Partial Enteral Discharge Programs for High-risk Infants

Premature infants or infants born with complex medical problems are at increased risk of having delayed or dysfunctional oral feeding ability. These patients typically require assisted enteral nutrition in the form of a nasogastric tube (NGT) during their NICU hospitalization. Historically, once these infants overcame their initial reason(s) for admission, they were discharged from the NICU only after achieving full oral feedings or placement of a gastrostomy tube. Recent programs show that these infants can be successfully discharged from the hospital with partial NGT or gastrostomy tube feedings with the assistance of targeted predischarge education and outpatient support. Caregiver opinions have also been reported as satisfactory or higher with this approach. In this review, we discuss the current literature and outcomes in infants who are discharged with an NGT and provide evidence for safe practices, both during the NICU hospitalization, as well as in the outpatient setting.

The Effect of Intravenous Metoclopramide on Pain, Nausea, Discomfort, and Ease of Insertion of Nasogastric Tube in Emergency Department: A Double-blind Randomized Clinical Trial

Background: Placement of nasogastric tube (NGT) is a routine procedure in the emergency departments, which can be uncomfortable, painful, and cause nausea. The aim of this study was to investigate the effect of intravenous metoclopramide on the ease of NGT insertion, as well as reduction of patients’ pain, nausea, and discomfort during NGT insertion in the emergency department. Methods: In this randomized, double-blind, placebo-controlled trial, 80 patients referred to Imam Khomeini Hospital, Mazandaran Province, Iran were enrolled. Data were collected from December 2015 to March 2016. Participants were selected via convenience sampling and randomly divided into two equal groups (placebo and intervention groups). In metoclopramide and placebo groups, 10 mg of metoclopramide and 10 mg of normal saline solution were administered, respectively. All of the NGT was inserted 15–20 mins after the intravenous infusion. Patient-reported pain, discomfort, and nausea were evaluated using visual analogue scale (VAS), at four time points including before (T0), immediately (T1), 30 min after (T2), and 1 hr after the NGT placement (T3). The ease of NGT insertion was evaluated as easy, moderate, and difficult to pass. Results: None of the patients had pain, nausea, and discomfort in T0. Additionally, for those who received intravenous metoclopramide, pain intensity significantly decreased compared with the placebo group in T1 (37.7 vs 55.0), T2 (26.2 vs 41.7), and T3 (20.5 vs 33.7), respectively (P < 0.001). Nausea intensity decreased significantly over time among patients in the intervention group compared with the placebo group in T1 (32.7 vs 43.2), T2 (19.5 vs 31.2), and T3 (9.0 vs 21.7), respectively (P < 0.001). The intensity of patients’ discomfort decreased significantly among patients in the intervention group compared with the placebo group in T1 (39.5 vs 54.0), T2 (28.7 vs 40.2), and T3 (26.2 vs 39.6), respectively (P < 0.001). Patients in the intervention group had easier placement of NGT compared with the placebo group (Easy: 40.0% vs 0.0%, Moderate: 45.0% vs 62.5%, and Difficult: 15.0% vs 37.5%; P < 0.001). Conclusion: Based on the results of the present study, it seems that intravenous metoclopramide can be used as a promising modality for improving the ease of NGT placement and reducing patients’ pain, nausea, and discomfort during NGT insertion in the emergency department.

Laryngospasm Caused by Removal of Nasogastric Tube after Tracheal Extubation: Case Report

Background: We report a case of laryngospasm during nasogastric tube removal. Laryngospasm is a severe airway complication after surgery and there have been no reports associated with the removal of nasogastric tubes. Case Report: After abdominal surgery, the patient was extubated the tracheal tube, and was removed the nasogastric tube. Thereafter patient went into respiratory arrest. We attempted to ventilate using a face mask, and then through a supraglottic device, but both attempts were unsuccessful. Finally, we re-intubated her and stabilized her vitals. Conclusion: When patients are in emerging from anesthesia, nasogastric tube withdrawal may cause irritation of the vocal cords by gastric acids, and thereby, provoke laryngospasm. This can be avoided by removing it before reversing anesthesia or after the patient is awake.

