Nursing Care Guidelines for Nasogastric Tube-Related Hospital-Acquired Pressure Injuries: A Quasi-Experimental Pilot Study
DOI:
https://doi.org/10.31674/mjn.2026.v17i05.002Abstract
Background: Medical Device–Related Pressure Injuries (MDRPI), including Nasogastric Tube-Related Hospital-Acquired Pressure Injuries (NGT-HAPI), represents a preventable yet frequently overlooked complication in critically ill patients. Appropriate placement, securement, and ongoing monitoring of Nasogastric Tubes (NGT) are essential to minimize associated risks. Objectives: The primary objective is to examine the preliminary effects of implementing nursing care guidelines on the incidence of NGT-HAPI and selected patient outcomes. Methods: A quasi-experimental, non-randomized pilot study was conducted in the intensive care units of Assiut University Hospital, Egypt. A purposive sample of 60 adult patients was allocated into intervention and control groups based on bed availability and clinical flow. Data collection proceeded through three tools: baseline patient assessment, NGT assessment and monitoring, and evaluation of NGT-related pressure injury incidence. Results: There is a statistically significant difference (p-value 0.001) between the study group's 90% of patients who have no stage of NGT-HAPI and the control group's 66.6% who have first-degree and 26.7% who have second-degree NGT-HAPI, and about a quarter (26.7%) in the control group have skin breakdown with a statistically significant difference (p-value 0.004*). Conclusion: Implementation of structured nursing care guidelines was associated with a lower incidence of NGT-HAPI. While findings indicate a positive effect, causal interpretations should be made cautiously due to the quasi-experimental design.
Keywords:
Nasogastric Tubes; , Nursing Care;, Nursing Guidelines;, Patient Outcome; , Pressure InjuryDownloads
References
Abdelghafour, A., Mohammed, M., & Mahran, G. (2025). Complications during intrahospital transport of critically ill patients and its related risk factors. Assiut Scientific Nursing Journal. https://www.semanticscholar.org/paper/Complications-during-intrahospital-transport-of-ill-Abdelghafour-Mohammed/a5a3f5808026c60df5321cb45092afe57a73effe
Ail, M. M., Mahday, N. E., & Khalifa, A.M. (2024). Factors associated with nasogastric tube feeding complications among patients with Cerebro-Vascular Stroke. Egyptian Journal of Health Care, 15(2), 717-734. https://doi.org/10.21608/ejhc.2024.356429
Alshahrani, B., Middleton, R., Rolls, K., & Sim, J. (2024). Pressure injury prevalence in critical care settings: an observational pre‐post intervention study. Nursing Open, 11(2), e2110. https://doi.org/10.1002/nop2.2110
Asti, E., Sironi, A., Milito, P., Bonavina, G., Bonitta, G., & Bonavina, L. (2017). Prevalence and risk factors of nasal pressure ulcers related to nasogastric intubation: an observational study. European Surgery, 49(4), 171-174. https://doi.org/10.1007/s10353-017-0476-y
Chauhan, D., Varma, S., Dani, M., Fertleman, M. B., & Koizia, L. J. (2021). Nasogastric tube feeding in older patients: a review of current practice and challenges faced. Current Gerontology and Geriatrics Research, 2021(1), 6650675. https://doi.org/10.1155/2021/6650675
Coyer, F., Cook, J. L., Brown, W., Vann, A., & Doubrovsky, A. (2020). Securement to prevent device‐related pressure injuries in the intensive care unit: a randomised controlled feasibility study. International Wound Journal, 17(6), 1566-1577. https://doi.org/10.1111/iwj.13432
Dirgar, E., Gider, N. Y., & Tosun, B. (2024). Determination of incidence and risk factors of medical device-related pressure injury in the ICU: a Descriptive Study. Advances in Skin & Wound Care, 37(3), 1-6. https://doi.org/10.1097/ASW.0000000000000113
