Preclinical Trial of the Effectiveness of the Safety Nasogastric Tube to Detecting Tube Position Based on Tidal Volume and Pepsin Assay Results in the Gastrointestinal Tract of Macaca Fascicularis

doi:10.21203/rs.3.rs-1150455/v1

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Research Article

Preclinical Trial of the Effectiveness of the Safety Nasogastric Tube to Detecting Tube Position Based on Tidal Volume and Pepsin Assay Results in the Gastrointestinal Tract of Macaca Fascicularis

https://doi.org/10.21203/rs.3.rs-1150455/v1

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published 12 Jul, 2023

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Background: Generally, insertion of a nasogastric tube (NGT) does not use imaging guidance. This procedure has a risk of malposition to the lungs from 0.3–15%. The NGT verification only detects the position of the tube in the end of procedure. Misplacement of NGT into the respiratory tract can result in damage to the lungs. Safety nasogastric tube (SNGT) has been created to detect the position of the tube in real-time, simple, and inexpensive. This study aims to prove the effectiveness of the SNGT prototype in Macaca fascicularis.

Result: The SNGT with an airbag size of 50% of tidal volume (SNGT 50% TV) had 100% sensitivity and specificity in detecting the position of the tube. While the SNGT with an airbag size of 100% of TV (SNGT 100% TV) has sensitivity of 100% and specificity of 87.5%. There was significant difference between the movement of airbag of SNGT 50% TV and SNGT 100% TV (p ≤ 0.05). However, there was no significant difference between the accuracy of placement of 50% TV SNGT, 100% TV SNGT, and conventional NGT (p > 0.05). The pepsin enzyme has better sensitivity (100%) than pH paper (91.66%) in detecting the end position of tube.

Conclusion: SNGT tube has high effectiveness in detecting the position of the tube inside of the respiratory and digestive tracts to prevent misplacement.

Biomedical Engineering

Nasogastric Tube

Malposition

Pepsin

NGT have been available for a long time, with the first insertion dating back to the seventeenth century. They were first used solely for providing nutrition. Currently, NGT is also used for other indications such as administering drugs, gastric decompression, or gastric irrigation [1]. NGT placement is a procedure commonly performed in patient beds, with thousands of NGTs installed in the hospital environment daily. For critically ill patients, enteral nutrition must be established as early as possible. The NGT is generally used for temporary enteral nutrition and is considered safe. However, in an unconscious patient, special care is needed to detect complications that may be life-threatening [2].

As NGT placement is performed without imaging guidance, tube malposition in the tracheobronchial tract is common. This can be associated with pulmonary complications [3]. In perioperative patients who will receive sedation, NGT placement is one of the routine procedures. This procedure is generally low-risk, but severe consequences of tube malposition have been reported. Rare and fatal potential complications include pneumothorax and even perforation of the internal jugular vein, as reported by Smith et al. in 2017 [4]. Malpositioning in the tracheobronchial tract can occur at a frequency of 0.3–15% [^{5, 6}]. Pneumothorax has also been reported to occur in 1.2% of patients in a retrospective series [7].

Misplaced NGT inserted in the respiratory tract was first identified as a patient safety issue by the National Patient Safety Agency (NPSA) in 2005, and three further warnings were issued by the NPSA England between 2011 and 2013 [8]. Between September 2011 and March 2016, 95 incidents where fluids or drugs were introduced into the respiratory tract or pleura through a misplaced NGT were reported to the National Reporting and Learning System and Strategic Executive Information System. This incident demonstrates that the risk to patient safety remains. Checking the tube placement before use through aspiration pH testing and, if necessary, radiographic imaging is essential to prevent harm. However, reports of incidents of NGT insertion by clinical reviewers indicated that the most common cause was misinterpretation of radiographic images by medical staff who had not received the necessary training. Other types of errors involve nursing staff and pH tests, methods of verifying improper tube placement, and communication failures resulting in the tube placement not being checked. In the report, 32 incidents in which the patient later died were indicated [9].

