الفهرس 
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Abstract
Gastric tube (GT) insertion in critically ill patients can be challenging even for experienced critical care nurses. It is often difficult to place the GT in critically ill patients. The more insertion attempts the more complications occurred. Repeated attempts of GT insertion may injure the nasal mucosa, and pharynx that may cause nasal bleeding. Various techniques have been proposed to facilitate the GT insertion with variable success rate. The existence of several methods for proper placement of gastric tube (GT) and introduction of various novel methods day-by-day indicates that no method is perfect or universally accepted. However, the quest for the best is still on.
Aim of the study: this study was conducted to compare between two novels versus traditional methods of gastric tube insertion among critically ill patients.
This study was conducted in the intensive care units at the Alexandria Main University Hospital namely; unit I that includes 14 beds, unit II that includes 12 beds, and unit III that includes 15 beds. These units receive patients with different disorders in the acute stage of illness and patients with different types of injuries.
A convenience sample of 90 adult critically ill patients, who were required a gastric tube (GT) insertion included in this study. Patients were assigned randomly to one of the following three groups (30 patients each). group A: water-filled method of GT insertion; group B: tip burning method of GT insertion; and group C: traditional method of GT insertion.
To accomplish the aim of the current study; Two tools were used in this study for data collection.
Tool one: Gastric tube insertion assessment this tool was developed by the researcher to assess physiological parameters as a data base before GT insertion. It consists of three parts: Part I ″Patients’ socio-demographic and clinical data‶ this part includes patients’ demographic data such as age, sex and patients’ clinical data. Part II ″Physiological parameters‶ this part includes respiratory parameters, cardiovascular parameters and neurological parameters. Part III ″Factors that may affect GT insertion‶ this part assesses the factors that may affect GT insertion. These factors include the advanced airway related factors; the gastric tube (GT) related factors, and the patient-related factors.
Tool two: Gastric tube insertion outcomes this tool developed by the researcher after reviewing relevant literature to assess gastric tube insertion outcomes after insertion. This tool includes two parts: Part I ″Clinical outcomes‶ this part includes respiratory outcomes, cardiovascular outcomes, neurological outcomes and integumentary outcomes. Part II ″Technical outcomes‶ this part includes number of the trials, site of each trial (nasal, oral), duration of insertion and number of used GT, success or failure of GT insertion after trials.
Data collected as the following:
Before insertion:
For the three groups, patients’ demographic and clinical data were obtained and recorded using part I of tool one. Patients’ physiological parameters as a baseline data were assessed and recorded using part II of tool one. For the factors that may affect the gastric tube insertion were assessed and recorded using part III of tool one. The same manufacture product of gastric tube was used in the three methods of the GT insertion to avoid failure of the insertion related to the type of the GT.
During insertion:
For group A (The water filled method)
In this method, the GT will be filled with distilled water at room temperature and cold water alternatively. Then immersing the distal segment of the GT with its side holes in water. Water will be sucked into the tube with a tommy syringe. The tommy syringe connected to the proximal end of the GT and the proximal end of the tube is tapped to keep the water in the tube.
For group B (The tip burning method)
The gastric tube will be heated 1.5cm from the tip to form 30֯ angle. The GT was advanced in patient nose/ mouth till it reaches the nasopharynx/ oropharynx. Then GT will be rotated 180֯ further advancement of the tube lead to entry into the esophagus.
For group C (The traditional method)
After measure the length of tube to be inserted, for orogastric intubation: Insert the tube into oral cavity over the tongue, for nasogastric intubation: Insert the tube into more patent nostril. Then direct the tube downward toward the pharynx, when the tube hits the pharynx, have the patient flex the head forward or flex the unconscious patient’s head, then continue to advance tube until the marked position of the tube is reached.
For the three groups:
Successful GT insertion was defined as the passage of the tube in no more than two attempts.
Patients were assessed for physiological parameters after GT insertion and recorded using part I of tool two.
Technical outcomes after GT were assessed a recorded using part II of tool two.
The main results of the current study:
It was observed that the lowest change occurred in the respiratory rate, peak airway pressure, SPO2 and MAP in the water-filled group and the tip burning group in comparison with the traditional group with statistically significant difference between the three groups {(H=8.865, P=0.012), (H=10.581, P=0.005), (H=8.288, P=0.016),and (H=9.859, P=0.007) respectively}. While, the lowest change was found in the minute volume in the tip burning group in comparison with the water-filled group and the traditional group with a statistically significant difference (H=7.376, P=0.025).
The GT insertion successfully achieved in 83.3% of the patients in the water-filled group, about three quarter of them had successful insertion from the first attempt. While, the GT insertion successfully achieved in 96.7% of the patients in the tip-burning group, 90% of them had successful insertion from the first attempt. Finally, the GT insertion successfully achieved in 76.7% of the patients in the traditional group, 60% of them had successful insertion from the first attempt.
It was noted that the highest mucosal trauma occurrence was observed in 23.3% of the patients in the traditional group, while, the least mucosal trauma occurrence was found in 16.7% of the patients in the tip-burning group. There were no statistically significant differences in mucosal trauma in the three groups
It was noted that in the water filled group, and the tip burning group the duration of tube insertion was from 2 to 4 minutes, and in the traditional group duration of insertion was more than 4 minutes.
Endotracheal tube/ tracheostomy tube (ETT/TT) size, the gag reflex and level of consciousness have statistical significant effect on the GT insertion success.