Friday, 9 September 2016

How best to place a nasogastric tube

Roger Watson, Editor-in-Chief

The debate about placing nasogastric tubes continues. It was a procedure I hated carrying out and when I was a student some of my classmates volunteered to have one passed - not me!  I sincerely hope that students are no longer asked to volunteer; the procedure is not without its risks. The options for verifying placement when I was in practice were aspiration of contents (hopefully from the stomach) and testing for acidity with litmus paper followed by lisening to the stomach with a stethoscope while some air was introduced into the tube with a syringe.  If all was well you'd hear a bubbling sound; if not, the patient would cough violently and develop pneumonia.  I sincerely hope the latter practice has ceased;  x-ray was an option but I don't recall its use.

The aim of a study by McFarland (2016) titled: 'A cost utility analysis of the clinical algorithm for nasogastric tube placement confirmation in adult hospital patients' and publshed in JAN was: 'to evaluate the effectiveness of pH paper testing of aspirate and chest x-ray for determining nasogastric tube (NGT) placement in terms of cost and patient outcome.'  McFarland obtained six studies using a systematic review method.  A cost utility analysis was performed and also a sensitivity analysis. The methods are described in full in the article.

The results showed that: 'the current UK algorithm advocated by the National Patient Safety Agency appears to offer the most cost effective approach to NGT confirmation in terms of cost and patient outcome. Sensitivity analyses indicate that these findings may be significantly altered by tube aspiration success and the rates of chest x-ray interpretation errors.'

You can listen to this as a podcast

Reference

MCFARLAND A. (2016) A cost utility analysis of the clinical algorithm for nasogastric tube placement confirmation in adult hospital patients. Journal of Advanced Nursing doi: 10.1111/jan.13103

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