鼻胃管插入後錯置偵測方法之系統文獻回顧

A Systematic Review of Methods for Detecting Nasogastric Tube Misplacement after Insertion

江月琇(Yue-Xiu Jiang) ； 林豐裕(Feng-Yu Lin) ； 高美菁(Mei-Ching Kao) ； 林瑞娥(Ri-Ao Lin) ； 吳尚蓉(Shung-Jong Wu)

《長期照護雜誌》 17卷2期 (2013/08) Pp. 105-124

https://doi.org/10.6317/LTC.201308_17(2).0005

摘要

目的：本文透過系統文獻回顧探討及整合鼻胃管置入後位置偵測方法，以作為管路安全照護應用的參考。方法：以接受鼻胃管置入的成人個案為研究對象，搜尋CINAHL、PubMed、MEDLINE等9個中英文資料庫，搜尋自1993年至2013年4月，有關鼻胃管置入後位置偵測方法之系統文獻回顧（systematic review）、臨床指引（clinical guideline）及隨機對照試驗研究。篩選文章後，依Critical Appraisal Tool（CAT）、Appraisal of Guidelines for Research & Evaluation（AGREE），及Quality Assessment for Diagnostic Accuracy Studies（QUADAS）量表評定研究品質。共計篩選系統文獻回顧7篇、臨床指引3篇，及13篇隨機對照試驗研究。結果：總共整理出13種鼻胃管位置偵測方法；X光及抽出液pH值測定，乃為驗證鼻胃管後正確位置準確度較高的偵測方法；目前使用的空氣注入後聽診腹部氣泡音、水下冒泡法，及抽出物的目視檢測安全性不佳。結論：X光是驗證鼻胃管位置最可靠的方法，但若每次灌食或給藥前，皆執行X光檢測則不符合經濟效益。建議以效度較高的抽出液pH值測定，同時輔以其他方法比單一技術較為可靠。

關鍵字

鼻胃管置入 ； 鼻胃管位置 ； 錯置

並列摘要

Aim: This article conducted a systematic review to investigate and integrate the methods for detecting nasogastric (NG) tube misplacement. Methods: Adults (age 19 years and over) inserted NG tube were included. The search strategy aimed to find published and unpublished studies written in English and Chinese between 1993 and 2013 in ten databases (e.g. CINAHL, PubMed, Medline). Eligible studies were systematic reviews, clinical guidelines, and randomized controlled trials. Critical Appraisal Tool (CAT), Appraisal of Guidelines for Research & Evaluation (AGREE) and Quality Assessment for Diagnostic Accuracy Studies (QUADAS) were used to apprize the methodological quality. Seven systematic reviews, three clinical guidelines, and 13 randomized controlled trials were included. Results: There were 13 methods for detecting the NG tube misplacements. X-rays and the determination of pH extracts are the most precise methods to verify the position of NG tubes. The sensitivity and specificity of auscultation using the ”whoosh” test, bubbling method, and visual inspection of aspirate drawn from the NG tube are poor. Conclusion: Radiology was the most reliable method to confirm the correct placement of NG tubes in adults. However, it is not the cost effective test before oral feeding and drug administration. To test the acidity of the aspirate drawn from the NG tube and combine the other methods are suggested to confirm the correct NG tube placement.

並列關鍵字

nasogastric tube insertion ； nasogastric tube placement ； misplacement