Mónica Francisca Santana Apablaza

Objectives: This scoping review synthesized the available evidence on bedside ultrasonography used to confirm short-term nasogastric tube (NGT) placement in adults. Methods: The review followed JBI Collaboration methodology. Searches were conducted in CINAHL, Embase, LILACS, PubMed, and Scopus, as well as in gray literature sources (Google Scholar and ProQuest Dissertation & Thesis Global). Primary studies and clinical guidelines addressing bedside ultrasonography for short-term NGT placement in adults (≥18 years) were eligible, with no limits on language or publication year. Data were extracted and narratively summarized with the I-AIM framework (Indication, Acquisition, Interpretation, and Decision-Making). Results: Twenty-nine studies met the inclusion criteria. Most were single-center observational studies performed in intensive care units or emergency departments. Ultrasound was primarily used for confirmation prior to enteral nutrition initiation, while gastric decompression was less frequently reported. Acquisition protocols varied, although supine positioning, convex abdominal probes, and linear cervical probes were most commonly described. The gastric antrum and esophagus were the principal anatomical landmarks, with interpretation based on direct tube visualization and dynamic fogging; color Doppler was occasionally used. Radiography remained the reference standard in most studies, and only a minority initiated feeding based solely on ultrasound findings. Reported facilitators included bedside feasibility, absence of radiation exposure, and timeliness. Barriers included operator dependency, limited visualization in patients with obesity or gas interposition, protocol heterogeneity, and the limited methodological robustness of available studies. Conclusions: Current evidence suggests that ultrasonography may represent a feasible, radiation-free bedside approach for confirmation of NGT placement. Evidence from selected studies suggests that, with structured training, healthcare professionals may achieve diagnostic accuracy in specific clinical settings, although further robust multicenter investigations are needed to confirm these findings.

Objectives: This narrative review aimed to synthesize available evidence on procedures used for bedside ultrasonography-guided verification of nasogastric tube (NGT) placement. Methods: A comprehensive search was conducted in five databases, supplemented by gray literature and clinical guidelines, without restrictions on language or publication year. Eligible studies focused on ultrasound-guided NGT insertion or verification in adults. Data were extracted and synthesized descriptively using the I-AIM framework (Indication, Acquisition, Interpretation, and decision-Making). Results: 29 studies were included, most of them observational and conducted in intensive care or emergency settings. Ultrasound was primarily indicated for enteral nutrition, with gastric decompression less frequently reported. Acquisition protocols varied, though supine positioning, convex abdominal probes, and linear cervical probes were most common. The gastric antrum and esophagus were the main landmarks, with interpretation based on direct tube visualization and dynamic fogging; color Doppler was occasionally employed. Radiography remained the reference standard in over 90% of studies, though a few initiated feeding based on ultrasound alone. Facilitators included bedside feasibility, absence of radiation, and timeliness, whereas barriers encompassed operator dependency, limited visualization in patients with obesity or gas interposition, and heterogeneity of protocols. Conclusions: Ultrasonography is a promising, safe, and innovative method for NGT verification that can reduce delays, avoid radiation exposure, and improve patient safety. With structured training, nurses can achieve accuracy comparable to physicians, supporting greater autonomy in clinical decision-making. Standardized protocols and integration into nursing education are essential to ensure reliable and widespread adoption.

RESUMO Objetivos: relatar a experiência da introdução da técnica de acesso venoso difícil guiado por ultrassom usando point-of-care ultrasound em disciplina de graduação em enfermagem. Métodos: estudo descritivo, do tipo relato de experiência, realizado com estudantes de enfermagem do 5º período. A disciplina utilizou plataforma Moodle, aula interativa com recursos audiovisuais e quizzes, e laboratório hands-on com simulador virtual, fantoma e simulador físico de acesso venoso. Docentes receberam treinamento específico em point-of-care ultrasound. Resultados: observaram-se organização e integração entre teoria e prática, com materiais disponíveis no Moodle, atividades práticas alinhadas ao conteúdo teórico e feedback individualizado. Alunos relataram satisfação, aprendizado significativo e maior confiança na aplicação da técnica. Conclusões: a inclusão do point-of-care ultrasound no currículo de enfermagem se mostrou eficaz, preparando os estudantes para cenários clínicos complexos com maior segurança. A experiência demonstra a importância da inserção de tecnologias como a point-of-care ultrasound na formação de enfermeiros.

Objectives: to report the experience of introducing ultrasound-guided difficult venous access using point-of-care ultrasound in an undergraduate nursing course.

Recentemente, mais um caso de dano grave associado ao cuidado em saúde foi reportado pela mídia. Uma jovem grávida teve a mão e o punho amputados depois de dar à luz ao terceiro filho em um hospital do Rio de Janeiro(¹ 1 Nestlehner C, Koga G. Mulher tem a mão amputada após parto[Internet]. CNN Brasil. 2023 [cited 2023 Nov]. Available from: https://www.cnnbrasil.com.br/nacional/mulher-tem-a-mao-amputada-apos-parto/ https://www.cnnbrasil.com.br/nacional/mu... ). Após o incidente ocasionado pelo acesso vascular, a mulher apresentou hemorragia e foi reinternada.

Recientemente, los medios de comunicación informaron sobre otro caso de daños graves relacionados con la atención sanitaria. A una joven embarazada le amputaron la mano y la muñeca después de dar a luz a su tercer hijo en un hospital de Río de Janeiro(¹ 1 Nestlehner C, Koga G. Mulher tem a mão amputada após parto[Internet]. CNN Brasil. 2023 [cited 2023 Nov]. Available from: https://www.cnnbrasil.com.br/nacional/mulher-tem-a-mao-amputada-apos-parto/ https://www.cnnbrasil.com.br/nacional/mu... ). Tras el incidente provocado por el acceso vascular, la mujer sufrió una hemorragia y fue reingresada.

Recently, another case of serious harm associated with healthcare was reported by the media. A young pregnant woman had her hand and wrist amputated after giving birth to her third child in a hospital in Rio de Janeiro(¹ 1 Nestlehner C, Koga G. Mulher tem a mão amputada após parto[Internet]. CNN Brasil. 2023 [cited 2023 Nov]. Available from: https://www.cnnbrasil.com.br/nacional/mulher-tem-a-mao-amputada-apos-parto/ https://www.cnnbrasil.com.br/nacional/mu... ). After the incident caused by vascular access, the woman suffered hemorrhage and was readmitted.