Tying a slipknot to an intubation stylet for facilitating insertion of a nasogastric tube in liver transplant recipients: A prospective, randomized study

Background: It is sometimes difficult and harmful to insert a nasogastric tube (NGT) into a patient with a tendency to bleed and anesthetized recipient of liver transplantation. As a "Rusch" intubation stylet tied by a slipknot, Highwayman's hitch, to the NGT, it is easy to introduce the NGT through nasal cavity and oropharyngeal space. We designed this study to evaluate the usage of this novel method in the guidance of NGT insertion in liver transplant recipients. Methods: Eighty recipients were randomly allocated to both groups. In the control group (group C), the NGT was inserted with the patient's head in neutral position. In the stylet group (group S), the NGT was inserted with the assistance of a Rusch intubation stylet tied together at the tips. The success rates, duration of insertions, and occurrences of complications were recorded. All of the failed cases in group C and the rescue success rate with the new technique were also evaluated. Results: Successful insertions were recorded in 38/40 patients (95%) in group S and in 27/40 patients (67.5%) in group C, and the difference was statistically significant. The incidences of kinked NGT were 17.5% in group C and 2.5% in group S, respectively, and the difference was statistically significant. The rates of nasal mucosal bleeding were 22.5% in group C and 25% in group S. The rescue success rate of 13 failure cases in the group C was 84.6%. Conclusion: The intubation stylet-guided method is reliable, with high success rate of NGT insertion in patients with a tendency to bleed anesthetized recipients of liver transplantation.