背景:准确确定鼻胃管的内部长度对于安全有效地完成盲插入至关重要,常规护理程序。广泛使用的鼻-耳垂-剑突距离缺乏证据和有效性。最近的一项随机对照试验提出了一种替代方案,校正后的鼻-耳垂-剑突距离公式。然而,其在现实临床实践中的有效性尚未被研究。
目的:本研究评估了校正鼻-耳垂-剑突距离公式用于确定住院或重症监护病房的成年患者的内部鼻胃管长度的实际临床有效性。
方法:进行单中心回顾性临床效果研究,利用常规收集的观测数据。
■在2020年10月至2022年11月之间,纳入了358名需要鼻饲管的综合医院成年患者。主要结果包括由高级实践护士通过X射线验证评估鼻胃管尖端定位(食管下括约肌下方>3cm)。次要结果,从100名参与者的随机亚组的患者记录中获得,通过回顾放射科医生报告尖端位置的清晰度和评估。
结果:经过高级执业护士的评估,确定所有鼻饲管的正确位置。在100个管的分组中,X光检查方案,根据审查放射科医生的记录,显示了不同程度的管尖报告清晰度:4.0%缺乏报告,33.0%的报告不明确,63.0%的报告不明确。
结论:校正后的鼻-耳垂-剑突距离公式显示有可能成为确定鼻胃管内部长度的现有方法的更安全的替代方法。
结论:除了医疗保健提供者的教育和培训,建议放射科医师采用基于检查表的框架,明确报告鼻胃管尖端位置.
BACKGROUND: Accurate determination of the internal length of nasogastric tubes is essential for the safe and effective completion of blind insertions, a routine nursing procedure. The widely used nose-earlobe-xiphoid distance lacks evidence and effectiveness. A recent randomized controlled trial proposed an alternative, the corrected nose-earlobe-xiphoid distance formula. However, its effectiveness in real-world clinical practice has not yet been studied.
OBJECTIVE: This study assessed the real-world clinical effectiveness of the corrected nose-earlobe-xiphoid distance formula for determining the internal nasogastric tube length in adult patients admitted to hospitalization or intensive care units.
METHODS: A single-center retrospective clinical effectiveness study was conducted, utilizing routinely collected observational data.
UNASSIGNED: Between October 2020 and November 2022, 358 adult patients in a general hospital requiring a nasogastric feeding tube were included. The primary outcome involved assessing nasogastric tube tip positioning (>3 cm below the lower esophageal sphincter) by an advanced practice nurse through X-ray verification. Secondary outcomes, obtained from patient records for a random subgroup of 100 participants, were reporting clarity and evaluation of the tip position by reviewing radiologists.
RESULTS: Following evaluation by an advanced practice nurse, all nasogastric feeding tubes were determined to be correctly positioned. Among the subgroup of 100 tubes, X-ray protocols, as documented by the reviewing radiologists, showed varying levels of reporting clarity for the tube tip: 4.0 % lacked reporting, 33.0 % had ambiguous reporting and 63.0 % had unambiguous reporting.
CONCLUSIONS: The corrected nose-earlobe-xiphoid distance formula demonstrates potential to emerge as a safer alternative to existing methods for determining the internal length of nasogastric tubes.
CONCLUSIONS: In addition to healthcare provider education and training, a checklist-based framework is recommended for radiologists to unambiguously report nasogastric tube tip positions.