Acil servis hastalarında nazogastrik tüp yerinin doğrulamasında ultrason kullanımının etkinliği
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Tarih
2022
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Bakırçay Üniversitesi Lisansüstü Eğitim Enstitüsü
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu araştırma, nazogastrik tüp takılan acil servis hastalarında tüp yerinin doğrulanmasında ultrason kullanımının etkinliğini araştırmak amacıyla metodolojik tanımlayıcı olarak planlanmıştır. Araştırma, Ağustos 2021 – Kasım 2021 tarihleri arasında Ege Üniversitesi Tıp Fakültesi Hastanesi Acil Tıp Anabilim Dalı acil servis kliniğinde yürütülmüştür. Araştırmanın örneklemini, herhangi bir nedenle NGT takılma endikasyonu bulunan hastalardan 18 yaş üzerinde olan, NGT takılmasından sonra göğüs röntgeni ile doğrulaması yapılan, Avustralya Triyaj Skoru “Kategori 1” olmayan ve araştırmaya katılmayı kabul eden 72 hasta oluşturmuştur. Verilerin toplanmasında “Olgu Rapor Formu” ve “Taşınabilir Ultrason Cihazı” kullanılmıştır. Veriler ultrason eşliğinde NGT yerinin doğrulanması konusunda eğitimi alan bir araştırmacı (araştırmayı yapan hemşire) tarafından toplanmıştır. Araştırmanın veri toplama aşamasında nazogastrik tüp yerinin doğrulaması, ultrason ile sonografik görüntüleme, oskültasyon ve x-ray göğüs röntgeni yöntemleri ile yapılmıştır. Araştırmayı yapan hemşire ultrason ile tüpün özofagus, subksifoid, gastroözofageal ve antriyum bölgelerinde tüp yerini değerlendirmiştir. Araştırmadan elde edilen veriler SPSS 22.0 programı kullanılarak incelenmiş ve direkt radyografilerden elde edilen bulgular standart referans olarak kabul edilmiştir. Ultrason, oskültasyon ve göğüs röntgeni yöntemlerinin tüp yerini doğrulama yöntemi olarak duyarlılık (sensitivite), özgüllük (spesifite), pozitif öngörü (prediktif) değeri ve negatif öngörü (prediktif) değerleri hesaplanmıştır. Oskültasyon ve ultrason yöntemleri ile göğüs röntgeni yöntemi arasındaki uyum derecesini değerlendirmek için Cohen'in Kappa analizi yapılmıştır. Araştırma sonucunda; hastaların yaş ortalamasının 69,49 ± 13,75 yıl olduğu, %55,6’sının erkek olduğu, %23,6’sınınn siyah/kanlı dışkılama şikayetiyle acil servise başvurduğu ve %43,1’ine gastrointestinal kanama nedeniyle nazogastrik tüp takıldığı saptanmıştır. Hastaların boyun ultrason değerlendirmesine göre %66,7’sinde, mide ultrason değerlendirmesinde %52,8’inde, boyun ve mide ultrason değerlendirmesinde %38,9’unda, boyun veya mide değerlendirmesinde %80,6’sında nazogastrik tüp midede doğrulanmıştır. Sadece standart referans kabul edilen göğüs röntgeni ile boyun veya mide ultrason yöntemi arasında düşük düzeyde bir uyum olduğu saptanmıştır (K = 0.321, p = 0.002). Boyun veya mide ultrason yönteminin duyarlılığı %84,84, özgüllüğü %66,66, pozitif öngörü değeri %96,55 ve negatif öngörü değeri %28,57’dir. Sonuç olarak, nazogastrik tüp takılan acil servis hastalarında ultrason ile tüpün özofagus veya midede görüntülenmesinin etkin olduğu ancak ultrason sonucu negatif olan hastalarda göğüs röntgeni ile bunun doğrulanması gerekmektedir.
