. Multiple pelvic trauma was revealed in 95% of them. Surgical treatment was performed in 24 dogs, conservative one - in 13, that amounted to 65% and 35%, respectively. Surgical treatment consisted in open juxtaposing of fragments and focal transosseous and/or internal osteosynthesis with subsequent external fixation using devices of various designs. The external structures were of three types: half-ring support or U-shaped staple, pair of parallel curved plates connected by two threaded rods with each other, and pair of curved plates located bilaterally on both sides of the pelvis and connected by two threaded rods with the help of threaded ends. The terms of fixation for pelvic injuries in toy-breed dogs at the age under one year were 42 days on the average, and in the dogs at the age above one year - 60 days. Surgical treatment in toy-breed dogs with pelvic injuries was performed more often in comparison with conservative one. Pelvic trauma was accompanied by pronounced pain shock. The osteosynthesis techniques used in toy-breed dogs are little traumatic and not limiting functions thereby contributing to recovery of all the structures of pelvis and pelvic limbs.

scholarly journals Acute Gastric Dilatation: A Cause for Concern

2021 ◽  
pp. 171-177
Author(s):  
Danial Haris Shaikh ◽  
Abhilasha Jyala ◽  
Shehriyar Mehershahi ◽  
Chandni Sinha ◽  
Sridhar Chilimuri
Keyword(s):  
Nasogastric Tube ◽  
Radiological Finding ◽  
Plain Film ◽  
Tube Placement ◽  
Gastric Dilatation ◽  
Acute Hyperglycemia ◽  
Acute Gastric Dilatation ◽  
Physician Awareness ◽  
Gastric Emphysema ◽  
Nasogastric Tube Placement

Acute gastric dilatation is the radiological finding of a massively enlarged stomach as seen on plain film X-ray or a computerized tomography scan of the abdomen. It is a rare entity with high mortality if not treated promptly and is often not reported due to a lack of physician awareness. It can occur due to both mechanical obstruction of the gastric outflow tract, or due to nonmechanical causes, such as eating disorders and gastroparesis. Acute hyperglycemia without diagnosed gastroparesis, such as in patients with diabetic ketoacidosis, may also predispose to acute gastric dilatation. Prompt placement of a nasogastric tube can help deter its serious complications of gastric emphysema, ischemia, and/or perforation. We present our experience of 2 patients who presented with severe hyperglycemia and were found to have acute gastric dilation on imaging. Only one of the patients was treated with nasogastric tube placement for decompression and eventually made a full recovery.

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