Electromagnetic-guided nasogastric tube insertion by nurses: a multicenter non-inferiority study

BACKGROUND: Nasogastric tube feeding is essential for critically ill patients, yet blind insertion risks misplacement and related complications. Electromagnetic guidance enables real-time tracking, potentially enhancing safety and efficiency. This study aimed to compare the safety and effectiveness of nurse-led electromagnetic-guided nasogastric tube insertion with those of physician-performed blind insertion in critically ill patients. METHODS: This multicenter prospective non-inferiority trial was conducted in seven Japanese ICUs (July 2023-February 2025). Physicians performed blind insertions in the initial phase, followed by nurse training and electromagnetic-guided insertions using the CORTRAK system. The primary outcome was successful gastric placement without special techniques. Secondary outcomes included insertion time, attempts, complications, and tube position. RESULTS: A total of 283 patients were analyzed (141 electromagnetic-guided, 142 blind). Success rates were similar (63.1% vs 65.5%; difference -2.4%, 95% CI -13.5 to 8.8), confirming non-inferiority (Farrington-Manning P=0.001). Electromagnetic-guided insertions required fewer reinsertions (median 0 vs 1; P=0.049) and less time (3.3 vs 4.5 min; P=0.03) in unadjusted analyses. No tracheobronchial misplacements occurred (blind: 1.4%). Complication rates were low and comparable. CONCLUSION: Nurse-led electromagnetic-guided nasogastric tube insertion appears to be a safe, effective alternative to physician blind insertion, with comparable success and potential efficiency advantages.