J. Rehbein1, E. Stroumpi1, H. Moit1, R. Alley1 1Children Hospital Of Illinois / OSF Saint Francis Medical Center, Surgery, Peoria, IL, USA
Introduction:
Early removal of nasal gastric tubes (NGTs) can lead to an increase in pneumonitis, pneumonia, and pleural effusions, as well as patient discomfort. This study is to assess the risks and benefits of clamping NGTs and checking residual output 4 hours after clamping before considering the removal of the NGT compared to immediate removal of the NGT. We compared the outcomes of patients admitted requiring NGT decompression, including patients with small bowel obstruction (SBO) and ileus. Specific outcomes were occurrence of NGT replacement, number of emesis episodes if any, failure of clamp trial, pneumonia, other unplanned outcome, and length of hospital stay after NGT removal.
Methods:
Prospective randomized controlled trial with IRB approval. The patients are randomly assigned at the time of NGT placement to a four-hour clamp trial arm or simple removal once signs of bowel function occur. The signs of return of bowel function included in this study are NGT output less than 750mL over the previous 24 hours with at least one additional supportive sign such as lightening in color of NGT output, flatus, or hunger. Inclusion criteria includes women or men 18 years or older who are admitted with a SBO or ileus. Exclusion criteria includes patient self-removal of NGT requiring replacement. All analyses were conducted using SPSS. Our goal study population is 120 subjects. 45 patients have been enrolled thus far with ongoing enrollment.
Results:
Of the current 45 patients, the rate of NGT re-insertion in the clamp trial vs immediate removal group was 9.5% vs 4.2% (p=0.592), which was identified as a failure of the clamp trial. The days to discharge after removal of NGT were recorded as 2.7 days for the clamp trial patients, and 4.0 days for the immediate removal patients (p=0.359). None of the patients in either group developed pneumonitis or pneumonia.
Conclusion:
After assessing our first 45 patients, we found no statistically significant difference in rate of NGT re-insertion between study arms. There was also no statistically significant difference in duration of days to discharge and no difference in complication rates. Study goals include enlarging the study population to strengthen the quality of data to allow for further conclusions to be drawn regarding the risks or benefits of evaluating residual NGT output after clamping for 4 hours to help determine if the tube is ready to be removed. Based on initial data gathered, there seems to be no benefit or harm to either clamping or directly removing an NGT once criteria is met for removal.