title: Potential risk of malposition of nasogastric tube using nose-ear-xiphoid measurement.
abstract: BACKGROUND
  Correct placement of nasogastric tubes provide proper functionality and maximize benefit and minimize risk. The Nose-Ear-Xiphoid (NEX) body surface estimate method is a long-lasting technique, and this study was conducted to evaluate the correlation between NEX method and the secure insertion depth of nasogastric tube.
  
  
  METHODS
  Thirty patients with nasogastric tube insertion who received whole body positron emission tomography with computerized tomography scan (PET-CT) were recruited. All data were gathered in the image center, which included Nose-Ear (NE), Ear-Xiphoid (EX), Nose-Ear-Xiphoid (NEX), glabella-xiphoid (GX) and glabella-umbilicus (GU) lengths. The distances of the inserted portion of the nasogastric tube between the cardiac and the nostril were measured by multiplanar reconstruction algorithm.
  
  
  RESULTS
  Only one patient successfully placed all side-holes into the stomach while using NEX method to estimate inserting depth. Twenty-nine patients (96.7%) failed to place correctly. Fourteen participants had one or more side-holes in both the esophagus and the stomach sides. Fifteen patients could not pass through any side-hole across the gastroesophageal junction. They had shorter EX distances (p = 0.02), but no difference among the NE distances. Body height had the highest statistical correlation with nasogastric tube length (adjusted R(2) = 0.459), as compared with the NEX, GX and GU body surface methods.
  
  
  CONCLUSIONS
  This study suggests that NEX method is inappropriate for adult patients to estimate the ideal inserting length of nasogastric tube. Physicians should realize these underinsertions with any side-hole above the gastroesophageal junctions may increase the potential risk of complications.
authors: Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, Changhua, Taiwan.
authors: Yen-Chun
authors: YC
authors: Chen
authors: Department of Nuclear Medicine, Changhua Christian Hospital, Changhua, Taiwan.
authors: Lien-Yen
authors: LY
authors: Wang
authors: Laboratory of Epidemiology and Biostatistics, Changhua Christian Hospital, Changhua, Taiwan.
authors: Yu-Jun
authors: YJ
authors: Chang
authors: Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, Changhua, Taiwan.
authors: Chao-Pin
authors: CP
authors: Yang
authors: Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, Changhua, Taiwan.
authors: Tsung-Ju
authors: TJ
authors: Wu
authors: Department of Nuclear Medicine, Changhua Christian Hospital, Changhua, Taiwan.
authors: Fung-Ru
authors: FR
authors: Lin
authors: Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, Changhua, Taiwan ; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
authors: Sen-Yung
authors: SY
authors: Liu
authors: Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, Changhua, Taiwan.
authors: Ta-Sen
authors: TS
authors: Wei
mesh_terms: D000328:Adult; D000368:Aged; D004423:Ear / Q000033:anatomy & histology*; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000009:adverse effects*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000033:anatomy & histology*; D012307:Risk Factors; D014989:Xiphoid Bone / Q000033:anatomy & histology*