الفهرس 
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Abstract
The insertion of a GT in emergencies, and intensive care units is an invasive routine procedure. Proper choice of size, evaluation of correct location, and method of fixing are some of the simplest methods to avoid complications. Complications may be mild, such as nose bleeds, sinusitis, tube decompression or breakage, kinking and GT coiling which is the most common complication of GT placement, or maybe severe, such as nose erosion, esophageal or tracheobronchial perforation, laryngeal edema with asphyxia, pulmonary aspiration, pneumothorax, and intracranial placement. Following tracheal intubation, a gastric tube is usually inserted to aid gastric emptying, administer activated charcoal to a poisoned patient, and allow for intermittent enteric feeding. Negotiating the posterior nasopharyngeal angle and tube entry into the proximal esophageal orifice is critical to the performance.
Although the development of new methods, the healthcare providers depend mainly on the traditional methods for measuring gastric tube length which have some complications. Therefore, this study was conducted to compare the novel and the traditional method of gastric tube length estimation in critically ill patients.
Materials & Method
A Quasi-experimental research design was used to identify outcomes of utilizing novel versus the traditional method of gastric tube insertion in critically ill patients.
This study was carried out at the ICUs of the Alexandria University Main Hospital (AUMH) in the General ICUs namely; General ICU (unit III) and continuous renal replacement therapy (CRRT) ICU.
A Convenience sample of 60 adult unconscious critically ill patients from both genders, their ages ranged from 18 to 65 years, who were newly admitted to the previously mentioned ICUs within 24 hours of admission who required gastric tube insertion were included in this study. The sample size estimation was based on the power analysis using EPI-Info 7 program, applying the following parameters Population size = 60 patients over 3 months, Expected frequency = 50%, Acceptance error = 5%, Confidence coefficient = 95%, Minimum sample size = 50 patients. Patients who met the inclusion criteria were assigned randomly to one of the two groups (30 patients in each); group “A” patient was subjected to the traditional method of insertion (control group), group B; patients were subjected to the novel method of insertion (study group).
Two tools were used in the current study for data collection:
Tool I namely the ’’gastric tube insertion assessment tool’’. was utilized to collect the data of this study. This tool is used to assess gastric tube insertion of patients who were newly admitted to the ICUs. Which was developed by the researcher after reviewing the related literature. This tool consists of three parts:Part I named Patients’ demographic and clinical profile, Part II named ’’Patients physiological parameters before insertion’’ and part III ’’Factors affecting gastric tube insertion ’’
ToolII namely’’gastric tube insertion outcomes’’ was utilized to collect the clinical and technical data of this study. This tool was adopted from (Santos et al.,2016) to assess gastric tube insertion outcomes. This tool consists of two parts: -
Part I ‘’Patients’ clinical outcomes after insertion’’, and Part II ’’Technical outcomes ’’
Approval of the ethics committee of the faculty of nursing was obtained. Permission to conduct the study was obtained from the hospital’s responsible authority after an explanation of the aim of the study and delivery of an official letter from the Faculty of Nursing.
Results
Sixty patients were recruited in the current study. Concerning patients’ age, this table shows that 33.3 % of the study group of patients aged from 40 to ≥ 50 years while 36.7 % of the control group of patients aged from 40 to 50 years. The mean age was 44.13±9.054 and 44.60±10.71 for the study and control group respectively with no statistical difference between the two groups (P= 0.989).
Concerning heart rhythm, it can be noted from this table that 100 % of patients in the study group experienced regular rhythm compared to 80 % in the control group of patientswith a significant difference between the two groups (P= 0.010). The mean MAP was 84.26±15.26 and 79.68±14.12 for the study and control group respectively with no significant difference between the two groups (P= 0.232).
In relation to the degree of pain, it can be noted from this table that 96.70 % of patients in the study group experienced mild pain compared to 100 % in the control group of patients with no significant difference between the two groups (P= 0.313).
As regards the site of gastric tube insertion, it can be noted from this table that the majority of patient (86.70%) in the study group subjected to orogastric tube insertion compared to 100 % in the control group of patientswith a significant difference between the two groups (P= 0.038).
Concerning the total respiratory rate, the mean total RR was 18.60±2.943 and 25.83±4.284 for the study and control group respectively with a significant difference between the two groups (P= 0.000).
The mean peak pressure was 25.17±4.094 and 28.80±1.901 for the study and control group respectively with a significant difference between the two groups (P= 0.000).
The mean MAP was 83.20±9.941 and 82.21±12.04 for the study and control group respectively with no significant difference between the two groups (P= 0.731).
The mean number of gastric tube insertion trials was 1.03±0.183 and 1.47±0.571 for the study and control group respectively with a significant difference between the two groups (P= 0.000).
The mean time elapsed or required for insertion of GT was 5.27±1.437 and 12.30±2.521 for the study and control group respectively with a significant difference between the two groups (P= 0.000).
Concerning the proper position, it can be noted from this table that 100% of patients in the study group experienced proper position compared to 46.7% in the control group of patients with a significant difference between the two groups (P= 0. 001).
Conclusion
• The success rate of GT insertion can be increased by using an angiography catheter (as stylet) with the appropriate length which includes measuring the distance from the xiphisternum to nose to earlobe plus ten centimeters rather than the traditional methods.
• Gastric tube insertion is an acritical and stressful procedure that affects in physiological parameters of the patient especially (spo2, RR, HR, MAP) and pain.
• Using GT insertion with the novel method can decrease the number of insertion trial and complication as decreases trauma occurrence and pain which can occur by using the traditional method.
• In contrast to the insertion of a nasogastric tube, several factors influence the success rate of GT. For example, the insertion of a GT orally has a higher success rate.
• There is a significant relation between novel methods and saving nurse time, effort during GT insertion.
Recommendations
Recommendation regarding education and training:
A teaching program should be conducted to raise awareness of critical care nurses about a novel method of gastric tube insertion that may help in saving time, effort and prevent serious complications.
A novel method of GT insertion should be included in the curricula of undergraduate nursing students in both theory and practice.
Regular critical care staff meetings and conferences must be conducted regularly to discuss the importance of novel methods for GT insertion.
Recommendation regarding clinical practice:
Critical care nurses should use a novel method of GT insertion incorporated into daily practice.
Critical care nurses should be oriented with significant differences between the novel and traditional method of GT insertion.
Recommendation regarding administration:
Written guidelines for the application of the novel method of GT insertion.
Recommendation regarding future research:
Replication of this study on a larger sample is needed to allow generalization of the finding.
Address barriers to applying different novel methods of GT insertion in critically ill patients.