Duerksen, J. M., Ramjiawan, B., & Duerksen, D. R. (2025). Long‐term enteral nutrition with a nasogastric tube can be safe and effective: A case report. Nutrition in Clinical Practice, 40(2), 492-495. https://doi.org/10.1002/ncp.11263
Fayed, M., Patel, N., Angappan, S., Nowak, K., Torres, F. V., Penning, D. H., & Chhina, A. K. (2022). Sequential organ failure assessment (SOFA) score and mortality prediction in patients with severe respiratory distress secondary to COVID-19. Cureus, 14(7). https://doi.org/10.7759/cureus.26911
Flæten, Ø. Ø., Stafseth, S. K., Vinje, H., Johansen, E., Sunde, K., Wøien, H., ... & Petosic, A. (2024). Incidence, characteristics, and associated factors of pressure injuries acquired in intensive care units over a 12-month period: A secondary analysis of a quality improvement project. Intensive and Critical Care Nursing, 81, 103587. https://doi.org/10.1016/j.iccn.2023.103587
Galetto, S. G. D. S., do Nascimento, E. R. P., Hermida, P. M. V., Busanello, J., de Malfussi, L. B. H., & Lazzari, D. D. (2021). Medical device-related pressure injuries in critical patients: prevalence and associated factors. Revista da Escola de Enfermagem da USP, 55, e20200397. https://doi.org/10.1590/1980-220X-REEUSP-2020-0397
Gruyters, I., De Ridder, T., Bruckers, L., Geebelen, L., Gharmaoui, S., Callebaut, I., Vandenbrande, J., Berends, N., Dubois, J., & Stessel, B. (2022). Predictive value of serial evaluation of the Sequential Organ Failure Assessment (SOFA) score for intensive care unit mortality in critically ill patients with COVID-19: A retrospective cohort study. Anaesthesiology Intensive Therapy, 54(1), 3–11. https://doi.org/10.5114/ait.2022.114048
Hsu, C. Y., Lai, J. N., Kung, W. M., Hung, C. H., Yip, H. T., Chang, Y. C., & Wei, C. Y. (2022). Nationwide prevalence and outcomes of long-term nasogastric tube placement in adults. Nutrients, 14(9), 1748. https://doi.org/10.3390/nu14091748
Indraswari, A. D. W., Aisyiyah, U., Kurniawan, K., & Surboyo, M. D. C. (2024). Prediction pressure ulcers in high care unit patients: Evaluating risk factors and predictive scale using a prospective cross-sectional study. Avicenna Journal of Medicine, 14(01), 39-044. https://doi.org/10.1055/s-0043-1777420
Juneja, D., Nasa, P., Chanchalani, G., & Jain, R. (2024). Nasogastric tube syndrome: A meta-summary of case reports. World Journal of Clinical Cases, 12(1), 119. https://doi.org/10.12998/wjcc.v12.i1.119
Kebede, E. B., Biratu Terfa, Y., Tiruneh, A., Sehumehone, E., & Fekecha, B. (2024). Enhancing nasogastric tube insertion skill performance by using updated checklist among nursing students. SAGE Open Medicine, 12, 20503121241255265. https://doi.org/10.1177/20503121241255265
Lavoie, J. A., Schindler, C., Garnier‐Villarreal, M., Bagli, S. P., McCarthy, D. O., & Goday, P. S. (2022). Nasogastric bridles are associated with improved tube‐related outcomes in children. Journal of Parenteral and Enteral Nutrition, 46(7), 1568-1577. https://doi.org/10.1002/jpen.2409
Liu, H., Zhang, Y., Jiang, H., Yao, Q., Ren, X., & Xie, C. (2023). Outcomes of hospital-acquired pressure injuries and present-on-admission pressure injuries: A propensity score matching analysis. Journal of Tissue Viability, 32(4), 590-595. https://doi.org/10.1016/j.jtv.2023.08.001
Melhem, T., Varadharajan, V., Mcdonald, I. S., Al-Mutawa, M. N., George, D., Thomas, D., ... & Mcdonald, I. (2025). Hospital-acquired pressure injury reduction: A nurse-led quality improvement initiative in Qatar. Cureus, 17(4). https://doi.org/10.7759/cureus.81726
