Nasogastric tube insertion in anesthetized and intubated patients: a new and reliable method

Abstract

Background: The "Rusch" intubation stylet is used to make endotracheal tube intubation easy. We designed this study to evaluate the usage of this equipment in the guidance of nasogastric tube (NGT) insertion.

Methods: A total of 103 patients, aged 23 to 70 years, undergoing gastrointestinal or hepatic surgeries that required intraoperative NGT insertions were enrolled into our study. The patients were randomly allocated to the control group (Group C) or the stylet group (Group S) according to a computerized, random allocation software program. In the control group, the NGT was inserted with the patient's head in an intubating position. In the stylet group, the NGT was inserted with the assistance of a "Rusch" intubation stylet tied together at the tips by a slipknot. The success rates of the two methods, the durations of the insertions, and the occurrences of complications were recorded. All of the failed cases in the control group were subjected to the new technique used in the stylet group, and the successful rescue rate was also evaluated.

Results: Successful insertions were recorded for 52/53 patients (98.1%) in Group S and for 32/50 patients (64%) in Group C. The mean insertion times were 39.5 ± 19.5 seconds in Group C and 40.3 ± 23.2 seconds in Group S. Successful rescues of failure cases in Group C were achieved in 17/18 patients (94.4%) with the assistance of a "Rusch" intubation stylet.

Conclusions: The "Rusch" intubation stylet-guided method is reliable with a high success rate of NGT insertion in anesthetized and intubated patients.

Trial registration: Institutional Review Board of Chang Gung Memorial Hospital (IRB: 98-2669B) and Australian New Zealand Clinical Trials Registry (ACTRN12611000423910).

Figure 1

(A) “Rusch” intubation stylet is tied to nasogastric tube by a Highwayman’s hitch. (B) A magnified picture of the slipknot (Highwayman’s hitch). A Fr.14 nasogastric tube and a 2.6 mm “Rusch” intubation stylet were tied together at the tip by a slipknot (Highwayman’s hitch) with a surgical silk suture (70 cm in length, size 3–0).

Figure 2

The flow of the participants in the study.

Figure 3

The success rates of nasogastric tube insertion. Group C = control group; Group S = stylet group. Data are shown as percentages of cases in each group. The p values were <0.001 for both the first attempt and the overall success rate vs. the control group.