Several kinds of conventional verification tests have been used to confirm the position of the tube in the hull. The auscultation test (whoosh test) is performed with a rapid injection of air into the NGT tube while auscultating (listening for a “whoosh” sound) under the xiphoid process. Many case reports, studies, and warnings point to the ineffectiveness of this test [^{10, 11}]. The auscultation test is most frequently used to check for proper NGT placement. The sound produced by the air being exhaled through the tube is used to determine the placement of the tube in the hull. However, the sound of air entering the tube can also be heard over the epigastrium when the tube is improperly placed into the tracheobronchial tract, pleural cavity, or esophagus. Another verification method is to collect aspirated fluid from the NGT tube. This fluid is usually grassy green or colorless, with pale white-to-brownish flakes of mucus. The pH measurement results of these liquids are often £5. In the absence of infection, respiratory secretions are usually clear. However, measuring the pH level alone does not differentiate between the respiratory and gastrointestinal tracts; both sites can have high pH values (>6); for example, the pH value of the stomach may increase if the patient is receiving acid-suppressing drugs [12].

Recent NGT verification methods include the use of pepsin, trypsin, and pH levels to confirm NGT placement and check for complications of reflux of gastric fluid into the respiratory tract. Research was conducted using pH £ 6, pepsin ≥ 100 μg/ml, and trypsin £ 30 μg/ml as criteria for proper tube placement to precisely predict NGT placement. The results indicated that these three variables can correctly classify 93.4% of the tube position in the stomach [13].

The conventional NGT insertion procedure that many physicians and nurses perform in hospitals is a blind NGT procedure, that is, without the use of technology to guide or visualize the internal passage of the tube inside the body. Although most NGT insertions using this procedure result in the successful placement in the intended location, which is the stomach, any tube insertion has the potential to be misplaced, even when the procedure is performed by an experienced healthcare provider [14]. In addition, a conventional verification test will determine whether the tube is properly inserted in the digestive tract after the entire tube has been inserted in the body. The length of the tube from the nose to the stomach is longer than that of the alveolus. As a result, if an insertion error occurs, the tube that has completely entered the respiratory tract damages the bronchioles, alveoli, and even the pleura. Misplaced NGTs can be detected in awake patients with intact cough reflexes [15].

The safety NGT (SNGT) is an innovative NGT that can solve problems in conventional NGT insertion. It is shaped like a normal NGT tube but has an airbag that can be expanded and collapsed when the tube is passed through the respiratory tract. However, how much air from the vital capacity of the lungs can enter the airbag and how long the laryngeal boundary should be marked are unknown. A SNGT prototype has been made and patented (No. IDP000056746) [16]. The aim of this study was to prove the effectiveness of the SNGT prototype in NGT placement in the gastrointestinal tract and in preventing misplacement of the tube in the respiratory tracts of monkeys as experimental animals. Monkeys were chosen as test animals because of their similar anatomical structure to humans. Their lungs most closely resemble the human lungs in structure and physiology [17].

5.1 Research model and samples

This research is an in vivo experimental study in Macaca fascicularis (age, >4 years and weight, 3–5 kg). Three animals were randomly divided into three groups as follows: the SNGT group with an airbag size of 50% of the TV, the SNGT group with an airbag size of 100% of the TV, and the conventional NGT. The sample size was calculated using Federer's formula.

The study was based on the replacement, reduction, and refinement (3R) principle. Therefore, three animals were used. Each animal received eight tube insertions.

5.2 SNGT prototype

The prototype is shown in Figure 4. The dimensions of the SNGT with an airbag size of 100% of the TV were 6.5 ´ 5 ´ 1.6 cm, with a total volume of 52 ml, and those of the SNGT with an airbag size of 50% of the TV were 4 ´ 5 ´ 1.25 cm, with a total volume of 25 ml.

5.3 Procedures

5.3.1 SNGT insertion

The monkey was positioned semi-fowler with a flexed position of the head, then the tube fitting set was brought closer to the monkey. The SNGT tube was measured starting from the nose, ear, hyoid bone, and xipoideus process. After that, the tube had marked with tape at the boundary of the hyoid bone (first marker) and xipoideus process (second marker). The tip of the tube 15-20 cm long is given 2% lidocaine gel lubricant. The tube is slowly inserted through the nose through the monkey's nose. If there is an obstacle, the tube is pulled a little slower then the monkey position is adjusted more with the neck extension. The airbag of SNGT had moved to expand and collapse while inserted into the upper respiratory tract. The tube had been inserted until the limit of the first marker, after that the tape has opened. Subsequently, the tube has inserted again about 5 cm. If the tube passes through the esophagus, the airbag had stopped to move. And vice versa, the airbag had been moving if the tube passes through the trachea and should be pulled out.

