Nasogastric Tube Insertion Using Midazolam in the Emergency Department
Status: | Completed |
---|---|
Conditions: | Hospital |
Therapuetic Areas: | Other |
Healthy: | No |
Age Range: | 18 - Any |
Updated: | 10/14/2017 |
Start Date: | May 2011 |
End Date: | April 2013 |
Nasogastric tube placement involves insertion of a flexible tube through the nose into the
stomach. Placement of the tube can irritate the nose and palate and trigger gagging, causing
discomfort, even if topical or local anesthetics are used. This study aims to determine if
administration of an ultra-short acting sedative agent (midazolam) into a vein before the
procedure, in addition to topical local anesthetic, will decrease the level of discomfort.
stomach. Placement of the tube can irritate the nose and palate and trigger gagging, causing
discomfort, even if topical or local anesthetics are used. This study aims to determine if
administration of an ultra-short acting sedative agent (midazolam) into a vein before the
procedure, in addition to topical local anesthetic, will decrease the level of discomfort.
Our overall objective is to improve patient satisfaction with nasogastric (NG) tube placement
(placement of a flexible tube through the nose into the stomach) in the emergency department.
Placement of an NG tube into the stomach is often performed in the emergency department (ED)
setting to evacuate air, blood, or other contents. Generally performed by nursing staff at
the bedside in the emergency department, the procedure may produce significant pain and
discomfort for the patient despite typical measures including local medications to constrict
and numb the nasal mucosa. In one questionnaire of emergency department patients at a large
university hospital, placement of an NG tube was reported to be the most painful procedure,
ahead of fracture reduction, abscess drainage, and urethral catheterization (Singer et al.
1999). The typical medication used for placement of an NG tube placement is administration of
local, topical medications; the use of intravenous drugs to improve patient tolerance of the
procedure varies widely in clinical practice (Juhl and Conners 2005). Midazolam (Versed) is
an FDA-approved agent for procedural sedation, which has been used frequently at this
institution for the placement of NG tubes in the emergency department. In our experience, it
facilitates placement by relaxing muscles, thereby decreasing gag, and its anxiolytic and
amnestic properties improve patient satisfaction. However, there are no published studies of
midazolam for NG tube placement in the ED or any other setting.
The investigators will perform a randomized controlled trial to determine if a single 2mg
unit midazolam dose administered intravenously decreases discomfort for patients undergoing
nasogastric tube placement in the emergency department. Adult emergency department patients
who require NG tubes will be screened and following informed consent they will be randomly
assigned to receive either midazolam or saline control. Medications are provided by pharmacy.
Registered nurses will perform the placement and administer medications; researcher, nurse
and subject will be blinded to the treatment arm. Following the procedure, subjects will be
asked to assess their level of discomfort and complete a brief researcher-assisted
questionnaire about their experience. The nurse will also complete a questionnaire that
addresses the difficulty of the procedure, level of success, and occurrence of unanticipated
problems or adverse events. This study may provide support for a clinical practice to improve
care for patients requiring NG tube placement in the ED.
(placement of a flexible tube through the nose into the stomach) in the emergency department.
Placement of an NG tube into the stomach is often performed in the emergency department (ED)
setting to evacuate air, blood, or other contents. Generally performed by nursing staff at
the bedside in the emergency department, the procedure may produce significant pain and
discomfort for the patient despite typical measures including local medications to constrict
and numb the nasal mucosa. In one questionnaire of emergency department patients at a large
university hospital, placement of an NG tube was reported to be the most painful procedure,
ahead of fracture reduction, abscess drainage, and urethral catheterization (Singer et al.
1999). The typical medication used for placement of an NG tube placement is administration of
local, topical medications; the use of intravenous drugs to improve patient tolerance of the
procedure varies widely in clinical practice (Juhl and Conners 2005). Midazolam (Versed) is
an FDA-approved agent for procedural sedation, which has been used frequently at this
institution for the placement of NG tubes in the emergency department. In our experience, it
facilitates placement by relaxing muscles, thereby decreasing gag, and its anxiolytic and
amnestic properties improve patient satisfaction. However, there are no published studies of
midazolam for NG tube placement in the ED or any other setting.
The investigators will perform a randomized controlled trial to determine if a single 2mg
unit midazolam dose administered intravenously decreases discomfort for patients undergoing
nasogastric tube placement in the emergency department. Adult emergency department patients
who require NG tubes will be screened and following informed consent they will be randomly
assigned to receive either midazolam or saline control. Medications are provided by pharmacy.
Registered nurses will perform the placement and administer medications; researcher, nurse
and subject will be blinded to the treatment arm. Following the procedure, subjects will be
asked to assess their level of discomfort and complete a brief researcher-assisted
questionnaire about their experience. The nurse will also complete a questionnaire that
addresses the difficulty of the procedure, level of success, and occurrence of unanticipated
problems or adverse events. This study may provide support for a clinical practice to improve
care for patients requiring NG tube placement in the ED.
Inclusion Criteria:
- at least 18 years old
- Receiving a nasogastric tube by a registered nurse at Fletcher Allen Health Care
Exclusion Criteria:
- less than 18 years old
- weight < 40 kg
- Need immediate nasogastric tube placement
- Endotracheal intubation
- Hemodynamically unstable
- Non-English speaking
- Without capacity to provide informed consent
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