Korean J Adult Nurs.  2022 Apr;34(2):158-167. 10.7475/kjan.2022.34.2.158.

Risk Factors associated with Unplanned Removal of Nasogastric Tubes in Neurocritical Patients

• Kang J
• Yoo YS

• KMID: 2529693
• DOI: http://doi.org/10.7475/kjan.2022.34.2.158

Abstract

Purpose
The purpose of this study was to identify the incidence and risk factors associated with the unplanned removal of nasogastric (NG) tubes in neurocritical patients.
Methods
Data were collected retrospectively from the medical records of 479 patients admitted to the tertiary hospital's neuro-intensive care units (NCU). Subjects were divided into two groups depending on whether there was unplanned NG tube removal. Multivariate logistic regression analysis was used to identify risk factors.
Results
Unplanned removal of NG tubes occurred in 35.9% of patients. The incidence of unplanned NG tube removal was 47.2 per 1,000 patient days. Intubated time of the NG tube was 3.96 days in patients with unplanned removal. Risk factors associated with unplanned removal were men (Odds Ratio [OR]=2.19), epilepsy (OR=9.99), traumatic brain injury (OR=5.50), stroke (OR=4.42), improvement of Glasgow Coma Scale (GCS) (OR=1.08), delirium (OR=1.88), physical restraint (OR=2.44), and drainage or decompression purpose (OR=1.67).
Conclusion
Unplanned removal of NG tubes occurred very frequently in neurocritical patients. Care should be taken for patients with neurological diseases who show improvement in their level of consciousness but are still confused due to brain lesions or delirium to reduce it. The application of physical restraints cannot guarantee the prevention of unplanned NG tube removal. Therefore, nurses need to assess the condition of patients and NG tubes frequently.In particular, more attention should be paid to using NG tubes for decompression or drainage purposes. It is also proposed to actively review the NG tube removal plan through periodic evaluation.

Keyword

Enteral nutrition; Device removal; Nervous system diseases; Intensive care units; Survival analysis