Torsy Tim, van Noort Harm H J, Taylor Stephen, Eriksson Mats, Verhaeghe Sofie, Beeckman Dimitri
Department of Healthcare, Odisee University of Applied Sciences, Brussels, Belgium.
University Centre for Nursing and Midwifery, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
Am J Clin Nutr. 2022 Sep 2;116(3):798-811. doi: 10.1093/ajcn/nqac146.
Blind insertion of nasogastric (NG) tubes is performed for several reasons: nutrition and medication administration, gastric aspiration/decompression, and other, diagnostic reasons. Accidental intraesophageal and intestinal placement is common, and increases the risk of serious complications. Therefore, accurate determination of the internal length of the NG tube before placement is considered a prerequisite for achieving correct gastric positioning.
We aimed to identify, assess, and summarize the evidence on the accuracy of methods for determining the internal length of an NG tube in adults.
Cochrane Library, Excerpta Medica database (EMBASE), PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Web of Science were searched up to 31 January, 2022. Studies were eligible when reporting data on the accuracy of methods for determining internal NG tube length in adults. Study selection, risk-of-bias assessment, and data extraction were performed independently by 2 investigators. Risk-of-bias was assessed using the Cochrane Risk-of-Bias Tool and the Joanna Briggs Institute Critical Appraisal Checklist for Cross Sectional Studies. A narrative synthesis of the results was then conducted.
Twelve articles were included in this review. All studies were observational, cross-sectional in nature, except for 1 randomized controlled trial. Ten methods for determining the internal length of an NG tube were described. Correctly positioned NG tubes ranged from 13% to 99%. Results showed that the tip of the nose-earlobe-xiphoid distance (NEX) + 10 cm (mean: 59.9-60.7 cm) and (NEX × 0.38696) + 30.37 + 6 cm (mean: 56.6-56.7 cm) could potentially result in accuracy as high as 97.4% and 99.0%, respectively.
Current data do not provide conclusive evidence of 100% accuracy in finding a correctly placed NG tube when using a method for determining the internal length. Blind placement, using any of the documented methods, cannot be considered safe without additional verification of tube tip positioning. Furthermore, using any of these 10 methods does not reduce the risk of pulmonary intubation.This systematic review was registered at https://www.crd.york.ac.uk/PROSPERO/ as CRD42021243180.
鼻胃管（NG）盲插有多种原因：营养支持与药物给药、胃内容物抽吸/减压以及其他诊断性原因。意外插入食管和肠道很常见，会增加严重并发症的风险。因此，在放置鼻胃管前准确测定其插入体内的长度被认为是实现正确胃内定位的先决条件。
我们旨在识别、评估和总结关于成人鼻胃管插入体内长度测定方法准确性的证据。
检索截至2022年1月31日的Cochrane图书馆、医学文摘数据库（EMBASE）、PubMed、护理学与健康相关文献累积索引（CINAHL）和科学引文索引数据库。纳入报告成人鼻胃管插入体内长度测定方法准确性数据的研究。由两名研究人员独立进行研究选择、偏倚风险评估和数据提取。使用Cochrane偏倚风险工具和乔安娜·布里格斯循证卫生保健中心横断面研究批判性评价清单评估偏倚风险。然后对结果进行叙述性综合分析。
本综述纳入了12篇文章。除1项随机对照试验外，所有研究均为观察性横断面研究。描述了10种鼻胃管插入体内长度的测定方法。鼻胃管位置正确的比例在13%至99%之间。结果显示，鼻尖 - 耳垂 - 剑突距离（NEX）+ 10 cm（平均值：59.9 - 60.7 cm）和（NEX×0.38696）+ 30.37 + 6 cm（平均值：56.6 - 56.7 cm）可能分别导致高达97.4%和99.0%的准确率。
目前的数据并未提供确凿证据表明使用测定插入体内长度的方法能100%准确找到位置正确的鼻胃管。在未额外验证管端位置的情况下，使用任何已记录的方法进行盲插都不能被认为是安全的。此外，使用这10种方法中的任何一种都不能降低肺内插管的风险。本系统评价已在https://www.crd.york.ac.uk/PROSPERO/注册，注册号为CRD42021243180。
