Abstract
Background
Misplacements of endotracheal and nasogastric tubes are frequent encounters in critically
ill patients.
Objectives
The purpose of this study was to assess the effectiveness of a single standardised
training session on the ability of intensive care registered nurses (RNs) to recognise
the misplacement of endotracheal and nasogastric tubes on bedside chest radiographs
of patients in intensive care units (ICUs).
Methods
In eight French ICUs, RNs received a 110-min standardised teaching on the position
of endotracheal and nasogastric tubes on chest radiographs. Their knowledge was evaluated
within the subsequent weeks. For 20 chest radiographs, each with an endotracheal and
nasogastric tube, RNs had to indicate whether each tube was in the proper or incorrect
position. Training success was defined as >90% for the lower bound of the 95% confidence
interval (95% CI) of the mean correct response rate (CRR). Residents of the participating
ICUs underwent the same evaluation (without prior specific training).
Results
In total, 181 RNs were trained and evaluated and 110 residents were evaluated. The
global mean CRR for RNs was 84.6% (95% CI: 83.3–85.9), significantly higher than for
residents (81.4% [95% CI: 79.7–83.2]) (P < 0.0001). The mean CRR for RNs and residents
was 95.9% (93.9–98.0) and 97.0% (94.7–99.3) for misplaced nasogastric tubes (P = 0.54),
86.8% (85.2–88.5) and 82.6% (79.4–85.7) (P = 0.07) for nasogastric tubes in the correct
position, 86.6% (83.8–89.3) and 62.7% (57.9–67.5) for misplaced endotracheal tubes
(P < 0.0001), and 79.1% (76.6–81.6) and 84.7% (82.1–87.2) for endotracheal tubes in
the correct position (P = 0.01), respectively.
Conclusions
The ability of trained RNs to detect tube misplacement did not reach the predetermined
arbitrary level, indicating training success. Their mean CRR was higher than that
for residents and was considered satisfactory for detecting misplaced nasogastric
tubes. This finding is encouraging but insufficient to ensure patient safety. Transferring
responsibility for reading radiographs to detect the misplacement of endotracheal
tubes to intensive care RNs will need a more advanced or more in-depth teaching method.
Keywords
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Article info
Publication history
Published online: March 03, 2023
Accepted:
January 10,
2023
Received in revised form:
September 23,
2022
Received:
April 18,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
