Novel Visual Nasogastric Tube Insertion System: A Feasibility and Efficiency Study in a Manikin

Abstract

Background. Conventional nasogastric tube placement is an essential clinical procedure; however, complications may arise from blind manipulation. We tested the feasibility and efficiency of a visual nasogastric tube insertion system (VNGS) using a manikin. Methods. A microimaging fiber (0.8 mm) was integrated into the nasogastric tube to create the VNGS. Twenty inexperienced physicians were enrolled and assigned to the visual or conventional group. Each physician performed 10 repeated nasogastric tube insertions with visual guidance or the conventional method; another 20 inexperienced medical students received nasogastric tube insertion training using visual guidance or the conventional method. Results. The nasogastric tube successfully reached the stomach and the narrow anatomic structures were visualized with the VNGS. Time required for insertion was significantly shorter in the visual group compared to the conventional group (22.56 ± 3.08 versus 37.30 ± 4.12 seconds, P < 0.001). Tube misplacement was observed in 19/100 cases (19%) in the conventional group; no misplacement was observed in the visual group. Less mucosal damage was noted in the visual group (3.43 ± 1.63 versus 9.86 ± 2.31 cm²). Medical students performed better NGT insertions (shorter insertion time and less procedure-related complications) after undergoing the visual guidance training. Conclusions. The VNGS may provide a new technique for nasogastric tube insertion applicable to clinical use or simulation training.

Figure 1

Laboratory human analog model test setup for the visual nasogastric tube insertion system (VNGS). A: nasogastric tube (outer diameter: 4 mm). B: microimaging fiber (outer diameter: 0.8 mm). C: microimaging fiber inserted into the nasogastric tube.

Figure 2

(a) Graph showing the nasogastric tube insertion times of the visual group (VP) and conventional group (CP) of inexperienced physicians with repeated measurements. (b) Comparison of nasogastric tube insertion times. (c) Comparison of nasogastric tube misplacement. (d) Comparison of damaged mucosal areas (∗ indicates P < 0.05).

Figure 3

Images from the visual nasogastric tube insertion system (VNGS) in the manikin. (a) Turbinate. (b) Pharynx. (c) Esophageal stenosis. (d) Mucosal damage.