Learning curve of nurse‐performed electromagnetic‐guided nasogastric tube placement in adult ICU patients: A multicenter prospective study

Abstract Background Safe and timely nasogastric tube (NGT) placement is essential for effective enteral nutrition delivery in critically ill patients. Electromagnetic‐guided systems has been shown to improve placement accuracy and may reduce delays from confirmatory imaging, but evidence on how nurses acquire competence with this technology remains limited. Methods This pre‐specified subgroup analysis used data from the nurse‐performed electromagnetic‐guided arm of a previously published multicenter prospective non‐inferiority study conducted across seven ICUs. A total of 23 ICU nurses without prior experience performed 197 tube‐placement episodes following simulator training and four supervised cases. Target‐range placement was defined as tube tip positioning 3–10 cm below the esophagogastric junction, confirmed by electromagnetic guidance and radiography. Segmented regression was used to explore the learning curve. Results A potential change point was suggested at Case 2.3 (95% CI: 2.0–2.3), indicating a trend toward early improvement following supervised practice, although this did not reach statistical significance ( P = 0.068). Target‐range placement rates improved progressively, rising from 57.1% during the supervised phase (Cases 1–4) to 64.6% and 69.2% in the independent‐practice phase (Cases 5–7 and 8–15, respectively). Gastric placement was achieved in 99.5% of cases, with no serious complications. Conclusion To our knowledge, this exploratory multicenter study provides the first quantitative characterization of a potential learning curve for nurse‐performed electromagnetic‐guided NGT placement. Structured training incorporating supervised practice may support early performance improvement and facilitate timely initiation of enteral nutrition in critical care settings.