Sonography as a tool to confirm the position of the nasogastric tube in ICU patients

Introduction

More than 80% of ICU patients are fed enterally via nasogastric or nasoenteric tubes. Incorrect placement of these tubes, however, can have fatal consequences for these patients. Several methods have been used to ensure proper placement of the nasogastric tube before starting enteral feeding. Our aim was to estimate the value of bedside sonography (ATL, ultramark9) in confirming the position of a common radio-opaque nasogastric tube (NG-Levin) and compare this procedure with simple radiography.

Methods

A prospective study in a five-bed ICU over a 5-month period from May to September 2005. Confirmation of the nasogastric tube position was made by sonographically identifying the air bubble that comes out of the Levin after injecting a 10 cm³ mixture of 5% dextrose and air as well as by standard radiography. All NG tubes where inserted by the same individual. The success and the accuracy of the procedure, as well as the procedure times for both sonography and radiography, were recorded and compared. The APACHE score was estimated for every patient.

Results

Sixteen patients were included in the study, nine of them men and seven women, with a mean age of 66.3 ± 7.1 years and a mean APACHE II score of 21 ± 5.2. All patients were intubated and mechanically ventilated. The nasogastric tube position was confirmed sonographically in 15 out of 16 patients. In one case the ultrasound failed to produce results due to gas interposition. The nasogastric tube position was also confirmed radiographically. The median procedure time was 14.93 ± 1.71 min for sonography and 84 ± 30.64 min for radiography (P < 0.001). No case of mispositioning occurred.

Conclusion

Bedside sonography is a sensitive method for confirming the position of nasogastric tube. It is easy to perform by ICU physicians, it is an easy procedure to be learned and it is quicker than conventional radiography.