Evaluation of early feeding through nasogastric tube in patients after cardiovascular surgery at the Hanoi Heart Hospital

Objectives: The goal of the study was to describle and understand the factors related to the nasogastric tube feeding in patients after cardio-vascular surgery. Methods: The study involved 100 consecutive patients who underwent cardio-vascular surgery at Hanoi Heart Hospital from April 1 to August 3, 2019..All subjects underwent assessed with the early feeding through nasogastric tube after 6 hours operation. Main results: The mean age of the patients was 54.4 ± 14.5 years old. The percentage of men were 48%, BMI <18.5 were 25%, used inotropic drug were 46% and sedative were 27%. The incidence of patients with abdominal distension and vomiting were 13%. No complications related to early feeding. Factors related to the residual index were sedation and duration of mechanical ventilation. Conclusion: Early nasogastric tube feeding in patients after cardiac and vascular surgery is safe, feasible and feasible.

Are Differences in Dysphagia Assessment, Oral Care Provision, or Nasogastric Tube Insertion Associated with Stroke-Associated Pneumonia? A Nationwide Survey Linked to National Stroke Registry Data

<b><i>Introduction:</i></b> Stroke-associated pneumonia (SAP) is a common complication associated with poor outcomes. Early dysphagia screening and specialist assessment is associated with a reduced risk of SAP. Evidence about oral care and nasogastric tube (NGT) placement is equivocal. This study aimed to expose variations in dysphagia management practices and explore their associations with SAP. <b><i>Participants and Methods:</i></b> Speech pathologists from 166 stroke units in England and Wales were surveyed about dysphagia assessment and management, oral care, and NGT placement. Survey data were then linked to the Sentinel Stroke National Audit Programme (SSNAP), the national register of stroke. Univariable and multivariable linear regression models were fitted to estimate the association between dysphagia management practices and SAP incidence. <b><i>Results:</i></b> 113 hospitals completed the survey (68%). Variation was evident in dysphagia screening protocols (DSPs), oral care, and NGT practice while specialist swallow assessment data patterns were more consistent. Multivariable analysis showed no evidence of an association in incidence of SAP when using a water-only hospital DSP compared to a multiconsistency DSP (B −0.688, 95% CI: −2.912 to 1.536), when using written swallow assessment guidelines compared to not using written guidelines (B 0.671, 95% CI: −1.567 to 2.908), when teams inserted NGTs overnight compared to teams which did not (B −0.505, 95% CI: −2.759 to 1.749), and when teams had a written oral care protocol compared to those which did not (B −1.339, 95% CI: −3.551 to 0.873). <b><i>Discussion and Conclusion:</i></b> Variation exists in dysphagia screening and management, but there was no evidence of an association between clinical practice patterns and incidence of SAP. Further research with larger sample sizes is needed to examine association with SAP.

Preclinical Trial of the Effectiveness of the Safety Nasogastric Tube to Detecting Tube Position Based on Tidal Volume and Pepsin Assay Results in the Gastrointestinal Tract of Macaca Fascicularis

Background: Generally, insertion of a nasogastric tube (NGT) does not use imaging guidance. This procedure has a risk of malposition to the lungs from 0.3–15%. The NGT verification only detects the position of the tube in the end of procedure. Misplacement of NGT into the respiratory tract can result in damage to the lungs. Safety nasogastric tube (SNGT) has been created to detect the position of the tube in real-time, simple, and inexpensive. This study aims to prove the effectiveness of the SNGT prototype in Macaca fascicularis. Result: The SNGT with an airbag size of 50% of tidal volume (SNGT 50% TV) had 100% sensitivity and specificity in detecting the position of the tube. While the SNGT with an airbag size of 100% of TV (SNGT 100% TV) has sensitivity of 100% and specificity of 87.5%. There was significant difference between the movement of airbag of SNGT 50% TV and SNGT 100% TV (p ≤ 0.05). However, there was no significant difference between the accuracy of placement of 50% TV SNGT, 100% TV SNGT, and conventional NGT (p > 0.05). The pepsin enzyme has better sensitivity (100%) than pH paper (91.66%) in detecting the end position of tube. Conclusion: SNGT tube has high effectiveness in detecting the position of the tube inside of the respiratory and digestive tracts to prevent misplacement.