The effectiveness of ultrasonography in verifying the placement of a nasogastric tube in patients with low consciousness at an emergency center

Hyung Min Kim, Byung Hak So, Won Jung Jeong, Se Min Choi, Kyu Nam Park, Hyung Min Kim, Byung Hak So, Won Jung Jeong, Se Min Choi, Kyu Nam Park

Abstract

Background: This study was designed to compare the effectiveness of using auscultation, pH measurements of gastric aspirates, and ultrasonography as physical examination methods to verify nasogastric tube(NGT) placement in emergency room patients with low consciousness who require NGT insertion.

Methods: The study included 47 patients who were all over 18 years of age. In all patients, tube placement was verified by chest X-rays. Auscultation, pH analysis of gastric aspirates, and ultrasonography were conducted on each patient in random order. The mean patient age was 57.62 ± 17.24 years, and 28 males (59.6%) and 19 females (40.4%) were included. The NGT was inserted by an emergency room resident. For pH testing, gastric aspirates were dropped onto litmus paper, and the resulting color of the paper was compared with a reference table. Ultrasonography was performed by an emergency medicine specialist, and the chest X-ray examination was interpreted by a different emergency medicine specialist who did not conduct the ultrasonography test. The results of the auscultation, gastric aspirate pH, and ultrasonography examinations were compared with the results of the chest x-ray examination.

Results: The sensitivity and specificity were 100% and 33.3%, respectively, for auscultation and 86.4% and 66.7%, respectively, for ultrasonography. Kappa values were the highest for auscultation at 0.484 compared to chest x-rays, followed by 0.299 for ultrasonography and 0.444 for pH analysis of the gastric aspirate. The ultrasonography has a positive predictive value of 97.4% and a negative predictive value of 25%.

Conclusions: Ultrasonography is useful for confirming the results of auscultation after NGT insertion among patients with low consciousness at an emergency center. When ultrasound findings suggest that the NGT placement is not gastric, additional chest X-ray should be performed.

Figures

Figure 1
Figure 1
Normal esophagus (A). White arrow indicates the nasogastric tube in the esophagus (B).
Figure 2
Figure 2
Sonographic visualization of a nasogastric tube. The weighted tip appears as a hyperechogenic line with a posterior acoustic shadow.
Figure 3
Figure 3
A mixture of 40 ml normal saline with 10 ml air was injected into the tube to visualize the hyperechogenic "fog" existing at the tip of the tube (white arrows).

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Source: PubMed

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