Page 232 - HA Convention 2016 [Full Version]

HOSPITAL AUTHORITY CONVENTION 2016 Service Enhancement Presentations

F8.4 Young HA Investigators Presentations 14:30 Room 421

Nurse Performed Ultrasonography in Confirming the Position of Nasogastric Tube in Emergency Department: A

Prospective Single Group Diagnostic Test Study
Tai PH 1, Lau WS 1, Chan PY 2, Ng SY 2, Lam YC 3, Mak HT 3, Mak YT 3
1Accident and Emergency Department, Queen Elizabeth Hospital, 2Accident and Emergency Department, Yan Chai Hospital,
3Accident and Emergency Department, Tseung Kwan O Hospital, Hong Kong

Introduction

Emergency nurses often encounter patients with nasogastric tube (NGT) dislodgements who require re-insertion. Gastric
placement verification of the NGT is a common task for nurses in Accident and Emergency Department (AED). Such
procedure is essential after NGT insertion, before each feeding and whenever malposition of NGT is suspected. Ensuring
correct position of NGTs is critical because complications resulted from misplacement can be serious and life threatening.
Conventionally, nurses perform pH test of the gastric aspirate and auscultation test (“Whoosh” Test) to confirm the NGT
placement. However, there are limitations for using the conventional methods. Although radiological determination is
regarded as the golden standard for verifying gastric placement of NGT, it is not practical to use x-ray routinely every single
time before NGT feeding for gastric placement verification as it increases patients’ exposure to radiation and consumes
transportation resources. The utilisation of bedside ultrasonography in NGT placement verification is suggested in overseas
literatures. However, empirical evidence supporting the use of bedside ultrasonography in verifying the position of NGT in
local AEDs is scanty. There is also a lack of validation of nurse performed ultrasonography in Hong Kong. With the support
from hospitals and medical personnel, the possibility of nurse performed ultrasonography in verifying the position of NGT in
AED would be reviewed.

Objectives

(1) To identify the sensitivity and specificity of nurse-performed ultrasonography in confirming position of nasogastric tube in
AED; and (2) to compare the effectiveness of nurse performed ultrasonography in confirming the position of nasogastric tube
with conventional methods.

Wednesday, 4 May Methodology

This study was conducted in the AED of three local hospitals with approval from Research Ethics Committees of the Kowloon
Central, Kowloon East, and Kowloon West Cluster. Written informed consents were obtained from patients before data
collection. Standard treatments of patients were respected and disturbances were minimised during the study. Interventions
of this study included bedside ultrasound performed by investigators with specific ultrasound training in addition to
conventional pH test and “whoosh” test. The ultrasound scan consists of three parts: Neck scan, epigastric scan and air
injection “fogging” test. Results were compared with chest or abdominal X-Ray for evaluation of accuracies.

Results

A total of 72 patients were included in the study with a male/female ratio of 27/45 and a mean age of 84.76 ± 8.46 years.
This study confirmed a high sensitivity and specificity of nurse performed ultrasonography in confirming the position of
NGT in AED. The high positive predictive value and positive likehood ratio supported the confirmation of NGT position by
bedside ultrasound. The high specificities and minimal negative likehood ratios of ultrasonography tests also suggested the
application of bedside ultrasound in ruling out patients with misplaced NGTs. Nurse performed ultrasonography allowed
immediate bedside confirmation of NGT position in AED. Apart from the reduction of radiation exposure and promotion of
patient safety, bedside ultrasound is also beneficial to the overcrowded AED while conventional confirmation methods still
with limitations. Nurse performed ultrasonography can be incorporated into daily practice for providing extra evidence for the
confirmation of NGT position. However, radiological confirmation is still necessary if ultrasound cannot verify the position of
the NGT.

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