The monkey was put to sleep in a hyperextended head position if the tube goes into the esophagus. After that, a visual examination will be performed with the help of a laryngoscope to ensure the position of the tube is right above the larynx. If the position is above the larynx, a marker will be given using a marker and a small scratch on the part of the gastric tube around the monkey's nostrils. This will show the length of the tube from the tip of the nostril to the top of the larynx.

The tube was inserted again into the esophagus, then continued again until it reached the second tape marker on the tube. The method of verifying the position of the tube whether it is properly inserted into the stomach will use the pepsin enzyme and pH paper measurement. Aspiration of the monkey stomach fluid was carried out with a 10 cc syringe connected to the base of the tube. If pepsin enzyme has been found, it means that the aspirated liquid comes from the digestive tract and the tube enters the digestive tract properly. After aspiration of fluid, the NGT tube has removed slowly. Then the monkey is returned to the cage and supervised in the recovery process until the individual can sit down.

5.3.2 NGT insertion

The monkey was positioned semi-fowler with a flexed position of the head, then the tube fitting set was brought closer to the monkey. The NGT tube was measured starting from the nose, ear, hyoid bone, and xipoideus process and then marked with tape at the boundary of the hyoid bone (first marker) and xipoideus process (second marker). The tip of the tube 15-20 cm long is given 2% lidocaine gel lubricant. The tube is slowly inserted through the nose through the monkey's nose. If there is an obstacle, the tube is pulled a little slower then the monkey position is adjusted more with the neck extension. The tube has been inserted until the first tape. Then the tape has opened. The tube has been inserted again until 5 cm after the limit of the first marker. Afterward, the monkey was put to sleep in a hyperextended head position with a pillow on the head. After that, a visual examination will be performed with the help of a laryngoscope to ensure the position of the tube is right above the larynx. If the position is above the larynx, a marker will be given using a marker and a small scratch on the part of the gastric tube around the monkey's nostrils. This will show the length of the tube from the tip of the nostril to the top of the larynx.

This study was conducted from January to June 2021. Spirometric examination was performed in two animals from the SNGT group.

2.1 Tidal volume

Table 1. Tidal volumes of the SNGT groups

No.	ID No.	VE (ml)	RR	TV (ml)
1	140405	1,480	28	52.8
2	151220	1,050	21	50

The size of the SNGT airbag was made according to the TV, as shown in Table 1.

2.2 Effectiveness of the SNGT

On the basis of the results of the study, the Thornier-Remain confirmatory test was performed to determine the sensitivity and specificity of the SNGT 50% TV or SNGT 100% TV. The test calculations were performed using a 2 ´ 2 table to compare the results of the SNGT airbag verification with the laryngoscopic verification. The SNGT passes properly into the digestive tract in the absence of movement of the airbag. With movement of the airbag (inflation and deflation), the SNGT does not enter the digestive tract properly (tube misplaced in the respiratory tract).

Table 2. Differences between the SNGT 50% TV and SNGT 100% TV using a confirmatory test in detecting tube position

No.	Tube	Airbag movement	Laryngoscopic examination		Thornier-Remain
			Gastrointestinal tract	Respiratory tract	Sensitivity	Specificity
1	SNGT 50% TV	Absent	8	0	100%	100%
		Present	0	8
2	SNGT 100% TV	Absent	7	0	87.5%	100%
		Present	1	8

Table 2 shows that the sensitivity and specificity of the SNGT 50% TV are both 100%. However, the sensitivity of the SNGT 100% TV is 87.5%, and its specificity is 100%. A decrease in sensitivity due to one of the insertions indicates movement of the airbag in the stomach.

The results presented in Figure 1 show that the mean movement of the airbag was 3.5 mm for the SNGT 50% TV and 2 mm for the SNGT 100% TV. The results of the t-dependent test showed a p value of 0.026 (≤0.05), which indicates a significant difference.

