Department of Nursing, Odisee University College, Hospitaalstraat 23, 9100, Sint-Niklaas, Belgium.
University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.
Eur Radiol. 2021 Apr;31(4):2444-2450. doi: 10.1007/s00330-020-07302-w. Epub 2020 Oct 4.
Chest X-ray imaging is frequently used for verifying the position of a blindly inserted nasogastric tube. A high-quality X-ray increases the likelihood of conclusive visibility of tube tip positioning, thus avoiding risks due to a misplaced tube (e.g., pulmonary intubation, pneumothorax, small bowel insertion). Therefore, this study aims to determine patient-related and environmental factors affecting the visibility of nasogastric tubes on X-ray in adults.
A retrospective descriptive analysis of routinely collected clinical data was performed on all included patients (N = 215) from a prospective randomized trial in a general hospital. A chest X-ray was taken of each patient needing a nasogastric feeding tube, after which visibility and positioning of the tube on X-ray was independently evaluated by 3 radiologists.
In 14.9% (n = 32) of all patients, image quality was insufficient, so no conclusive visibility of nasogastric tube positioning could be found. A patient-related predictor regression model (sex, age, body mass index) explained 21% of variance for an insufficient visibility of the nasogastric tube (Nagelkerke R = 0.21). An environmental factor regression model demonstrates a guidewire being inside the tube or not during X-ray as a predictor for a conclusive visibility on X-ray.
High body mass index, male sex, and the absence of a guidewire inside the nasogastric tube at the time of chest X-ray are associated with a risk of insufficient visibility of the tube on X-ray. Patient profiles can be defined in which supplementary attention is needed when obtaining chest X-rays whose purpose is to confirm nasogastric tube positioning.
• The quality of chest X-rays to confirm the positioning of nasogastric tubes in adults can be improved considerably. • There are several factors influencing the confirmation of nasogastric tube positioning on X-ray. • Defining patient profiles at risk for an insufficient visibility of the tube on X-ray will indirectly contribute to an improvement of the chest X-ray quality.
胸部 X 光成像常用于验证盲目插入的鼻胃管的位置。高质量的 X 光片增加了管尖定位的明确可见性的可能性，从而避免因管位置不当（例如，肺插管、气胸、小肠插入）而带来的风险。因此，本研究旨在确定影响成人 X 光片上鼻胃管可见度的与患者相关和环境因素。
对来自一家综合医院的前瞻性随机试验中所有纳入的患者（N=215）进行了常规收集的临床数据的回顾性描述性分析。每位需要鼻胃管喂养的患者都拍摄了一张胸部 X 光片，然后由 3 名放射科医生独立评估 X 光片上的管的可见性和定位。
在所有患者中，有 14.9%（n=32）的图像质量不足，因此无法确定鼻胃管的定位。患者相关预测因子回归模型（性别、年龄、体重指数）解释了管的不明确可见性的 21%（Nagelkerke R=0.21）。环境因素回归模型表明，X 光片中导丝是否在管内是管可见性的预测因素。
高体重指数、男性和胸部 X 光检查时导丝不在鼻胃管内与 X 光检查时管不明确可见的风险相关。在获取目的为确认鼻胃管定位的胸部 X 光片时，可确定需要额外关注的患者特征。
可以大大提高确认成人鼻胃管位置的胸部 X 光质量。
有几个因素会影响 X 光片上的鼻胃管定位确认。
定义 X 光片上管可见度不足的风险患者特征将间接有助于提高胸部 X 光片的质量。
