NGT: End-Tidal CO2 (etCO2) and pH in the Correct Naso-gastric Tube Placement
Study Details
Study Description
Brief Summary
The laying of a naso-gastric tube is an extremely common event in intensive medicine; although standard naso-gastric tube laying is performed at the patient's bedside, this procedure is not without risk. Through the use of methods already used in the clinical field, of daily use, we want to identify the threshold value between tracheal and esophageal etCO2 (group A) and the threshold value between gastric and esophageal pH (group B).
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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Detailed Description
Numerous methodologies have been evaluated to recognize the correct positioning of NGT at the gastric level, including different clinical techniques (such as gastric auscultation, aspiration of the NGT), ultrasound techniques, etc. Actually, the diagnostic gold standard is the thoraco-abdominal anterior-posterior radiography, which is considered the only non-invasive method capable to confirm the correct pose of the NGT at intra-diaphragmatic level. This method, however, even if it is non-invasive, requires the use of ionizing radiation (4 micro-Sievert (uSv) for radiography) which could be repeated multiple time for the same patient; NGT may need to be repositioned several times during the same hospital stay, increasing patient exposure to ionizing radiation and, potentially, also the health workers exposure.
The aim is to identify into the group A the threshold value between tracheal and esophageal etCO2 and into the group B the theshold value between gastric and esophageal pH.
Phase A: etCO2 measurement will be collected 1. after intubation, when the tube is inserted into the endotracheal tube, before proceeding with the aspiration of secretions and 2. once the NGT has been inserted, by a probe located at the end of the tube.
Phase B: pH measurement will be collected at the end of the procedure, once the NGT is inserted, at 1.a distance of 25 cm from the mouth (oesophageal site) and at 2. a distance of 40 cm (gastric site), aspirating the gastric contents and measuring on specific litmus paper.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Group A - etCO2 At the end of the anaesthesia , as usual, the secretions are aspirated with a suction tube of 18 Fr of caliber (diameter 6 mm). When the tube is inserted into the endotracheal tube, before proceeding with the aspiration of the secretions, a capnometer is attached to its outer end, measuring the etCO2 value for 10-15 seconds. At the end of the measurement, authors proceed with the aspiration of the secretions as usual. Authors then proceed with the laying of a NGT according to local protocols. Also in this case, once the NGT has been inserted, the etCO2 is measured at the end of the probe for 10-15 seconds. At the end of the measurement, the capnometer can be detached, as a standard procedure, and the NGT can be used as usual. At the end of the procedure, therefore, for each patient, two values of etCO2 are acquired which will allow to obtain two "populations of values" of the etCO2: the values recorded at the endotracheal level and the one recorded at the oesophageal level. |
Other: etCO2
At the end of the procedure, therefore, for each patient two values of etCO2 are acquired which will allow to obtain two "populations of values" of the etCO2: the values at the endotracheal level and the esophageal level values. The authors will find the "threshold value" of etCO2 collected when the NGT is well positioned in trachea. The study manager is not directly involved in the measurement and recording of etCO2 values.
Other Names:
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| Group B - pH At the end of the anaesthesia , once the NGT is inserted, the pH is measured by aspirating the gastric contents and measuring on specific litmus paper the pH values, both at a distance of 25 cm from the mouth (oesophageal site) and at a distance of 40 cm (gastric site). At the end of the procedure, for each patient two values of pH are acquired which will allow to obtain two pH "value populations": a value at oesophageal level and a value at the gastric level. |
Other: pH
At the end of the procedure, for each patient two values of pH are acquired which will allow to obtain two pH "value populations": a value at esophageal level and a value at the gastric level. The authors will find the "threshold value" of pH collected when the NGT is positioned in the esophagus and in the stomach. The study manager is not directly involved in the measurement and recording of pH values.
Other Names:
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Outcome Measures
Primary Outcome Measures
- etCO2 level [30-60 seconds]
to find a threshold value of etCO2 collected when the NGT is well positioned in trachea
- pH [30-60 seconds]
to find a threshold value of pH collected when the NGT is positioned in the esophagus and in the stomach.
Secondary Outcome Measures
- etCO2 level in chronic obstructive pulmonary disease (COPD) patients [30-60 seconds]
subanalysis for the threshold value in the group with chronic obstructive pulmonary disease (COPD)
- pH in patients taking proton pump inhibitors (PPIs) [30-60 seconds]
identify patients taking proton pump inhibitors (PPIs) and perform a sub-subanalysis for the threshold value in the group with already diagnosed gastro-esophageal reflux disease.
Eligibility Criteria
Criteria
Inclusion criteria:
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Adult patients (> 18 years)
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Patients male and female
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Patients intubated by oro- or naso-tracheal way
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Post-induction curarized patients
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Fasting patients (from at least 6 hours)
Exclusion criteria:
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Patient refusal
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Patients with known bleeding diathesis / ongoing bleeding
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Patients at risk of bleeding (defined as thrombocytes <50 G/l, fibrinogen <1.0 g/l, international normalized ratio (INR) > 2.5, activated partial thromboplastin time (aPTT) > 70 sec)
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Patients with traumatic brain injury / Polytrauma
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Patients with esophagus-tracheal fistulas or malformations of the ear, nose, and throat (ENT) sphere
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Patients with current or previous radiotherapy of the ENT sphere
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Patients unable to give their informed consent due to language barriers
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Women who are pregnant
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Clinica Luganese Moncucco | Lugano | Switzerland | 6900 |
Sponsors and Collaborators
- Clinica Luganese Moncucco
- Ospedale Regionale Bellinzona e Valli
Investigators
- Principal Investigator: Samuele Ceruti, MD, Clinica Luganese Moncucco
Study Documents (Full-Text)
None provided.More Information
Additional Information:
- Principles for medical research involving human subjects
- Federal law concerning research on human subjects
- Definitions and standards on clinical safety information
- Guideline for good clinical practice
- Ordinance on Clinical Trials in Human Research
Publications
- Bercik P, Schlageter V, Mauro M, Rawlinson J, Kucera P, Armstrong D. Noninvasive verification of nasogastric tube placement using a magnet-tracking system: a pilot study in healthy subjects. JPEN J Parenter Enteral Nutr. 2005 Jul-Aug;29(4):305-10.
- Nguyen L, Lewiss RE, Drew J, Saul T. A novel approach to confirming nasogastric tube placement in the ED. Am J Emerg Med. 2012 Oct;30(8):1662.e5-7. doi: 10.1016/j.ajem.2011.09.010. Epub 2011 Nov 17.
- Ozer S, Benumof JL. Oro- and nasogastric tube passage in intubated patients: fiberoptic description of where they go at the laryngeal level and how to make them enter the esophagus. Anesthesiology. 1999 Jul;91(1):137-43.
- Prasad G, Garg R. The 'bubble technique': an innovative technique for confirming correct nasogastric tube placement. J Clin Anesth. 2011 Feb;23(1):84-5. doi: 10.1016/j.jclinane.2010.03.006.
- Vigneau C, Baudel JL, Guidet B, Offenstadt G, Maury E. Sonography as an alternative to radiography for nasogastric feeding tube location. Intensive Care Med. 2005 Nov;31(11):1570-2. Epub 2005 Sep 20.
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