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A1269
October 18, 2011
8:00:00 AM - 11:00:00 AM
Hall A1 South Area D
A Manometry-Guided Technique to Facilitate Nasogastric Tube Placement
Hung-Shu Chen, M.D., Jan Spielberger, M.D.,Ph.D., Kao-Chi Chung, Ph.D.
E-DA Hospital, Kaohsiung City, Taiwan
Introduction

Placement of a nasogastric tube (NGT) is a common procedure for gastric decompression, nutrition, and drug administration. NGT placement is sometimes difficult in anesthetized and intubated patients because of the inability to swallow and existence of endotracheal tube (1). Manometry is measurement of pressure within various parts of the gastrointestinal tract. We hypothesized that if operators continuously observed pressure readings through manometry during NGT insertion, they were able to instantly identify NGT position and adjust the movement of NGT until achieving correct placement. The purpose of this study was to investigate whether use of manometry to guide NGT insertion improved insertion success rates compared with blind insertion technique in anesthetized and intubated patients.

Methods

After institutional review board approval and written informed consent, 40 adult patients (age, >18 y) requiring NGT placement during elective open abdominal surgery were enrolled in this study. They were randomized into two groups: a group to insert a 16 Fr. NGT by blind insertion technique (Control group; n = 20) and a group to insert a 16 Fr. NGT through manometry guidance (Manometry-guided group; n = 20). In the Control group, the NGT was inserted by the routine blind manner with patient’s head in neutral position. In the Manometry-guided group, a cuff pressure manometer (Mallinckrodt Medical GmbH, Hennef, Germany) was connected to the NGT via a disposable adapter (the proximal end of a suction tube; Sigma Medical Supplies Ltd., Taipei, Taiwan) to obtain pressure readings [Fig. 1A]. The operators continuously observed pressure readings during NGT insertion and adjusted the movement of NGTs until interpreting intragastric placement [Fig. 1B]. After each insertion of NGTs was accomplished, a blinded observer used a fiberscope (Olympus Optical Ltd., Tokyo, Japan) to confirm the success of NGT placement. Insertion success rates were analyzed by the Chi square analysis or Fisher’s exact test, as appropriate. P < 0.05 was considered significantly different.

Results

All patients enrolled in this study completed the trial protocol. The patient characteristics were similar in both groups. The success of NGT insertion was more frequent in the Manometry-guided group than in the Control group (100% vs 70%, respectively; P = 0.02). No major complications related to NGT insertion occurred in this study.

Discussion

This preliminary study shows that the success of NGT insertion at first attempt is more likely with the manometry-guided technique than with blind insertion technique. Use of the manometry-guided technique may change clinical NGT placement from a blind insertion manner into a perceivable procedure. A further large-scale study is needed to validate these findings.

References

1. Carey TS, Holcombe BJ: Endotracheal intubation as a risk factor for complications of nasoenteric tube insertion. Crit Care Med 1991; 19: 427-9.

Figure 1

Copyright © 2011 American Society of Anesthesiologists