The important role of positioning in nasogastric tube insertion in unconscious patients: A prospective, randomised, double-blind study.

AIMS AND OBJECTIVES: To investigate whether positioning the body in a lateral decubitus position will facilitate nasogastric tube insertion in unconscious patients.

BACKGROUND: Inserting a nasogastric tube into unconscious patients can be challenging because these patients cannot cooperate with the operator. The piriform sinus and arytenoid cartilage are the most commonly reported impaction sites. However, we found that the first impaction site was the backward displaced tongue when inserting a nasogastric tube in unconscious patients who often exhibited glossoptosis. Performing an intubation in the lateral decubitus position could make this procedure easy.

DESIGN: This prospective, double-blind, parallel, randomised controlled trial was conducted in Hengshui City, Hebei Province, China.

METHODS: A total of 110 cases of unconscious patients were enrolled. The patients were randomly assigned to a conventional group (group C) or a lateral decubitus position group (group L). In group C, the nasogastric tube was inserted while the patients were in a supine position using the conventional technique, and in group L, the tube was inserted in a lateral decubitus position or further tilting the body to a prone decubitus position 20-30°. We discussed reasonable intubation methods in unconscious patients by comparing the success rate on first insertion, the overall success rate, the intubation time and the complication rates between the two groups.

RESULTS: Group L had a higher success rate on first insertion and overall success rate than group C (p < .05). The intubation time in group L was shorter than that in group C (p < .001), and the complication rate in group L was lower than that in group C (p < .05). The differences were statistically significant.

CONCLUSIONS: The backward displaced tongue blocks the pharyngeal passage. Nasogastric tube insertions in the lateral decubitus position are recommended in unconscious patients because of the higher success rate, reduced intubation time and lower complication rate.

RELEVANCE TO CLINICAL PRACTICE: This study provides an effective method for nasogastric tube insertions in unconscious patients.