Evidence Based Nursing Unit, National University Hospital, Singapore.
Int J Evid Based Healthc. 2011 Mar;9(1):51-60. doi: 10.1111/j.1744-1609.2010.00200.x.
Nasogastric (NG) tube is a device passed through the gastrointestinal tract of patients for the purpose of feeding, gastric decompression and medication administration. However, a small risk involved in the process is that the tube may be misplaced into the trachea during insertion or may get displaced at a later stage, leading to disastrous results. Recent adverse incidences arising out of the misplacement of NG tube raised concerns among the nursing and medical community and the Patient Safety Officer of the hospital. The Evidence Based Nursing Unit, in collaboration with some of the key nursing leaders in nursing administration, was tasked to explore and institute the current best practice in confirming the correct placement of NG tube.
The aim of this project was to institute the best practice to confirm the correct placement of NG tube in patients in an acute care hospital setting.
The project comprised of a few stages. The first stage involved reviewing the existing recommendations and guidelines on the methods for checking correct NG tube placement. The second stage involved incorporation of the change of practice into the clinical setting. The final stage was to monitor and evaluate the impact of the new practice on the patients, nurses and other healthcare professionals.
Evidence search from guidelines and journals supported the test that used pH indicator instead of the litmus test. There is no evidence that supports the method of auscultation and bubbling to confirm correct NG tube placement in the absence of aspirate. Radiology remains the 'gold standard' for checking correct NG tube placement. The revised method of NG tube placement and workflow was incorporated in the revised Standard Operating Procedures. A total of 17 roadshows were conducted to create awareness regarding the new method amongst the nurses, and the implementation of the revised method and workflow was commenced on 3 November 2008. The initial audit conducted 1 month after the practice change was implemented reported 26 (50%) observations of NG tube feeding in 26 audit wards. The key areas of practice change in feeding when tube placement was confirmed (84.6%) and proper testing of aspirate (76.9%) showed good compliance.
The implementation of the change in the practice of confirming the correct placement of the NG tube in patients requires good coordination and a multidisciplinary team approach.
鼻胃管是一种通过患者胃肠道的装置，用于喂养、胃肠减压和给药。然而，在插入过程中，该管小概率会误入气管，或者在后期发生移位，导致灾难性后果。最近由于鼻胃管放置不当而引起的不良事件引起了护理和医疗界以及医院患者安全官员的关注。循证护理部门与护理管理方面的一些关键护理领导人合作，负责探索和实施确认鼻胃管正确位置的当前最佳实践。
本项目的目的是在急性护理医院环境中确立确认鼻胃管正确位置的最佳实践。
该项目分为几个阶段。第一阶段涉及审查现有的关于检查正确鼻胃管放置的方法的建议和指南。第二阶段涉及将实践的改变纳入临床环境。最后阶段是监测和评估新实践对患者、护士和其他医疗保健专业人员的影响。
从指南和期刊中进行的证据搜索支持使用 pH 指示剂而不是石蕊测试的检查。在没有抽吸物的情况下，听诊和冒泡来确认正确的鼻胃管放置没有证据支持。放射学仍然是检查正确鼻胃管放置的“金标准”。修订后的鼻胃管放置和工作流程已纳入修订后的标准操作程序。共进行了 17 次巡回演出，以提高护士对新方法的认识，并于 2008 年 11 月 3 日开始实施修订后的方法和工作流程。在实施实践变更后 1 个月进行的初始审核报告了 26 次（50%）在 26 个审核病房中进行的鼻胃管喂养观察。在确认管放置时进行喂养的关键实践变更领域（84.6%）和适当测试抽吸物（76.9%）显示出良好的依从性。
在患者中实施确认鼻胃管正确位置的实践变更需要良好的协调和多学科团队方法。
