11/16/2013

1

Authored by:

Kathy Karg Gutierrez, RN, BSN, CENKalev Freeman, MD, PhD

Mike O’Keefe MSMike O Keefe, MSEvangelia Zgonis

Alex Thomas

Demonstrate reduction in patient’s perception of pain and discomfort during nasogastric tube of pain and discomfort during nasogastric tube (NGT) insertion with the use of pre-procedural midazolam.

11/16/2013

2

Nasogastric tube (NGT) insertion is painful and uncomfortableuncomfortable. Influenced by past patient experience Provider expertise Patient perception

BenzodiazepineSh t ti Short acting

Rapid onset Amnesic properties Minimal impact on vital signs Reversible

11/16/2013

3

Determine if sedation improved patient’s perception of the NGT placementperception of the NGT placement.

Hoped to show reduction in complications such as gagging, coughing, endotracheal placement

We wondered if the midazolam would make placement easier on providers placing the NGT.

Conscious and alert adults that were clinically indicated to receive NGTindicated to receive NGT.

Patients over 60 years of age were elected to have a half-dose (1mg midazolam or 1ml saline) for the study.

Patients that were altered, sedated or otherwise incapable of completing the survey were incapable of completing the survey were excluded.

11/16/2013

4

54 patients agreed to be in the study45 ti t ll d 45 patients were enrolled (9 unable or unwilling to continue)

24 randomized to placebo dose21 midazolam (10 full, 11 half-dose)

Over 45kg 18 years or older 18 years or older All patients received atomized Co-Phenylcaine

with 3-8 minute dwell time and lubricated tube.

Double-blind, randomized, controlled trial (1-2 mg midazolam vs 1-2ml saline was given IV g gover 2 minutes.

NGT was placed by an experienced ED RN 1 minute after IV dose/placebo.

11/16/2013

5

A visual analog scale was used to rate pain and discomfort by each patient.

The difference in patient perception of pain andof discomfort was significant.

Surprisingly we found that 1mg midazolam was not onlynot effective, but patients experienced higher levels of pain.

11/16/2013

6

2mg midazolam was far superior in reducing patient’s pain and discomfortpatient s pain and discomfort.

1mg midazolam and placebo were NOT effective in reducing pain or discomfort.

There were no adverse reactions related to the drug administration.Th diff i h li i There were no differences in the complications (coughing/gagging) or ease of placement.

Replicate at an institution that is not already familiar with midazolam/NGTfamiliar with midazolam/NGT.

Difficult to enroll patients.

11/16/2013

7

Comfortable patients…