The results presented in Figure 2 show no significant differences in tube placement accuracy between the SNGT 50% TV, SNGT 100% TV, and conventional NGT. All the tubes were inserted in the stomach in the first attempt. The sensitivity of the SNGT 50% TV was higher than that of SNGT 100% TV in detecting the correct position of the tube in the gastrointestinal tract. Both the SNGT 50% TV and SNGT 100% TV had 100% specificity to detect the position of the tube in the upper respiration tract.

2.3 Difference of the pH Paper and Pepsin Enzyme Assay

Figure 3 shows that the pepsin assay had higher sensitivity (100%) than the pH paper (91.66%) in detecting the end position of the tube. Significant differences were found between the pH paper and the pepsin assay, as detailed in Table 3.

Table 3. Mean differences between the pH paper and the pepsin assay

No.	Verification Test	Mean	t Dependent test
1	pH paper	4	0.000*
2	Pepsin assay	3,462.5	0.000*

*p ≤ 0.05

The results presented in Table 3 show that in the pH paper verification, the average pH was 4. By contrast, pepsin enzyme verification revealed an average pepsin enzyme activity of 3,462.5 units/ml. The results of the t-dependent test showed a p value of 0.000 (≤0.05), which indicates a significant difference.

Verification using airbag movement at the base of the gastric tube is the latest method for identifying tube position. When the tube is in the respiratory tract, airbag movement occurs at the base of the SNGT tube. The airbag expands during expiration and collapses during inspiration. These movements will occur as long as the end of the tube is inside the nose at the top of the epiglottis. Once the end of the tube is advanced deeper, two possibilities occur. One is that the airbag will stop moving when the end of the tube enters the esophagus properly. The other is that the airbag will continue to move and deflate when the end of the tube enters the trachea. If this happens, the tube must be withdrawn immediately before going deeper and damaging the bronchi, alveoli, and lung pleura. This method of verifying the tube position is important because gastric fluid is not easily obtained during NGT insertion. According to Boeykens et al. (2014), aspiration can only be obtained directly in 48.6% of patients. In 33.5% of patients, aspiration was obtained after additional measures such as air insufflation into the NGT, lateral positioning, and retrying after 1 hour, which delays feeding. As for 18.4% of patients, this method is feasible because of the small amount of gastric fluid [18].

The results of this study are supported by several other studies that took advantage of the differences in physiological aspects between the respiratory and digestive tracts. According to Fan et al. (2017), the method of verifying the NGT position can be performed with capnography/colorimetric capnometry. Capnography is the continuous analysis and recording of carbon dioxide (CO₂) levels using infrared technology [19]. According to Chau et al. (2011), colorimetric devices as accurate as capnography can detect CO₂ levels during NGT placement. This seems to be a promising method for confirming NGT placement, especially when NGT aspiration is not obtained.²⁰ However, the drawback of this method lies in the false-positive results associated with reflux contamination of gastric contents. Carbonated drinks or drugs such as sodium bicarbonate have the potential to induce CO₂ production in the stomach [21].

Our results show once incidence of air movements (expansion and deflation) during SNGT 100% TV insertion in the stomach. These results are in accordance with the findings of Hani et al. (2015) that showed that air in the stomach can move out through the NGT. Tests of a modified gastric tube in pig test animals revealed that the presence of air in the stomach prevented gastric flushing [22]. According to Mari [23], the presence of excessive air in the stomach is caused by various factors such as visceral hypersensitivity, behavior-induced abdominal wall phrenic reflex, effects of poorly fermented carbohydrates, and changes in the microbiome. According to Sherwood [24], the abdominal muscles contract during expiration. They press the diaphragm upward to the narrow chest cavity. Organs in the abdomen, including the stomach, can be compressed when the abdominal muscles contract. If excessive gas is present in the stomach and a gastric tube is attached, the air in the gastric tube can move outward through the tube during expiration. This causes the movement of air in and out of the gastric tube, similar to inspiration and expiration.

