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 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.
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.
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Abbreviations
- BMI:
-
Body mass index
- CI:
-
Confidence interval
- CXR:
-
Chest X-ray
- Fr:
-
French gauge
- ICU:
-
Intensive care unit
- kVp:
-
Peak kilovoltage
- LES:
-
Lower esophageal sphincter
- M:
-
Mean
- mAs:
-
Milliampere-second
- NPSA:
-
National Patient Safety Agency
- OR:
-
Odds ratio
- PACS:
-
Picture archiving and communication systems
- RCT:
-
Randomized controlled trial
- SD:
-
Standard deviation
- STROBE:
-
Strengthening the Reporting of Observational Studies in Epidemiology
- VIF:
-
Variance inflation factor
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Acknowledgments
The authors would like to thank the Odisee University College and the General Hospital AZ Nikolaas for facilitating this study, in particular the ICU and the radiological department.
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The scientific guarantor of this publication is Tim Torsy.
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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.
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One of the authors has significant statistical expertise.
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Written informed consent was obtained from all subjects (patients) in this study.
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Institutional Review Board approval was obtained.
Study subjects or cohorts overlap
Some study subjects or cohorts have been previously reported in Torsy T, Saman R, Boeykens, K, Duysburgh I, Van Damme N, Beeckman D (2018) Comparison of Two Methods for Estimating the Tip Position of a Nasogastric Feeding Tube: A Randomized Controlled Trial. Nutr Clin Pract 6:843–850.
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• observational
• performed at one institution
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Torsy, T., Saman, R., Boeykens, K. et al. Factors associated with insufficient nasogastric tube visibility on X-ray: a retrospective analysis. Eur Radiol 31, 2444–2450 (2021). https://doi.org/10.1007/s00330-020-07302-w
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DOI: https://doi.org/10.1007/s00330-020-07302-w