Taylor Stephen, Allan Kaylee, McWilliam Helen, Manara Alex, Brown Jules, Toher Deirdre, Rayner Wendy
Research Dietitian, Frenchay Hospital, North Bristol NHS Trust.
Nutrition Support Dietitian, Frenchay Hospital, North Bristol NHS Trust.
Br J Nurs. 2014;23(7):352, 354-8. doi: 10.12968/bjon.2014.23.7.352.
Recent evidence suggests official statistics greatly underestimate the occurrence of complications from misplaced nasogastric (NG) tubes, even when detected. Current methods of confirming tube position do not provide adequate protection from misplacement. In addition, some tubes are inadequately radio-opaque. We prospectively audited placement of Cortrak polyurethane tubes (PUTs) to determine: accuracy of the electromagnetic (EM) trace in confirming tube position, radio-opacity of PUTs compared with previously placed polyvinylchloride (PVC) Ryles tubes and whether 12 French PUTs can be used to aspirate gastric residual volumes (GRVs). A total of 127 PUTs were placed in 113 patients. EM traces accurately confirmed tube position compared with X-ray (100% agreement). A 'gastric' EM trace has been defined for future use by other operators. PUTs were adequately radio-opaque with good agreement between interpreters (>98%) whereas PVC Ryles tubes were insufficiently radio-opaque (57-73%), invisible in 23% of cases and with poor agreement between interpreters leaving risk of error. The alternative of using pH confirmation was not possible in 44%. In these cases subsequent X-ray incurred a 2-hour delay to feed and medicines. In addition, neither post-placement pH testing nor X-ray warn of lung placement and potential trauma, whereas the EM trace warned of lung placement prior to damage in 7% of placements. 12 French, single-port PUTs appear adequate to aspirate large GRVs. EM tracing may be considered a standalone method of confirming NG tube position. Corflo (Cortrak) PUTs are adequately radio-opaque. Use of PVC Ryles and other inadequately radio-opaque tubes should stop.
近期证据表明，即使已被发现，官方统计数据仍大大低估了鼻胃管（NG）误置并发症的发生率。当前确认导管位置的方法并不能充分防止误置。此外，一些导管的显影性不足。我们对Cortrak聚氨酯管（PUT）的放置进行了前瞻性审核，以确定：电磁（EM）追踪在确认导管位置方面的准确性、PUT与先前放置的聚氯乙烯（PVC）赖尔氏管相比的显影性，以及12法式PUT是否可用于抽吸胃残余量（GRV）。共对113例患者放置了127根PUT。与X射线相比，EM追踪能准确确认导管位置（一致性为100%）。已定义了一种“胃”EM追踪，供其他操作人员日后使用。PUT的显影性良好，口译员之间的一致性较高（>98%），而PVC赖尔氏管的显影性不足（57 - 73%），在23%的病例中不可见，口译员之间的一致性较差，存在出错风险。44%的情况下无法使用pH值确认法。在这些病例中，随后进行X射线检查会导致喂食和用药延迟2小时。此外，放置后pH值测试和X射线检查均无法警示肺部放置及潜在损伤，而EM追踪在7%的放置病例中，能在造成损伤前警示肺部放置情况。12法式单端口PUT似乎足以抽吸大量GRV。EM追踪可被视为确认NG管位置的独立方法。Corflo（Cortrak）PUT的显影性良好。应停止使用PVC赖尔氏管和其他显影性不足的导管。
