The effectiveness of the diazoxide test in the determination of tip-end position after blind Insertion of the nasoenteric tube by ICU nurses: A prospective comparative study

This study aimed to investigate the predictive value of the diazoxide test for determining the tip position of blindly inserted nasoenteric tubes in ICU bedridden patients, and to compare its diagnostic accuracy with other common bedside methods. This prospective comparative study was conducted in the ICU of a tertiary hospital, and a consecutive sample of 436 patients requiring blind nasoenteric tube insertion was enrolled from June 2021 to January 2022. The tip position was pre-determined using the diazoxide test, the auscultation of water sound, the guidewire rebound test, the negative pressure test, judging the nature of the digestive fluid, and the pH test. The final confirmation was obtained through X-ray analysis. Diagnostic parameters, including accuracy, sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, Youden’s index, the Kappa coefficient, and the area under the receiver operating characteristic (ROC) curve (AUC), were calculated and compared. A total of 427 patients completed the diagnostic methods described above. The diazoxide test demonstrated the highest accuracy and Kappa coefficient, with values of 92.3% and 0.767, respectively. It also exhibited the most significant AUC of 0.879 (confidence interval: 0.829-0.929) and the highest Youden’s index of 0.757. The pH test determination method achieved the highest sensitivity and negative result rates, at 97.3% and 83.0%, respectively. The process for assessing the nature of digestive fluid yielded the highest values for specificity, positive predictive value, and favorable likelihood ratio, at 83.5%, 94.9%, and 5.030, respectively. The diazoxide test, as a predictive method, can effectively determine the success of nasoenteric tube placement and reduce patient pain.