Observations during the study showed that the SNGT airbag remained static when the tip of the tube was in the esophageal tract before reaching the gastric marker boundary (xiphoid process). This occurred in both the SNGT 50% TV and SNGT 100% TV treatment groups. On the basis of these findings, the procedure for inserting the SNG tube must be adjusted. The esophagus can be a substitute for marking the position of the tube in the ideal digestive tract. The organ has a lower sphincter that prevents the entry of air and fluids from the stomach. When the end of the tube is in this channel, the air in the stomach will not interfere with the movement of the SNGT airbag. Thus, the middle part of the manubrium sterni can be used as a boundary marker for the second SNG tube instead of the xiphoid process, whereas the trachea and esophagus are just behind the manubrium sterni [25].

The results of this study did not show a significant difference in insertion accuracy between the SNGT 50% TV, SNGT 100% TV, and conventional NGT (p > 0.05). This is because all gastric tube insertions led to proper tube placement in the digestive tract on the first insertion attempt. All gastric tube insertions were performed by senior trained staff. Insertions performed by trained senior staff in accordance with the standard procedures can prevent improper gastric tube insertion. Chauhan et al. (2021) suggested the importance of safety checks and correct interpretation of chest radiographs by trained senior medical staff. Misplacement in the pulmonary tract can occur when the system designed by the hospital does not ensure that staff have received competency-based training and does not provide a documentation format that includes all patient safety checks [26]. According to Cao et al. (2020), the incidence rate of pulmonary complications caused by malpositioning of the NGT in the tracheobronchial tree branches ranges from 1.2% to 2.4%. These complications include perforation, pneumothorax, pneumonia, lung abscess, and even severe acute respiratory distress syndrome [27]. For this reason, methods to prevent incorrect tube insertion in the respiratory tract must be developed. The verification method used so far has limitations related to convenience and cost. For example, radiographic verification carries a risk of cancer due to repeated exposure. The use of endoscopes and sensors is expensive. The use of a laryngoscope is also not easy for all health workers to perform. Meanwhile, the SNGT can more simply and inexpensively detect tube insertion errors early before entry into the bronchi and lungs.

The spirometric measurements showed that the TVs of the Macaca fascicularis test animals were 52.8 and 50 ml. The two test animals were 4 years old and weighed 4–5 kg. The results of this study are slightly different from those of Iizuka et al. [28] that showed a TV range of 36–40 ml for 11 male Macaca fascicularis.

The results showed a significant difference between the two types of airbags with sizes of 50% and 100% of the TV (≤0.05). The movement of the airbag whose size was 50% of the TV appeared greater than that of the airbag whose size was 100% of the TV. However, the changes were small, namely an average of 3.5 mm for the SNGT 50% TV airbags and 2 mm for the SNGT 100% TV airbags. This is due to an open system in the upper respiratory tract. Air from the trachea will exit through the oral and nasal cavities. The monkey's oral cavity was not closed during the insertion process of the NGT and SNGT tubes. As a result, more air was released through the oral cavity because of its larger hole diameter than that of the nostrils.

The resistance of the line in the tube affects the flow of air into the airbag. The tube has a diameter of 0.2 cm and a length of 120 cm. The tube diameter is small enough to reduce the amount of air that can pass through it, following Poiseuille's law, which states that the smaller the radius of a channel, the greater its resistance [23]. In addition, the loss of space in the airbag that is deflated during insertion will also affect its movement. Air that fills the tube will enter and fill the previously unfilled airbag. According to Ivanov (2015), the loss of air in the equipment can interfere with the amount of gas exchange that is expected to occur. Even a loss of space that is too large can match the TV [29]. Thus, the SNGT requires an airbag with a volume smaller than the TV to allow for easier observation of airbag movement.

The results of two pH paper tests showed a pH value of 7, which contradicts the general view that the pH of the stomach is <7. According to Hatton et al. [30], the gastric pH of primates ranges from 2 to 6. The results of this study are consistent with those of a study by Fan et al. (2017) that evaluated the effectiveness of pH 6, pepsin 100 g/ml, and trypsin 30 g/ml in fluid aspirated from a gastric tube as criteria for proper tube placement. These three indicators correctly classified all cases of misplacement in the respiratory tract and 93.4% of cases of misplacement in the digestive tract. Although this method seems promising, laboratory testing is needed to evaluate these biochemical markers. According to Metheny et al. (2017), the gastric proteolytic enzyme pepsin is a potential marker for examining tube position in the digestive tract. In a study of gastric aspiration in 32 critically ill infants, investigators used Western blot immunoassay with a sensitivity of 1 g/ml for a mean (SD) pepsin concentration of 111.9 (36.8) g/ml [31].