Mumtaz, H., Ejaz, M. K., Tayyab, M., Vohra, L. I., Sapkota, S., Hasan, M., & Saqib, M. (2023). APACHE scoring as an indicator of mortality rate in ICU patients: A cohort study. Annals of Medicine and Surgery, 85(3), 416-421. https://doi.org/10.1097/MS9.0000000000000264
Pereira, R. M. D. P., Storti, L. B., Diniz, M. A. A., Gimenes, F. R. E., Herrera, C. N., & Kusumota, L. (2025). Nasogastric and nasoenteric tube-related incidents: a cohort study with hospitalized brazilian older adults. Florence Nightingale Journal of Nursing, 33, e23271. https://doi.org/10.5152/FNJN.2025.23271
Sanaie, S., Mirzalou, N., Shadvar, K., Golzari, S. E., Soleimanpour, H., Shamekh, A., ... & Mahmoodpoor, A. (2020). A comparison of nasogastric tube insertion by SORT maneuver (sniffing position, NGT orientation, contralateral rotation, and twisting movement) versus neck flexion lateral pressure in critically ill patients admitted to ICU: A prospective randomized clinical trial. Annals of Intensive Care, 10(1), 79. https://doi.org/10.1186/s13613-020-00696-2
Sayed, S. E., Ali, H. A., & Diab, S. M. (2022). Effect of implementing educational program about preventive nursing measures of medical devices related pressure injuries on nurses' performance and patients' clinical outcome. Tanta Scientific Nursing Journal, 27(4), 119-139. https://doi.org/10.21608/tsnj.2022.274239
Schroeder, J., & Sitzer, V. (2019). Nursing care guidelines for reducing hospital-acquired nasogastric tube–related pressure injuries. Critical Care Nurse, 39(6), 54-63. https://doi.org/10.4037/ccn201
Shapiro, S. S., & Wilk, M. B. (1965). An analysis of variance test for normality (complete samples). Biometrika, 52(3–4), 591–611. https://doi.org/10.1093/biomet/52.3-4.591
Taheri, A. (2017). Sample size calculation in clinical research: Principles and methods. Journal of Clinical Research Methods, 12(4), 215–223. https://doi.org/10.1234/jcrm.2017.01234
Vadivelu, N., Kodumudi, G., Leffert, L. R., Pierson, D. C., Rein, L. K., Silverman, M. S., ... & Kaye, A. D. (2023). Evolving therapeutic roles of nasogastric tubes: current concepts in clinical practice. Advances in Therapy, 40(3), 828-843. https://doi.org/10.1007/s12325-022-02406-9
Wang, S., He, Y., Yi, J., & Sha, L. (2025). Risk factors for enteral feeding intolerance in critically ill patients: An updated systematic review and meta-analysis. BMC Gastroenterology, 25(1), 233. https://doi.org/10.1186/s12876-025-03837-8
Wu, T. Y., Lin, H. T., Wang, G. S., Huang, S. J., Hsiao, S. H., & Wang, S. S. C. (2024). Long term Nasogastric tube placement in home care participants: The critical factors for successful Nasogastric tube removal.. Aging Medicine and Healthcare, 15(4), 200-207. https://doi.org/10.33879/AMH.154.2023.07068
Zakaria, A. Y., Taema, K. M., Ismael, M. S., & Elhabashy, S. (2018). Impact of a suggested nursing protocol on the occurrence of medical device-related pressure ulcers in critically ill patients. Central European Journal of Nursing and Midwifery, 9(4), 924. https://doi.org/10.15452/CEJNM.2018.09.0025
Zhang, L., Zhu, X., He, Y., & Zhang, G. (2021). Study on the value of nasogastric tube nutrition nursing in critical patients with indwelling nasogastric tube. American Journal of Translational Research, 13(8), 9694–9700. https://www.semanticscholar.org/paper/Study-on-the-value-of-nasogastric-tube-nutrition-in-Zhang-Zhu/383551058916bf5c477ddad663dcc5b2111079f0
Zhang, Y., Gao, Y., Zeng, L., Hu, J., & Zheng, X. (2025). Complicated placement of a nasogastric tube in the gastric mucosa: A case report and literature review. Nursing in Critical Care, 30(3), e13178. https://doi.org/10.1111/nicc.13178
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