This study was designed as a methodological descriptive study to investigate the effectiveness of ultrasound use in confirming tube location in emergency room patients with a nasogastric tube. The study was carried out between August 2021 and November 2021 at Ege University Medical Faculty Hospital, Department of Emergency Medicine. The sample of the study consisted of 72 volunteering patients who were over 18 years of age with an indication for NGT insertion for any reason and who were also confirmed by chest X-ray after NGT insertion, and not listed in Australian Triage Score of "Category 1". "Case Report Form" and "Portable Ultrasound Device" were used to collect data. Data were collected by an investigator qualified to carry out ultrasound-guided NGT location verification. In the data collection phase of the study, the verification of the nasogastric tube location was made through ultrasound, sonographic imaging, auscultation, and x-ray chest X-ray. The investigator evaluated the tube location in the esophagus, subxiphoid, gastroesophageal and antrial regions of the tube with ultrasound. The data obtained from the study were analyzed using the SPSS 22.0 program and the findings obtained from the direct radiographs were accepted as standard reference. Sensitivity, specificity, positive predictive value and negative predictive values of ultrasound, auscultation and chest X-ray methods were calculated to verify tube location. Cohen's Kappa analysis was performed to evaluate the conformity between the auscultation and ultrasound methods and the chest X-ray method. As a result of the study, it was found that the mean age of the patients was 69.49 ± 13.75 years, 55.6% were male, and 23.6% applied to the emergency department with the complaint of black/bloody stools, and 43.1% were seen to be have a nasogastric tube because of gastrointestinal bleeding. The nasogastric tube was confirmed in the stomach in 66.7% of the patients according to the neck ultrasound evaluation, while in the stomach ultrasound evaluation in 52.8% of the ptients, 38.9% in the neck and stomach ultrasound evaluation, and 80.6% in the neck or stomach evaluation. A low level of conformity was found only between chest x-ray, which is accepted as a standard reference, and neck or stomach ultrasound method (K = 0.321, p = 0.002). The sensitivity of the neck or stomach ultrasound method is 84.84%, the specificity is 66.66%, the positive predictive value is 96.55%, while the negative predictive value is 28.57%. In conclusion, in emergency room patients with a nasogastric tube, imaging of the tube in the esophagus or stomach with ultrasound is effective, but in patients with negative ultrasound results, this should be confirmed by chest X-ray.
This study was designed as a methodological descriptive study to investigate the effectiveness of ultrasound use in confirming tube location in emergency room patients with a nasogastric tube. The study was carried out between August 2021 and November 2021 at Ege University Medical Faculty Hospital, Department of Emergency Medicine. The sample of the study consisted of 72 volunteering patients who were over 18 years of age with an indication for NGT insertion for any reason and who were also confirmed by chest X-ray after NGT insertion, and not listed in Australian Triage Score of "Category 1". "Case Report Form" and "Portable Ultrasound Device" were used to collect data. Data were collected by an investigator qualified to carry out ultrasound-guided NGT location verification. In the data collection phase of the study, the verification of the nasogastric tube location was made through ultrasound, sonographic imaging, auscultation, and x-ray chest X-ray. The investigator evaluated the tube location in the esophagus, subxiphoid, gastroesophageal and antrial regions of the tube with ultrasound. The data obtained from the study were analyzed using the SPSS 22.0 program and the findings obtained from the direct radiographs were accepted as standard reference. Sensitivity, specificity, positive predictive value and negative predictive values of ultrasound, auscultation and chest X-ray methods were calculated to verify tube location. Cohen's Kappa analysis was performed to evaluate the conformity between the auscultation and ultrasound methods and the chest X-ray method. As a result of the study, it was found that the mean age of the patients was 69.49 ± 13.75 years, 55.6% were male, and 23.6% applied to the emergency department with the complaint of black/bloody stools, and 43.1% were seen to be have a nasogastric tube because of gastrointestinal bleeding. The nasogastric tube was confirmed in the stomach in 66.7% of the patients according to the neck ultrasound evaluation, while in the stomach ultrasound evaluation in 52.8% of the ptients, 38.9% in the neck and stomach ultrasound evaluation, and 80.6% in the neck or stomach evaluation. A low level of conformity was found only between chest x-ray, which is accepted as a standard reference, and neck or stomach ultrasound method (K = 0.321, p = 0.002). The sensitivity of the neck or stomach ultrasound method is 84.84%, the specificity is 66.66%, the positive predictive value is 96.55%, while the negative predictive value is 28.57%. In conclusion, in emergency room patients with a nasogastric tube, imaging of the tube in the esophagus or stomach with ultrasound is effective, but in patients with negative ultrasound results, this should be confirmed by chest X-ray.
Açıklama
Anahtar Kelimeler
Acil servis, Nazogastrik tüp, Ultrason, Göğüs röntgeni, Hemşire, Nurse, Chest x-ray, Ultrasound, Nasogastric tube, Emergency service