The SNGT had high effectiveness in detecting the tube position inside the respiratory or digestive tract. An airbag with a size of 50% of the TV has better movement than that with a size of 100% of the TV. This is because of the loss of air space along the tube, which reduces the amount of air entering the tube. Therefore, the size of the air pocket volume must be modified, and the marking procedure in the middle of the manubrium sterni as a second marker should be determined. In addition, we found no significant difference in insertion accuracy between the SNGT and the conventional NGT. The final verification examination of the tube position also showed that the pepsin assay was more effective than the pH paper.

CO₂Carbon dioxide

NGT Nasogastric tube

NPSA National Patient Safety Agency

SNGT 100% TV SNGT with an airbag size of 100% of TV

SNGT 50% TV SNGT with an airbag size of 50% of tidal volume

SNGT Safety nasogastric tube

Ethical Approval

This research has received ethical approval from the research center at the Center for Primate Animal Studies, Bogor Agricultural University (PSSP IPB) with the document number: 6860/IT3.L1.9/HM/2021.

Consent for publication

Not applicable.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding

The research received funding from Hibah PUTI Q2 2020 of Universitas Indonesia. The contract number of funding is NKB-4182/UN2.RST/ HKP.05.00/2020.

Authors' contributions

Conceptualization, funding acquisition, formal analysis, resources, supervision, validation, writing-review and editing: Neng Tine Kartinah. Conceptualization, writing-original draft, investigation, methodology, and data curation: Sigit Mohammad Nuzul. Formal analysis, resource, and writing-review and editing: Busjra M. Nur. Funding acquisition, data curation, writing-review and editing: Ermita Isfandiary Ibrahim.

Acknowledgements

The research leading to this publication was supported by Universitas Indonesia which is gratefully acknowledged.

