| Gastric tube insertion is widely used in gastrointestinal decompression,gastric lavage and injecting food,water or medicine through gastric tube,which is an important and common technology for diagnosis or treatment in clinical.The conventional gastric tube insertion has many defects:On the one hand,because it is mainly based on operators’ subjective experience and insertion is with our blindness,it is difficult for successful insertion by the anatomy of physiological stenosis or variation,different standard of insertion depth,which may result in a reduced one-time success rate,longer operation time and associated complications(e.g.mucosal bleeding,injury,misplacement into trachea or other anatomical locations,sympathetic excitement etc);On the other hand,when gastric tube insertion is difficult(e.g.shock,tracheal intubation and tracheotomy,unconsciousness,elderly etc),the operator cannot effectively complete the insertion using conventional method,delaying treatment opportunities for patients.Therefore,there is an urgent need that finding a more simple and effective method for inserting gastric tube in our clinical work.We had designed a novel visual gastric tube insertion system(VGIS)basing on our previous research(completing a sputum suctioning or thoracoabdominal exploration by the micro-imaging fiber).The new system was mainly including:endoscopic camera light source system,micro-fiber,display,acquisition system,gastric tube.The device could smoothly integrate a micro-fiber(OD=0.803mm)into a gastric tube and provide real-time images.The feasibility,effectiveness and safety of this device were evaluated through our analogue model experiment,animal experiment.PART ONE:THE DEBUGGING AND IMPROVEMENT OF VISUAL GASTRIC TUBE INSERTION SYSTEMObjective:To complete an improvement of our visual system for gastric tube insertion.Methods:1.Completing its debugging and improvement:Basing on our previous research,we specially developed a new micro-fiber for gastric tube insertion,which can satisfy its deep insertion.Meanwhile,to complete an assembly of our visual gastric tube insertion system,micro-fiber was combined with endoscopic camera light source system,computer acquisition system and display.The micro-fiber was smoothly integrated into a gastric tube,and then its physical parameters(brightness,focal length,contrast,saturation and others parameters)were debugged to obtain the best imaging.After its debugging,we verified that whether the system can provide a clear image during gastric tube insertion,whether can capture,collect or record real-time images.2.The images of fonts,tubes or human analog models’ anatomic structures were acquired by using our visual gastric tube insertion system,and optimal parameters were adjusted for obtaining an optimal imaging.Finally,we completed a visual gastric tube insertion using different types gastric tube.Results:The new visual gastric tube insertion system can provide a clear image during gastric tube insertion,clearly showing some anatomic structures(e.g.pharynx,the opening of trachea and esophageal,and three physiological stenosis of the esophagus),and it can provide those visual images in different types of gastric tube.Conclusions:The imaging effect of our visual gastric tube insertion system can meet the requirements of the anatomical structures for gastric tube insertion.It can provide a visual interface in different types of gastric tube,and help the operator to complete a gastric tube insertion in a visual method.PART TWO:NOVEL VISUAL GASTRIC TUBE INSERTION SYSTEM:A FEASIBILITY AND EFFICIENCY STUDY IN A MANIKINObjective:To evaluate the feasibility,safety and effectiveness of visual gastric tube insertion system by an analogue model experiment or a training experiment.Methods:The operators of physician group were divided into two groups,and required to complete gastric tube insertion using were visual guidance method(n=10)or conventional method(n=10).Each physician performed ten insertions.The researchers recorded the time,complications and other complications during the operation.The operators of training group were randomly divided into visual training method(n=20)or blind training method(n=20).After training,the same method was used to complete the assessments of five gastric tube insertions,such as the operation time,questionnaire and other indicators.Results:In physician group,the gastric tube successfully reached the stomach and the narrow anatomic structures(e.g.anatomic stenosis between the turbinates,anatomic stenosis of esophagus etc)were visualized with the VGIS.Time required for insertion was significantly shorter in the visual group compared to the conventional group(22.56±3.08 vs.37.30±4.12 seconds,P<0.01,n=100).Tube misplacement was observed in 19/100 cases(19%)in the conventional group;no misplacement was observed in the visual group.Less mucosal damage was noted in the visual group(3.43±1.63 vs.9.86±2.31 cm2,P<0.01,n=100).In the training group,visual training group had a higher performance after NGT insertion training using the visual guidance.Facing the same assessments after different training method,operating time of visual training group was significantly shorter compared to the conventional group(27.83±2.84 vs.32.71±2.34 seconds,P<0.01,n=100).There were 7/100 cases(7%)misplacement in visual training group,while blindness training group had 20/100 cases(20%)misplacement,and there was a significant difference between them.In addition,participants reported that the visual guidance training was more helpful or useful for improving their gastric tube insertion skill level according to the anonymous survey:3.0(3.0,4.0)vs.4.0(4.0,5.0)points(P=0.005,P<0.01,n=20).Conclusions:The VGIS may provide a new technique for gastric tube insertion applicable to clinical use according to an analogue model experiment or a training experiment.Comparing to the conventional method,the VGIS may provide a higher efficiency,less complications,safer method for inserting gastric tube,which providing a method for clinical skill training or a basic for further animal experiments.PART THREE:A STUDY FOR A FEASIBILITY AND EFFICIENCY OF VISUAL GASTRIC TUBE INSERTION SYSTEM IN ANIMAL MODELSObjective:To explore the feasibility,effectiveness and safety of a visual gastric tube insertion system(VGIS)using an animal model.Methods:Twenty experimental rabbits were randomly divided into visual group(n=10)and conventional group(n=10),and operators completed gastric tube insertion on those animals using visual method or conventional method respectively.Three insertions were performed in each rabbits.The operation time,associated complications(e.g.misplacement,mucosal damage)were used for evaluation.Results:Time required for insertion was significantly shorter in the visual group compared to the conventional group(29.38±3.70 vs.45.95±5.96 seconds,P<0.05,n=30).The misplacement was 9/30 cases(misplacement rate:30%)in the conventional group;and misplacement was 0/30 cases(misplacement rate:0%)in the visual group.Less mucosal damage was noted in the visual group,which was a statistically significant difference between the two groups(P<0.05,n = 30).Conclusions:The VGIS not only provides a for gastric tube insertion,but also displays the final location of the gastric tube in stomach,which can reduce misplacement and increase efficiency during gastric tube insertion,making the whole process more secure and effective. |
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