Ask an answerable question (PICO)：
Although the K-Y jelly or liquid paraffin is usually regarded as the lubricant in the process of the nasogastric Tube (NGT) insertion, nasal or throat pain, nausea and vomiting are the chief complains of patients after nasogastric intubation. Patients would remove tube by themselves and could not comply with medical treatment. The lidocaine jelly is often selected as a local anesthetic gel before many invasive procedures, such as gastroscopy or cystoscopy. The lidocaine jelly can quickly produce anesthesia on the entire mucosal surfaces, and quickly reduce pain in 5 minutes. Therefore, the aim of the study was to explore whether the lidocaine jelly can reduce pain and discomfort more than water-soluble gel (K-Y jelly) in nasogastric intubation?
The Method and Analysis of Literature Review：
To identify the clinical problem and create keywords with PICO (Intubation, Gastrointestina, Lidocaine, Jelly, Pain). Also, included MeSH term and natural language keywords, such as (Intubation, Gastrointestina or nasogastric intubation or nasogastric tube insertion) and (Lidocaine or Xylocaine) and (Gels or Jelly) and (Pain or discomfort). Databases from PubMed, Cochrane Library, Trip Database, Airiti online Library were searched until on November 2019. Inclusion criteria were the patient who being related to gastrointestinal disease required NGT insertion in emergency department. The patients, such as children, mental disorders, pregnancy, sepsis, suicide, mental illness, nasal injury, or NGT intubation from mouth, were excluded. A total of 50 articles were included. Studies were excluded duplicate papers and non-compliant with themes. In the end, there is only one article -“The application of lidocaine to alleviate the discomfort of nasogastric tube insertion: A systematic review and meta-analysis.” that coincides with clinical problem.
Critical Appraisal：
The Critical Appraisal Skill Program tools for Systematic Review (2018) were used to appraise the quality of this literature. According to Oxford CEBM (2011), the level of evidence is Level I. The paper finding indicated that it is effective for NGT insertion taking Lidocaine jelly for lubricant. The result of the study suggested that the minimum concentration of 2% Lidocaine jelly could effectively reduce pain and discomfort.
Clinical Application of Evidence：
The subjects who suspected gastrointestinal disease would enroll at emergency department. In the routine care group, K-Y jelly was used. 2% lidocaine jelly was used in the experiment group. The outcomes were evaluated in the immediate time and 5-minute after the insertion.
Evaluation of Effectiveness：
In total of 52 subjects participating in the study, 27 in the routine care group and 25 in the experiment group. The Chi-square test and independent t-test were used to examine the differences of demographic data between the groups. There was no significant difference. At immediate time after the insertion, the levels of pain and nausea in the experiment group were lower than the routine care group (p-value < 0.05).
After 5-minute after the insertion, the levels of pain, nausea, difficult swallow, and the part of pain in the experiment group were lower than the routine care group (p-value < 0.05).
Conclusions and Recommendations：
This study demonstrated that 2% Lidocaine was effective in the NGT insertion to reduce pain, nausea, and difficult swallow. We suggest the protocol of the nasogastric Tube (NGT) insertion skill needs to be modified in the clinical settings to improve the quality of nursing care.