Phillips NM. Nasogastric Tubes: An Historical Context. Mdsrg Nrs. 2006; 04;15(2):84-88.
Walldorf J, Michl P, Krug S. The nasogastric tube is stuck - and causes coughing and dyspnoea: A rare complication. Int Crit Care Nurs. 2019:102786.
Lim JY, Yong E, Aneez DBA, Tham CH. A simple procedure gone wrong: pneumothorax after inadvertent transbronchial nasogastric tube insertion necessitating operative management. J Surg Case Rep. 2019;2019(6):rjz186.
Smith KA, Fleming JP, Bennett RD, Taitano AA. A case of fatal internal jugular vein perforation during nasogastric tube insertion. J Surg Case Rep. 2017;2017(7):rjx128.
Rassias AJ, Ball PA, Corwin HL. A prospective study of tracheopulmonary complications associated with the placement of narrow-bore enteral feeding tubes. Crit Care. 1998;2(1):25-28.
Lo JO, Wu V, Reh D, Nadig S, Wax MK. Diagnosis and Management of a Misplaced Nasogastric Tube Into the Pulmonary Pleura. Arc of Otlary–Hd & Nck Surg. 2008;134(5):547-550.
de Aguilar-Nascimento JE, Kudsk KA. Clinical Costs of Feeding Tube Placement. J of Par and Ent Nut. 2007;31(4):269-273.
NHS. NHS England Patient Safety Alert: Stage 1 - Placement devices for nasogastric tube placement DO NOT replace initial placement checks. England: National Health Service; 2013; 12. p. 1.
NHS. NHS England Patient Safety Alert: Stage 2 - Nasogastric tube misplacement: continuing risk of death and severe harm. England: National Health Service; 2016; 07. p. 1.
Sparks DA, Chase DM, Coughlin LM, Perry E. Pulmonary complications of 9931 narrow-bore nasoenteric tubes during blind placement: a critical review. JPEN J Parenter Enteral Nutr. 2011;35(5):625-629.
Boeykens K, Steeman E, Duysburgh I. Reliability of pH measurement and the auscultatory method to confirm the position of a nasogastric tube. Int J of Nurs Std. 2014;51(11):1427-1433.
Lemyze M. The placement of nasogastric tubes. CMAJ. 2010;182(8):802-802.
Fan EMP, Tan SB, Ang SY. Nasogastric tube placement confirmation: where we are and where we should be heading. Proc of Sing Hlthcr. 2017;26(3):189-195.
Irving SY, Rempel G, Lyman B, Sevilla WMA, Northington L, Guenter P, et al. Pediatric Nasogastric Tube Placement and Verification: Best Practice Recommendations From the NOVEL Project. Nutr Clin Pract. 2018;33(6):921-927.
Nanjegowda N, Umakanth S, Undrakonda V. Laryngospasm during extubation. Can nasogastric tube be the culprit? BMJ Case Rep. 2013;2013.
Nuzul SM, inventor; Universitas Indonesia, assignee. Selang Nasogastrik Yang Mempunyai Kantung Udara dan Metode Pemasangannya. Indonesia patent IDP000058746. 2019 Februari.
Miller LA, Royer CM, Pinkerton KE, Schelegle ES. Nonhuman Primate Models of Respiratory Disease: Past, Present, and Future. ILAR Journal. 2017;58(2):269-280.
Boeykens K, Steeman E, Duysburgh I. Reliability of pH measurement and the auscultatory method to confirm the position of a nasogastric tube. Int J Nurs Stud. 2014;51(11):1427-1433.
Fan EMP, Tan SB, Ang SY. Nasogastric tube placement confirmation: where we are and where we should be heading. Proceedings of Singapore Healthcare. 2017;26(3):189-195.
Chau JP, Lo SH, Thompson DR, Fernandez R, Griffiths R. Use of end-tidal carbon dioxide detection to determine correct placement of nasogastric tube: a meta-analysis. Int J Nurs Stud. 2011;48(4):513-521.
Miller S. Capnometry vs pH testing in nasogastric tube placement. Gastrointestinal Nursing. 2011;9:30-33.
Bani Hani M, Ihim I, Harps J, Cunningham SC. A breath of fresh air: a quality-improvement study comparing an air-circulating technique versus conventional technique to prevent nasogastric tube dysfunction. BMC Nurs. 2015;14:63-63.
Mari A, Abu Backer F, Mahamid M, Amara H, Carter D, Boltin D, et al. Bloating and Abdominal Distension: Clinical Approach and Management. Adv Ther. 2019;36(5):1075-1084.
Sherwood L. Human Physiology: From Cells to Systems: Cengage Learning; 2015.
Tortora GJ, Derrickson BH. Principles of Anatomy and Physiology, 13th Edition: Wiley; 2010.
Chauhan D, Varma S, Dani M, Fertleman MB, Koizia LJ. Nasogastric Tube Feeding in Older Patients: A Review of Current Practice and Challenges Faced. Curr Gerontol Geriatr Res. 2021;2021:6650675-6650675.
Cao W, Wang Q, Yu K. Malposition of a nasogastric feeding tube into the right pleural space of a poststroke patient. Rad Cse Rpt. 2020;15(10):1988-1991.
Iizuka H, Sasaki K, Odagiri N, Obo M, Imaizumi M, Atai H. Measurement of respiratory function using whole-body plethysmography in unanesthetized and unrestrained nonhuman primates. J Toxicol Sci. 2010;35(6):863-870.
Ivanov VA. Reduction of Endotracheal Tube Connector Dead Space Improves Ventilation: A Bench Test on a Model Lung Simulating an Extremely Low Birth Weight Neonate. Respir Care. 2016;61(2):155-161.
Hatton GB, Yadav V, Basit AW, Merchant HA. Animal Farm: Considerations in Animal Gastrointestinal Physiology and Relevance to Drug Delivery in Humans. J Pharm Sci. 2015;104(9):2747-2776.
Metheny NA, Pawluszka A, Lulic M, Hinyard LJ, Meert KL. Testing Placement of Gastric Feeding Tubes in Infants. Am J Crit Care. 2017;26(6):466-473.

No competing interests reported.

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Preclinical Trial of the Effectiveness of the Safety Nasogastric Tube to Detecting Tube Position Based on Tidal Volume and Pepsin Assay Results in the Gastrointestinal Tract of Macaca Fascicularis

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