Factors associated with insufficient nasogastric tube visibility on X-ray: a retrospective analysis
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GASTROINTESTINAL
Factors associated with insufficient nasogastric tube visibility on X-ray: a retrospective analysis Tim Torsy 1,2
&
Renée Saman 3 & Kurt Boeykens 3 & Mats Eriksson 4 & Sofie Verhaeghe 2 & Dimitri Beeckman 2,4,5,6,7
Received: 9 January 2020 / Revised: 31 July 2020 / Accepted: 15 September 2020 # European Society of Radiology 2020
Abstract Objectives 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. Methods 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. Results 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 R2 = 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. Conclusions High body mass index, male sex, and the absence of a guidewire inside the nasogastric tube at the time of chest Xray 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. Key Points • 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. Keywords Gastrointestinal intubation . X-rays . Adult . Patient safety * Tim Torsy [email protected] 1
Department of Nursing, Odisee University College, Hospitaalstraat 23, 9100 Sint-Niklaas, Belgium
2
University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
3
AZ Nikolaas General Hospital, Sint-Niklaas, Belgium
4
School of Health Sciences, Örebro University, Örebro, Sweden
5
School of Nursing & Midwifery, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
6
Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health Sciences, University of Sou
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